I have had anorexia and fatigue for more than a month, and my skin and sclera have been jaundiced for 10 days.

Chronic disease appearance, anemic appearance, pale and yellow conjunctiva, poor nutrition, no venous distention

Consider the possibility of stones. Ultrasonography of gallbladder polyps. Ultrasounds of pancreas and spleen showed no obvious abnormalities.

Kidney atrophy

Causes of hilar bile duct stricture

Uremia

hypertension

lung infection

Liver routine and liver damage grading assessment

The patient had a history of chronic nephritis for more than 10 years and was diagnosed with renal failure. He underwent hemodialysis and peritoneal dialysis regularly.

Inhalation general anesthesia uses desflurane, which is nontoxic to the liver and kidneys.

neuraxial anesthesia

Opioids

Desflurane

Sevoflurane

This patient is prohibited from using depolarizing muscle relaxants (succinylcholine). In patients with impaired liver function, reduced synthesis of cholinesterase will prolong the efficacy of the drug. Non-depolarizing muscle relaxants such as pancuronium bromide and vecuronium bromide can be used. Ammonium etc.

The liver receives dual blood supply from the hepatic artery and hepatic portal vein

Controlled low central venous pressure technology can be used to reduce intraoperative blood loss during liver resection

Adjust Trendelenburg position

When performing hepatobiliary surgery, excessive traction on the gallbladder and bile duct area should be avoided as much as possible during the operation. The area should have abundant vagus nerve innervation. Reflexive traction can cause slowing of the heart rate, drop in blood pressure, and even cardiac arrest.

Pre-administration of M-receptor blockers to prevent the occurrence of the bile-cardiac reflex

Hypercapnia and acidosis increase hepatic blood flow, whereas hypocapnia and alkalosis decrease hepatic blood flow.

Due to the increase in vena cava pressure, hepatic venous pressure increases, liver congestion and swelling occur, and liver blood flow decreases accordingly.

The surgical site, surgical method, surgical scope, and surgical time will all affect

surgical stress trauma

Surgery type

Perioperative renal oliguria is usually caused by long-term renal ischemia due to prerenal causes or misuse of nephrotoxic drugs, both of which can be caused by decreased glomerular GRF and tubular necrosis.

Caused by obstruction, less common

Make adequate preoperative preparations, choose anesthesia methods and drugs that have less physiological interference on the body, and adjust the patient's preoperative physiological state to the best

The adverse effects of artificial ventilation on cardiac output should be reduced, mechanical ventilation should be mild hyperventilation, and patients with acidosis and hyperkalemia should be prevented and treated.