13 Mar Hepatic & Biliary Systems (Exam 3) Flashcards
What is the primary function of the liver in glucose metabolism?
The liver synthesizes glucose and stores excess glucose as glycogen.
What role does the liver play in drug metabolism?
The liver metabolizes drugs via the CYP450 enzyme and other enzyme pathways.
What are the main components involved in liver blood supply?
Hepatic artery (25%) and portal vein (75%).
How does the liver detoxify blood?
The liver detoxifies blood by processing bacteria and pathogens ingested with food.
What is the significance of the liver in the coagulation cascade?
The liver synthesizes all coagulation factors except factors III, IV, VII, and von Willebrand factor.
True or False: Nearly every organ in the body is impacted by liver function.
True
How is the liver anatomically divided?
The liver is divided into eight segments based on blood supply and drainage.
Right and left lobes are separated by the falciform ligament.
What is the hepatic venous pressure gradient and its significance?
It is used to determine the severity of portal hypertension.
What is considered a normal hepatic venous pressure gradient?
1 to 5 mmHg.
What indicates clinically significant portal hypertension in terms of hepatic venous pressure gradient?
Exceeds 10 mmHg.
What are some common causes of portal hypertension?
- Cirrhosis
- Schistosomiasis
- Liver damage
What are the symptoms of portal hypertension?
- Ascites
- Enlarged spleen
- Formation of collateral vessels
What can happen if varices rupture in patients with portal hypertension?
It can lead to massive, life-threatening bleeding.
What is hepatic encephalopathy?
A condition where toxins that the liver normally removes reach the brain, causing confusion and drowsiness.
What are some risk factors for liver disease?
- Family history of liver disease
- Heavy alcohol use
- Diabetes
- Obesity
- Illicit drug use
- Multiple sexual partners
- Unclean tattoos
What are common physical exam findings in liver disease?
- Jaundice
- Ascites
- Hepatomegaly
- Splenomegaly
- Spider nevi
Fill in the blank: The liver receives _______ of our cardiac output.
25%
What lab tests are important in assessing liver function?
- BMP
- CBC
- PT and INR
- AST
- ALT
- Bilirubin
- Alkaline phosphatase
- Gamma glutamyl transferase
What imaging techniques are useful for liver assessment?
- Ultrasound
- Doppler ultrasound
- CT
- MRI
What is the primary marker for hepatocellular injury?
Elevated AST and ALT levels.
What condition can lead to acute liver failure?
Liver toxicity.
What liver enzymes are elevated in hepatocellular injury?
AST and ALT
Elevated liver enzymes indicate hepatocellular injury, especially in conditions like acute liver failure.
In alcoholic liver disease, how do AST and ALT levels compare?
AST is double the ALT level
This pattern is characteristic of alcoholic liver disease.
How do AST and ALT levels present in non-alcoholic fatty liver disease?
Both AST and ALT are elevated equally
In this condition, neither enzyme significantly outweighs the other.
What happens to albumin levels in patients with reduced synthetic function of the liver?
Albumin levels are lower
Reduced albumin synthesis indicates liver dysfunction.
What laboratory findings indicate cholestasis?
Increased alkaline phosphatase, gamma glutamyl transferase, and bilirubin
Cholestasis is characterized by sluggish bile flow.
What is the primary symptom of gallstones?
Right upper quadrant pain
This pain may be referred to the shoulders and is often accompanied by nausea and vomiting.
What are some risk factors for developing gallstones?
- Obesity
- High cholesterol
- Diabetes
- Pregnancy
- Female gender
- Family history
These factors increase the likelihood of gallstone formation.
What is the most common procedure to treat severe gallstone symptoms?
Cholecystectomy
This procedure involves the surgical removal of the gallbladder.
What is cholelithiasis?
Presence of stones in the gallbladder
Cholelithiasis can lead to complications if stones migrate to the bile ducts.
What is the procedure called to remove a stone from the common bile duct?
ERCP (Endoscopic Retrograde Cholangiopancreatography)
This procedure allows for the visualization and retrieval of stones in the bile duct.
What are the two types of bilirubin?
- Unconjugated (indirect) bilirubin
- Conjugated (direct) bilirubin
These two forms of bilirubin differ in their solubility and transport in the body.
What causes elevated levels of unconjugated bilirubin?
Physiologic jaundice, hemolysis, or drug-induced conditions
Unconjugated bilirubin builds up when the liver cannot conjugate it efficiently.
What are the five types of viral hepatitis?
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
Hepatitis B and C are more chronic, while A, D, and E are generally acute.
What is the most common viral hepatitis requiring liver transplant?
Hepatitis C
Chronic hepatitis C can lead to significant liver damage and potential need for transplantation.
What is the primary treatment for hepatitis C genotype 1?
Sofosbuvir/Velpatasivir
This antiviral drug is effective in clearing hepatitis C in most patients.
True or False: Hepatitis C can be completely resolved with treatment.
True
Newer antiviral treatments can achieve high clearance rates for hepatitis C.
What happens to bilirubin levels in cases of cholestasis?
Increased conjugated bilirubin
Cholestasis leads to a backup of bile, elevating conjugated bilirubin levels.
What is the consequence of hepatitis advancing to cirrhosis?
It becomes untreatable and can progress to cancer
Liver transplant is possible, but damage cannot be reversed.
What antiviral drug is used to resolve hepatitis C?
Sofosbuvir
Administered over a 12-week course with 98-99% clearance for genotypes 1A and 1B.
What are common symptoms of hepatitis during the incubation period?
Fatigue, nausea, loss of appetite
More advanced symptoms include jaundice, bleeding, bruising, and dark urine.
What is the typical incubation period for hepatitis C?
1 to 2 months
What percentage of adults develop chronic liver disease from hepatitis B?
1 to 5%
What is the likelihood of hepatitis C developing into chronic liver disease?
75% of patients
What is the most common cause of cirrhosis in America?
Alcoholic liver disease
What is required for a patient to be eligible for a liver transplant due to alcoholic liver disease?
Abstinence from alcohol for about a year and a healthy lifestyle
What is the universally accepted platelet count cutoff for requiring a blood transfusion?
50,000
What are common physical signs of alcoholic liver disease?
Malnourishment, jaundice, ascites, hepatosplenomegaly
Patients may also show signs of edema and muscle wasting.
What is the gold standard for diagnosing non-alcoholic fatty liver disease?
Liver biopsy
What are the primary risk factors for non-alcoholic fatty liver disease?
Obesity, insulin resistance, type 2 diabetes, metabolic syndrome
What is the treatment for non-alcoholic fatty liver disease?
Fat reduction, diet, and exercise
What percentage of severely obese people have non-alcoholic fatty liver disease?
90%
What are the two main types of fatty liver disease?
Non-alcoholic fatty liver disease and alcoholic fatty liver disease
What is autoimmune hepatitis characterized by?
Presence of autoantibodies and elevated liver enzymes
What is the primary treatment for autoimmune hepatitis?
Steroids and azathioprine
What is the most common cause of drug-induced liver injury?
Acetaminophen overdose
What are congenital disorders that can cause liver ailments?
- Wilson’s disease * Alpha One antitrypsin deficiency * Hemochromatosis
What is Wilson’s disease associated with?
Impaired copper metabolism
What is the treatment for Wilson’s disease?
Copper chelation therapy and oral zinc
What does Alpha One antitrypsin deficiency affect?
The liver and lungs
- Alpha one antitrypsin protein protects these organs from the enzyme neutrophil elastase
What is the incidence rate of Alpha One antitrypsin deficiency?
1 in 16,000 to 1 in 35,000
What is the diagnosis for Alpha One antitrypsin deficiency confirmed by?
Alpha antitrypsin phenotyping
What is the primary genetic cause of liver transplant in children?
Alpha One antitrypsin deficiency
What is the only curative treatment for liver disease due to Alpha One antitrypsin deficiency?
Liver transplant
What condition is characterized by excessive intestinal absorption of iron?
Hemochromatosis
What are common symptoms of hemochromatosis?
Cirrhosis, heart failure, diabetes, adrenal insufficiency, polyarthropathy
How is hemochromatosis diagnosed?
Genetic mutation testing
What is the primary treatment for hemochromatosis?
Weekly phlebotomy
What is primary sclerosing cholangitis?
Autoimmune chronic inflammation of the larger bile ducts
What are common symptoms of primary sclerosing cholangitis?
Fatigue, itching, fat-soluble vitamin deficiency
What imaging studies are used to diagnose primary sclerosing cholangitis?
MRCP or ERCP
What is the main long-term treatment for primary sclerosing cholangitis?
Liver transplant
What is primary biliary cholangitis also known as?
Biliary cirrhosis
What are the common lab findings in primary biliary cholangitis?
Elevated alkaline phosphatase, gamma glutamyl transferase, positive antibodies
What is a common treatment for patients with primary biliary cholangitis?
Exogenous bile acids
Compare/Contrast Primary Sclerosing Cholangitis vs Primary Biliary Cholangitis
What is the most common cause of acute liver failure?
Drug-induced, primarily acetaminophen overdose
What are the classic signs of liver decline in acute liver failure?
Jaundice, nausea, right upper quadrant pain, encephalopathy, multi-organ failure
What is cirrhosis?
End stage liver disease characterized by replacement of normal liver tissue with scar tissue
What are common causes of cirrhosis?
- Alcoholic liver disease
- Non-alcoholic fatty liver disease
- Hepatitis C
- Hepatitis B
What is the most common complication of cirrhosis?
Ascites
What procedure can help manage portal hypertension in cirrhosis?
TIPS procedure (transjugular intrahepatic portosystemic shunt)
What is a common treatment for hepatic encephalopathy?
Lactulose and rifaximin
What is hepatorenal syndrome?
Acute kidney injury due to reduced renal blood flow from cirrhosis
What is the triad of symptoms for hepato pulmonary syndrome?
- Chronic liver disease releases NO into bloodstream
- Hypoxemia (D/T V/Q mismatch)
- Intrapulmonary vascular dilation (Creates pulmonary shunting and doen’t allow for adequate HPV)
Hepatopulmonary syndrome is hypoxemia due to dilated intrapulmonary vasculature in the presence of liver disease or portal hypertension.
What is platypnea?
Platypnea (hypoxemia when upright) d/t R to L intrapulmonary shunt
What are the two scoring systems used to determine the severity of liver disease?
- Child-Turcotte scoring system
- MELD score
What factors are considered in the Child-Turcotte scoring system?
- Bilirubin level
- Albumin level
- PT
- Encephalopathy
- Ascites
What does the MELD scoring system assess?
- Bilirubin level
- INR
- Creatinine
- Sodium
What is the relationship between scoring systems and mortality rates in patients with liver disease?
Higher scores on scoring systems indicate higher mortality rates.
What factors should be assessed to determine if a patient has cirrhosis?
Labs, imaging, scoring system, consult from the hepatologist.
What is the protocol if a patient with liver disease does not have cirrhosis?
Proceed to the operating room with caution.
What is the MELD score range indicating a patient is not in advanced cirrhosis?
Less than 10.
What should be monitored if a patient has a MELD score between 10 and 15?
Presence of portal hypertension.
What actions should be taken if a patient with liver disease has portal hypertension and requires elective surgery?
Consider postponing surgery, evaluate for TIPS procedure.
What is the recommended fluid resuscitation approach for patients with liver disease?
Heavier reliance on colloids than crystalloids.
True or False: Chronic alcoholism decreases the MAC of volatile anesthetics.
False.
What is a potential complication of administering succinylcholine to a patient with severe liver disease?
Prolonged paralysis due to reduced plasma cholinesterase levels.
What are some indications for a TIPS procedure?
Refractory variceal hemorrhages, refractory ascites, recurrent peritoneal bacterial infections.
What are contraindications for a TIPS procedure?
Heart failure, tricuspid regurgitation, severe pulmonary hypertension.
What is the maximum liver tissue that can be removed in healthy patients without affecting regeneration?
Up to 75%.
Patients MUST have normal liver function
What are anesthesia considerations for patients undergoing hepatectomy?
Invasive monitoring, blood products availability, adequate vascular access.
What is the most common indication for liver transplant?
Alcoholic liver disease.
What types of donors can provide livers for transplantation?
Living donors and brain dead donors.
What must be maintained during the intraoperative period for brain dead liver donors?
Hemodynamic stability.
What complications may arise during reperfusion after liver transplantation?
Acidosis, hypokalemia, hypocalcemia, hypercalcemia, hypothermia, hypoglycemia.
Fill in the blank: The liver can regenerate itself after a _______.
[partial hepatectomy]
What is a common monitoring tool used for assessing coagulation in liver disease patients?
Teg (Thromboelastography).
What is the significance of the Child-Pugh score in liver disease management?
Helps to stratify surgical risk.
What role do endogenous vasodilators play in patients with liver disease?
They can lead to hypotension due to a drop in systemic vascular resistance.
What is a common risk factor for aspiration in patients with liver disease?
Slower metabolism of food leading to a full stomach.
