الفهرس 
Initial evaluation of cirrhotic patientsOnly 14 pages are availabe for public view
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Abstract
Liver is considered as one of the most important vital organs in our bodies with many important metabolic functions as: storage of excess carbohydrates as glycogen so it preserves normal blood glucose level, synthesis of many of proteins as albumin and Coagulation factors, synthesis of cholesterol and phospholipids, storage and synthesis of number of such important vitamins ,carry out metabolism of many drugs,detoxification functions, and production of bile which is important for fat absorption.
It may be exposed to many diseases that might damage its cells and therefore failure and inability to perform its functions (liver failure) that reflects on the metabolism of different organs such as (brain, heart, GIT and blood). this diseases like :
sudden acute liver disease resulting from:(viral hepatitis especially hepatitis B,C ,C.M.V and E.B.V infection, hepato-toxic drugs as paracetamol toxicity),chronic liver disease in its advanced stages, including (primary biliary cirrhosis, primary sclerosing cholangitis, auto-immune hepatitis, chronic viral hepatitis and alcoholic hepatic cirrhosis),Congenital liver diseases as: (Biliary atresia, Wilson’s Disease, Alpha 1 anti trypsin deficiency) and local hepatic lesions as primary hepatic tumors.
For sure all of the above diseases are considered indications for liver transplantation if it lead to acute, fulminate or end stage liver failure.
Liver transplantation dates back to more than forty years ago since 1963, when Dr Thomas Starzl was abled to perform first human liver transplantation in America, then a great revolution in liver transplantation has occurred including evaluation and preparation of patients with end stage liver disease and also in contraindications for liver transplantation.
And the development in evaluation introduced the Child Turcotte Pugh (CTP) classification for the cirrhotic patients and then the MELD score to assess the different stages of End Stage Liver Disease and also predict the course of the disease.
There are also serious attempts to create the semblance of industrial liver to be used temporarily in cases of liver failure this attempts included mainly two liver support systems :either non biologic liver support systems that depend on chemical pathways to perform detoxification functions of the liver and biologic liver support systems that depend on the functionality of livers or hepatocytes from xenogeneic or human origin that can be exploited to support liver functions.
Pre-operative preparation of cirrhotic patients includes:
1-Proper selection and evaluation of the patient to exclude contraindication for this major operation and to ensure real indication
2-Preparation of the patients by laboratory, radiological and immunological studies. As well as consultation of specialists in the field of psychiatry aiming for psychological rehabilitation for this major operation. Also to manage the main complications of the advanced failure as Ascites, encephalopathy, Portal hypertension and bleeding esophageal varices as preoperative preparatory step. Finally it is responsible for Specific medical care during this period that includes : giving prophylactic antibiotic especially if there is previous history for spontaneous bacterial peritonitis, also giving specific vaccination and pre-operative nutritional support, and of course if possible to treat the primary or the underlying cause as chronic viral hepatitis.
3-Preparation of cirrhotic patients also includes detection and determination of contraindications for liver transplantation which is divided into absolute contraindications (such as advanced hepatic malignancy, extrahepatic malignancies, medical noncompliance and irreversible brain damage) and relative contraindications (such as severe extrahepatic disease, very young or very old age, anatomic difficulties).
Finally I hope always to remember that chronic hepatitis c viral infection is most common cause for liver cirrhosis particularly in Egypt regarding its prevalence, and let’s say to the Egyptians we hope that the time to be terrified by hepatitis c will be at an end.