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Review
. 2018 Jul 26;11(6):135-140.
doi: 10.1002/cld.711. eCollection 2018 Jun.

Pain management in patients with cirrhosis

Mina Rakoski  1 , Preeya Goyal  1 , Michelle Spencer-Safier  1 , Jill Weissman  1 , Gina Mohr  1 , Michael Volk  1
Affiliations
Review

Pain management in patients with cirrhosis

Mina Rakoski et al. Clin Liver Dis (Hoboken). .
No abstract available

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Figures

Figure 1
Figure 1
Factors that contribute to undertreatment of pain in patients with liver disease. Societal misconceptions, patient behaviors, as well as regulatory and litigious factors may consciously or unconsciously influence clinician perception of pain complaints. Moreover, impairment in drug metabolism and excretion in this medically complex population create uncertainty about how to safely and effectively use pain medications. Abbreviation: SES, socioeconomic status.
Figure 2
Figure 2
First‐pass metabolism of orally ingested medications. The drug enters the liver via the portal vein, becomes bioavailable after metabolism in the liver into active metabolites, and then enters systemic circulation via the hepatic vein. In patients with liver disease, impaired hepatic function, reduced hepatic blood flow, and portosystemic shunting reduce first‐pass metabolism, thereby increasing the proportion of drug that is bioavailable and increasing the risk for toxicity.
See this image and copyright information in PMC

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