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Preoperative evaluation of the patient with liver disease.

Patients with underlying liver disease have an increased surgical risk. Prediction of surgical risk is based on the degree of liver dysfunction, the type of surgery, and the preoperative clinical status of the patient. The medical consultant must determine the type of liver disease (acute or chronic) and the degree of impairment of liver function (based on physical examination and laboratory data). Any abnormalities should be corrected prior to surgery. Elective surgery should be postponed in patients with decompensated cirrhosis (class B and C) and acute hepatitis until the patient improves. The consultant internist's care of the patient should continue during the early postoperative course to monitor any deterioration in liver function.