Page 17 - HPB Handbook - May 30 2022 (Flipbook) v2

Page 17 of 22

after a major liver resection. INR usually peaks 48-72 hours after a major liver resection. Liver enzymes (transaminases) are
often elevated after a liver resection, particularly if a Pringle manoeuvre was used during the case (check the OR note!).

Rapidly rising transaminases (>500-600) are worrisome and may signify hepatic ischemia due to a major vascular problem
(hepatic artery, portal vein, hepatic vein). An urgent Doppler ultrasound assessment at the bedside should be considered.
Bilirubin and alkaline phosphatase levels usually rise after a major liver resection. Persistently elevated postop serum
bilirubin (>50-60) or a rapidly rising bilirubin should raise concern about a bile leak or other biliary problem and
consideration should be given to obtaining a CT scan or ultrasound.

Laparoscopic Liver Resection
Our unit has recently started a laparoscopic liver resection program. These patients are worked up pre-operatively the same
way as open patients. Post-operative care should be considered the same as in open cases, though is often accelerated.
Patients are still at risk of bleeding and liver failure and still go to the step-down unit post-op to monitor for these problems.
Patients generally have lower and shorter analgesic requirements and are able to be discharged sooner. Of course, the plan
and progress is tailored to the individual patient as is the case with open surgery.

Postoperative Liver Resection Orders
Vital Signs q4h  notify MD if BP  90 mmHg systolic
Urine Output q4h  notify MD if  120cc per 4 hrs
Patient to remain NPO
NG to replace losses with NS + 20 meq KCl / L q8h
Maintenance IV NS @100cc/hr
Change to 2/3-1/3 + 20meq KCl/L in am
Analgesia as per Acute Pain Service
Laboratory
++
PACU CBC, PT, Serum K Creatinine
++
POD 1 CBC, PT, Serum K Creatinine, Bili,
AST, ALT, ALP
POD 2 CBC, PT, Serum K Creatinine
++
Therapy
Ancef 1 gm IV 8 hours postop x 24 hours
DVT prophylaxis: enoxaparin 40MG sc daily
Famotidine 20 mg IV q12h
Vitamin K 10 mg S/C daily x 3
Accucheck q4h x 24h then reassess
Order patient normal medication regimen