Evaluation and Management of Perioperative Cirrhosis

Ryan Munyon, MD 

Based off the original module, Evaluation and Management of Perioperative Cirrhosis by Amir A. Qamar, MD.

If you are a Program Director and would like to grant access to your trainees, please reach out to education@hospitalmedicine.org for an academic access code.

Summary

Patients with liver disease who undergo surgery, whether elective or emergent, are at increased risk for complications. In patients with cirrhosis, perioperative morbidity and mortality vary depending on the type of surgery. An accurate assessment of the presence and severity of acute or chronic liver disease is necessary to plan for perioperative management. Although most patients should continue liver-directed therapies, adjustments in medications may be necessary for certain liver diseases. This module outlines the risk associated with different types of surgery and identifies the elements of the preoperative evaluation for patients with cirrhosis. The influences on morbidity and mortality and formulation of pre- and postoperative care plans are reviewed as well.

Goal

To provide hospitalists with up-to-date information about perioperative cirrhosis management.

Target Audience

This activity is designed for hospitalists. No prerequisites required.

Learning Objectives

After completing the module, the participant will demonstrate the ability to:

  1. Evaluate whether liver disease severity influences perioperative morbidity and mortality.
  2. Outline the risk associated with different types of surgery in patients with cirrhosis.
  3. Identify the elements of the preoperative evaluation for a patient with cirrhosis including how to manage medications on the day of surgery.
  4. Formulate a perioperative care plan for the patient with cirrhosis based on the underlying severity of disease including how to manage medications.
Accreditation Statement

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designator Statement

The Society of Hospital Medicine designates this activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: December 12, 2019

Expiration date: December 12, 2022

Estimated time to complete activity: 2 hours

SHM Conflict of Interest Disclosure Policy

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

Instructions

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & a CME evaluation. All sections must be completed to receive CME credit.

Additional Information

AttachmentSize
EvalandMgntCirrhosis_References.pdf119.27 KB
Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 ABIM MOC Self Evaluation Points
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit
Course opens: 
12/12/2019
Course expires: 
12/11/2022
Member cost:
$0.00
Your cost:
$95.00
Parent activity set: 
Rating: 
0

 

Faculty & Disclosures
Author

Ryan Munyon, MD (2019 Revision Author)
Assistant Professor of Medicine
Director, Internal Medicine Consults and Co-management Service
Division of General Internal Medicine
Penn State Hershey Medical Center
Hershey, Pennsylvania

Dr. Munyon reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Editors

Leonard Feldman, MD, FACP, SFHM 
Associate Professor of Medicine 
Johns Hopkins University School of Medicine 
Urban Health Residency  and Track Director
Associate Program Director, Osler Medical Residency
Founding Editor-in-Cheif, Consultative & Perioperative Medicine Essentials for Hospitalists
Deputy Editor, Journal of Hospital Medicine
Baltimore, Maryland

Dr. Feldman reports having no  relevant financial or advisory relationships with corporate organizations related to this activity.

Kurt Pfeifer, MD, FACP, SFHM
Professor of Medicine
General Internal Medicine
Medical Director, Froedtert and Medical College of Wisconsin Eye Institute Perioperative Services
Medical College of Wisconsin
Associate Editor-in Chief, Consultative & Perioperative Medicine Essentials for Hospitalist
Milwaukee, Wisconsin

Dr. Pfeifer reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Additional planners and faculty for this activity have no relevant relationships to disclose. 

SHM Conflict of Interest Disclosure Policy

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

 

Accreditation Statement

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designator Statement

The Society of Hospital Medicine designates this activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MPC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC points.  

Available Credit

  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 ABIM MOC Self Evaluation Points
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit

Price

Member cost:
$0.00
Your cost:
$95.00
Please login or register to take this course.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & CME evaluation. All sections must be completed to receive CME credit.

Click START to begin.

If you are a Program Director and would like to grant access to your trainees, please reach out to education@hospitalmedicine.org for an academic access code.