Hepatic Surgery

Question 1

Where does the majority of bleeding come from

during a liver resection?

Answer 1

Intrahepatic branches of hepatic and portal veins that are
injured during the dissection
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 564.

Question 2

Describe the Pringle maneuver

Answer 2

The Pringle maneuver is the temporary occlusion of the
hepaticoduodenal ligament. This ligament houses the hepatic
artery, main portal vein, and the common bile duct. It is a
technique used to minimize blood loss.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 564.

Question 3

What is the most important predictor of short-term

survival post liver resection?

Answer 3

Intraoperative blood loss
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 564.

Question 4

Morbidity and mortality following a liver resection

depends upon what factors?

Answer 4

The patient’s liver function, the extent of the surgery, and the
experience of the surgeon
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 564.

Question 5

What are the most common secondary tumors

removed during a liver resection?

Answer 5

Metastases from colorectal cancer
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 565.

Question 6

What is the most common primary liver tumor?

What leads to this type of tumor’s development?

Answer 6

Hepatocellular carcinoma (HCC). Cirrhosis due to chronic
alcohol abuse and chronic hepatitis B or C
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 564.

Question 7

What are the two main reasons liver resections are

performed?

Answer 7

1. For the removal of primary liver tumors 2. For the removal of
   metastatic tumors to the liver
   Dorsch JA, Dorsch SE. Understanding Anesthesia Equipment.
   5th ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2008:
   550.

Question 8

List postoperative complications resulting from a liver

resection.

Answer 8

Pulmonary insufficiency, DIC, hypoglycemia, hypothermia,
hemorrhage, decreased liver function, electrolyte imbalances
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 554.

Question 9

Why would a patient with normal liver function prior
to liver resection experience liver dysfunction
postoperatively?

Answer 9

Because of ischemic injury resulting from vascular occlusion or
from the loss of liver mass
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 569.

Question 10

Why is it prudent to know the size of the tumor and
any involvement of vascular structures prior to a liver
resection?

Answer 10

In order to adequately prepare for major intraoperative fluid and
blood losses
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 568.

Question 11

Should coagulopathy be a concern in patients

presenting for liver resection?

Answer 11

Yes. The liver manufactures all of the clotting factors with the
exception of factor VIII.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 568.