Liver Rotation

On a two week liver anesthesia rotation, we get assigned to some of the more complex liver surgeries and take call for all liver transplants that come in. It's a busy two weeks as the weekday surgeries tend to be busy, involved cases and liver transplants are some of the biggest cases we do, requiring a great deal of set-up time and lasting from eight to twelve hours. Patients with liver disease have important relevant medical issues, as well. As the liver produces all the clotting factors, these patients can bleed a lot if they have liver dysfunction or undergo a large resection; this can limit our ability to put in epidural catheters for post-operative pain. Liver disease can cause altered mental status with hepatic encephalopathy, involve the lungs with hepatopulmonary syndrome, and precipitate kidney failure with hepatorenal syndrome. While the heart is usually uninvolved, if patients develop liver disease because of alcohol or drugs, we have to rule out cardiac consequences. We depend a lot on the skill of our surgeons as well since the liver is next to important structures and receives a large blood supply. Bleeding can be brisk and catastrophic, and these cases are one of the few that I request a rapid transfuser such as a Level-1 or Belmont. Nevertheless, at this stage of my training, such cases are exciting, challenging, and educational, and I look forward to it.