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• W2039366980 abstract "Anaesthesia and surgery in patients with overt, or more particularly, unrecognized liver disease may lead to tragic consequences postoperatively. These result partly from the capacity of the liver to undergo extensive damage before a patient manifests any clinical signs or there are significant changes in the liver function tests, and also, even when liver damage is overt, the difficulty in estimating hepatic reserve. The liver is at the centre of most body processes, by virtue of its metabolism of carbohydrates, lipids, proteins, hormones and vitamins as well as its storage and excretory functions, and can respond to injury in a number of ways. The hepatic cells may be damaged chronically or acutely, there may be obstruction to blood or bile flow, or primary hepatoma (hepatocellular carcinoma) of the liver may occur. In addition the liver may be infected, most commonly with viruses, and may be the site of secondary deposits from malignancies elsewhere in the body. Congenital abnormalities of the vascular and biliary systems may be present at birth or manifest themselves in early childhood. Because of this variety many liver function tests and procedures have evolved. There is rarely one test alone that is diagnostic in any particular disease and in addition false positive and negative results occur. As a result, it is common to carry out batteries of tests as well as repeated estimations. For example, the combination of an increased plasma concentration of bilirubin, an elevated plasma concentration of aspartate aminotransferase (AST) or alanine aminotransferase (ALT), and an elevated plasma concentration of alkaline phosphatase (ALP) has a predictive accuracy for the presence of liver disease of over 90% (Henry et al, 1985). Another important point when comparing results from different institutions is to be aware of interlaboratory variations. All biochemistry laboratories publish their normal ranges and these should be taken into account when assessing results from different laboratories. Traditional liver function tests such as those outlined in Table 1 may be misleading in giving a sense of completeness. They are useful from a screening point of view as well as having some diagnostic and quantitative value, but they should be used in combination with a careful history, with specific questions concerning drug and alcohol intake, and exposure to the risk of viral and other infections, as well as clinical examination of the patient. In this respect it is important to remember that liver disease, depending on the cause, often involves other organs in the body. In" @default.
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• W2039366980 title "Preoperative assessment of hepatic function" @default.
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• W2039366980 doi "https://doi.org/10.1016/s0950-3501(05)80307-1" @default.
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