Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Optimizing intraoperative haemodynamics and haemostasis to enhance recovery after liver transplantation for cirrhosis in adults(College of Anaesthesiologists of Sri Lanka, 2022) Gunetilleke, B.; Welikala, N.; Ranamuni, R.; Jayaweera, D.; de Silva, T.; Amerasinghe, O.; Liyanage, C.; Dissanayake, J.; Appuhamy, C.; Fernando, M.; Thilakarathne, S.; Dassanayake, A.; Niriella, M.; Siriwardana, R.; Gilbert-Kawai, E.Cirrhosis with end stage liver disease is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multi-organ dysfunction characteristic of end stage liver disease, surgical and anaesthetic factors, quality of the graft, coagulopathy and haemodynamic instability, all lead to the complexity of the perioperative care for liver transplant. Aggressive management focused particularly on maintaining intra-operative haemodynamic stability and optimizing haemostasis, directly impacts successful patient outcomes and forms the core of the anaesthetic strategy.Item Non-alcoholic fatty liver disease: a Sri Lankan perspective(The Sri Lanka Medical Association, 2022) Niriella, M.; Dassanayake, A.; de Silva, J.No Abstract availableItem Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 2](The College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Hettiarachchi, D.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Fernando, M.; Hettiarachchi, D.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; Wijesuriya, R.; Liyanage, C.; Siriwardana, R.; Dissanayake, J.; Wijesuriya, N.; Rodrigo, U.; Rodrigo, U.; Mudalige, A.; de Silva, J.Globally, an estimated one million deaths occur annually due to complications of cirrhosis. Cirrhosis with end stage liver disease [ESLD] is a leading cause death due to non- communicable diseases in Sri Lanka. Non-alcoholic fatty liver disease [NAFLD] and alcohol related liver disease [ARLD] are the principal causes of ESLD due to cirrhosis in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multiorgan dysfunction and hemodynamic instability characteristic of ESLD adds to the complexity of perioperative care in liver transplantation. Maintenance of stable hemodynamics including optimal hemostasis forms the core of the anaesthetic strategy in liver transplantation.Item Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 1](College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Wijesuriya, N.; Rodrigo, U.; Mudalige, A.; Fernando, M.; Hettiarachchi, D.; Dissanayake, J.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; de Silva, J.; Siriwardana, R.; WIjesuriya, R.; Liyanage, C.ABSTRACT: Cirrhosis with end stage liver disease (ESLD) is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation is the only curative treatment for patients with ESLD. The complex multisystem involvement and unique cardiovascular profile characteristic of ESLD present formidable challenges during liver transplantation. Management of the rapid and varied hemodynamic changes during surgery requires an in depth understanding of the physiological effects of each intervention. Based on the current literature and the experience gained at our center during the management of 50 liver transplants, we present optimization strategies and perioperative hemodynamic interventions which we use to ‘Fast track’ recovery following liver transplantation. KEYWORDS: Liver transplantation, cirrhosis, non-alcoholic fatty liver disease, alcohol related liver diseaseItem One hour fast for liquids prior to upper gastrointestinal endoscopy seems safe, effective and results in minimum patient discomfort(Sri Lanka Medical Association, 2006) de Silva, A.P.; Amarasiri, L.; Kottahachchi, D.C.; Dassanayake, A.; de Silva, H.J.INTRODUCTION: Current guidelines for upper gastrointestinal endoscopy advice at least 6-8 hours fasting for solids and at least 4 hours for liquids. Studies have shown that is uncomfortable and probably unnecessary. A study was done by us using real-time ultrasonography on 10 patients established the minimal time for clearing non-opaque liquids was one hour. Aims: To determine the effects of allowing clear liquids one hour prior to endoscopy. METHODS: 40 patients referred for video endoscopy, without alarm symptoms or clinically obvious motility problems, were recruited. Patients were given a standard meal 6 hours before endoscopy. They were then randomized to either fasting for 6 hours (group A, n=20) or allowed to take clear fluids up to one hour prior to endoscopy (group B, n=20). Just prior to endoscopy patients indicated discomfort due to fasting on a visual analog scale (0-no discomfort to 10-severe discomfort). All endoscopies were done by a single investigator blinded to the period of fasting. Presence of fluid in the gastric fundus was noted, and endoscopic vision was graded as good, average or poor. RESULTS: Discomfort was significantly lower in group B than group A (mean visual analog score 0.3 vs. 4.4; p<0.001, Wilcoxon two-sample test). Endoscopic vision was good in all 20 patients in group A and 18 in group B, and average in 2 in group B. None were graded as poor. Fluid in the gastric fundus was noted in 6 patients in group A and 7 in group B. CONCLUSIONS: Allowing clear liquids for up to one hour prior to endoscopy seems acceptable, and causes minimum discomfort to patients. However, a larger study should be performed before revision of current guidelines can be made.