​Surgery Definition - What need to be considered in patient with liver disease in surgical setting?

Patient with liver disease may present with abnormal clotting therefore we need to monitor INR and APTT, metabolic disturbance may occur and need to be monitored by monitoring the urea and electrolytes results.Besides that nutritional status need to be up to date with as patient with liver disease commonly have poor nutritional status. Any evidence of complication from cirrhosis need to be considered such as ascites, encephalopathy and varices. Look for any signs of infection. Patient may suffer from increase level of aldosterone or secondary hyperaldosteronism due to low production of albumin in the liver. This may lead to reduction in the intravascular oncotic pressure. Saline infusion need to be carefully given as aldosterone lead to retention of the salt therefore there will be high risk of developing hypernatremia. Aldosterone is produced to maintain the blood pressure. 

The most important things is that patient with liver disease is more sensitive to medication such as sedatives or opioids which may lead to encephalopathy. Medication that suppose to undergoes hepatic metabolism may accumulate in the case of liver failure.