16. Hepatic physiology

Question 1

Liver characteristics

Answer 1

600-800g
80% from celiac plexus, rest SMA
C.O. 25%
75% blood flow from portal vein

Question 2

Zones of liver

Answer 2

3. Zone 3 more distant to the artery, more sensible to ischemia. Glycolysis

Question 3

Phases of liver metabolism

Answer 3

1. Oxidation, reduction, hydrolysis. Inducer Phenytoin
2. Conjugation. Mainly gluconization

Question 4

Primary sclerosing cholangitis

Answer 4

Woman 30 / 40
Typical with U.C.
inflammation and fibrosis of the bile ducts
Liver transplantation is the only effective therapy.

Question 5

TIPS indication

Answer 5

Increase portal pressure
Prevent encephalopathy
Ascitis
Bleeding from medula

Question 6

Pringle maneuver

Answer 6

Block of hepatic artery / portal vein

Question 7

Factors sensitize in the liver

Answer 7

fibrinogen, prothrombin, factor V, VII, IX, X, XI, XII, as well as protein C and S, and antithrombin

Question 8

Gilberts syndrome

Answer 8

Asymptomatic unconjugated hyperbilirubinemia

Question 9

Hepatorenal syndrome

Answer 9

Kidney failure in patients with cirrhosis. Dx. creat x 2 in two weeks
40% patients with ESLD
No responsiveness to fluids
Dialysis from prevention
No treatment (only transplant)
type I fast
Type 2 slow

Question 10

West raving rating for encephalopathy

Answer 10

1. Changes only in mood
2. Mood + performance + Lethargy/apathy
3. Somnolence, apathy
4. Coma

Question 11

In acute liver injury, what’s first

Answer 11

Increase in PT, after changes in albumin

Question 12

Child pugh score

Answer 12

Question 13

Primary biliary cirrhosis

Answer 13

90% woman, 60 years old
Autoimmune disease, due to decrease tolerance to mitochondrial antigens.
At diagnosis tiredness and itching
Treatment consists of ursodeoxycholic acid (UDCA)
Raynaud phenomenon

Question 14

CYP3A inh

Answer 14

Saquinavir

Question 15

Bile

Answer 15

400-600 ml day
95% water
Reabsorption in terminal ileum
participated in the elimination of toxins

Question 16

Half life of albumin

Answer 16

20 days

Question 17

What is the half-life of coagulation factor VII?

Answer 17

4 hours

Question 18

The earliest laboratory sign in blood tests for liver cirrhosis

Answer 18

Thrombocytopenia

Question 19

Kupffer cells are

Answer 19

resident hepatic macrophages and found in the sinusoids.

Question 20

CYP3A inducers

Answer 20

Phenytoin, rifampin, St. John’s wort, efavirenz, etravirine, nafcillin, prednisone

Question 21

Heme group in the liver

Answer 21

10% 90% bone marrow
Not dependent on iron
For Cytokine p450
Deficiency en synthesis leads to porphyria

Question 22

Porphyria

Answer 22

The most common porphyria is
acute intermittent porphyria, It is caused by a deficiency in porphobilinogen deaminase
Hyponatremia in 40%. Sensitivity to the sun

Question 23

AST and ALT

Answer 23

ALT is mainly a cytoplasmic liver enzyme.
In contrast, cytoplasmic and mitochondrial
isozymes of AST are found in many extrahepatic tissues
AST/ALT elevated in Wilson/alchoholic

Question 24

Lactate Dehydrogenase

Answer 24

Lactate dehydrogenase (LDH) is a nonspecific marker of hepatocellular injury. Extremely elevated LDH signifies massive hepatocyte damage, usually from ischemia or drug-induced hepatotoxicity (such as acetaminophen overdose)

Question 25

Albumin and prelalbumin

Answer 25

Prealbumin is another protein synthesized in
the liver that is also involved in transport and binding. It has a much shorter half-life than albumin (20 days).
The level of prealbumin reflects the status of protein nutrition

Question 26

Factor 7 1/2 life
fibrinogen

Answer 26

4 hours
4 days

Question 27

Gold standard for HCV

Answer 27

Antibodies HCV

Question 28

Main reason for death in liver cirrhosis

Answer 28

Portal hypertension

Question 29

Decompensated cirrhosis

Answer 29

Ascitis + bleeding + Encephalopathy

Question 30

Portal hypertension characteristics

Answer 30

Portal hypertension is defined as a hepatic venous pressure gradient (HVPG) greater than 5mm Hg.
Patients with an HVPG greater than 10 mm Hg
are deemed to have clinically significant portal hypertension.
Tx. nonspecific beta-blockers (i.e., propranolol, timolol), carvedilol or endoscopic variceal ligation to prevent variceal hemorrhage.

Question 31

Hepatitis B and cirrhosis

Answer 31

Not connected

Question 32

Beta blockers and portal hypertension

Answer 32

Decrease HVPG (hepatic venous portal gradient)

Question 33

After hepatic resection, values come back to normal…

Answer 33

INR POD 1-2
Ptl lowest POD 3-4
Return to baseline POD 4-5