الفهرس 
Anatomy of the liverOnly 14 pages are availabe for public view
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Abstract
Liver transplantation is the treatment of choice for various forms of end-stage liver disease, including viral liver disease, liver malignancies, acute liver failure, and certain metabolic derangements.What is also being seen in recent years is that sicker patients are undergoing transplantation. Sicker patients before transplant translate into sicker, more complicated patients after transplant. Frequently, these patients undergo transplantation when they have comorbidities and organ dysfunction.The unique pathophysiology of patients with end-stage liver disease has important implications for their critical care treatment, particularly in the postoperative state.
The long waiting list along with a nonexpanding pool of cadaveric liver donors have led to a shortage of grafts and prolonged waiting times. Novel solutions using segmental liver grafts, including those from living donors, have seen rapid growth in the last 5 years, until 2002 when the number of living donor liver transplants decreased for the first time because of reports of donor morbidity and mortality.
These reports underscore the physiologic trespasses associated with extensive hepatic surgery. Undoubtedly, further refinement of techniques designed to improve the supply of scarce donor organs will remain an area of focus for the future.
Preoperative management commences with the multidisciplinary patient selection conference where patients are evaluated in depth and any anesthetic concerns are raised
Deterioration in the patient’s physical condition often occurs during this time;therefore,the anesthesiologist must reexamine the patient and reevaluate the clinical picture on admission for transplantation.
Liver transplantation requires the management of severe coagulopathy, metabolic derangements, massive fluid shifts, blood loss, temperature derangement, hemodynamic instability, and renal dysfunction.
Intra-operative monitoring is performed with the aid of electrocardiogram, pulse oximeter, direct arterial pressure, CVP, end tidal carbon dioxide tension and oesophageal temperature.
After transplantation, careful management to avoid complications and intervene early is necessary.Common postoperative complications include graft dysfunction,vascular thrombosis, biliary tract complications, infection,rejection,neurologic injury,electrolyte imbalances, and drug interactions.A multidisciplinary approach to care including the critical care nurse is necessary for successful long-term outcomes.