1. Contraindications to receiving liver transplant vary by center, but the following are generally accepted:
-uncorrectable cardiopulmonary disease severe enough to be prohibitive for surgery
-extra-hepatic metastatic disease
-active alcohol and drug use
-(at some centers) advanced age, advanced AIDS
2. Contraindications to liver donation:
-Active malignancy (exception: primary brain tumor with no VP shunt)
-a-HIV seropositivity
-Sepsis, although this retrospective study found that organs from bacteremic donors had the same outcomes as those from non-bacteremic donors {Transplantation, 1999, n=1775}
3. Zinc is a treatment option for wilson's disease, as it prevents uptake of Cu. Good for asymptomatic and pregnant patients; symptomatic patients require chelating agents, like d-penicillamine.
4. Rapid progression of hypoxia and CXR findings- think PCP pneumonia. Treatment of choice is bactrim, PO or IV in more severe cases.
5. Healing after major abdominal surgery: Fascia is the last layer to heal; at 1 month postop, an average healthy person will be ~70% healed, and at 3 months postop they will be 100% healed. Advise no heavy lifting or anything else that significantly increases intra-abdominal pressure during that time.
6. Liver resection facts:
-Before surgery, consider IR embolization of venous supply of ipsilateral side to cause hypertrophy of the contralateral (i.e. remaining) lobe, to boost remnant liver function
-After major resection, watch phos, watch synthetic function closely esp INR (patients tend to crash 2-3 days post-op), watch for infection (fever, WBC), watch for bile leak, bleeding. Expect rising LFTs, lower protein.
7. Someone with BUN>100 is not a surgical candidate because of platelet dysfunction. I.e. the ESRD patient who needs dialysis will need a quinton or permacath placed first to dialyze down their uremia before they can get a fistula or graft for dialysis.
8. If someone's LVAD power usage is increasing, think clot-- the machine has to use more energy than before to maintain cardiac output, it's likely that there's something obstructing. Normal power is <10. LDH is a good marker for thrombosis. To prevent clotting, most people on an LVAD will have a goal INR of 1.5-2, although some people who may be hypercoagulable (as evidenced by clotting off their LVAD multiple times) may require much higher INRs. Remember that you can't put someone on plavix and walk away, assuming they're anticoagulated-- a significant portion (estimated 15-50%) of the population is resistant to plavix.
9. Lung cancer:
-Average doubling time 108 days (varies 20 to 800)
-Normal cigarettes => squamous cell CA, low-tar cigarettes => adenocarcinoma (peripheral cancer-- people think its safer so they inhale more deeply).
-Frequently produce paraneoplastic syndromes, and is assoc with hypertrophic pulmonary osteoarthritis/clubbing that is rapidly cured by tumor resection. People with lung cancer can present initially as "arthritis"
-Small cell is not operable; it responds well to chemo, but invariably comes back in 1 year, resistant and incurable.
10. Lung cancer resection: 
-Stage IIIA: possibly resectable; Stage IIIB: minimally resectable; Stage IV: not resectable
-Risk evaluation: FEV1<30%, DLCO<30, MVO2<10-15: poor risk:
-Palliation for effusion: sclerosing agents injected into the pleural space, i.e. talc, or a pleurx drain at home, will cause autosclerosis in 4-8 weeks.
-Palliation of obstruction: stent, radiation beam or ET brachytherapy