3. Hepatic / Renal Flashcards
1
Q
hepatic receives what % of CO
A
25%
2
Q
hepatic arterial supply comes from
A
the aorta via the hepatic artery
3
Q
hepatic BF intrinsic control
A
HABR
pressure-flow autoregulation
metabolic control
4
Q
HABR
A
hepatic arterial buffer response
5
Q
what is HABR
A
reciprocal flow between artery and portal vein
6
Q
how much affect does pressure0flow autoregulation have on hepatic blood flow?
A
minimal because other methods have more significant effect
7
Q
Hepatic BF extrinsic control
A
neural control
humoral control
8
Q
neural contreol
A
potent regulation with autonomic fibers controlling blood flow through portal vein
9
Q
sympathetic activity can shunt how much blood in dogs
A
400-500 mL
10
Q
hepatic/splanchnic arteries have
A
a1
a2
b2
11
Q
portal arteries have
A
a1
a2
12
Q
liver functions: metabolism
A
protein metabolism
carb metabolism
lipid metabolism
bile metabolism
13
Q
liver functions: production
A
heme production
bilirubin
angiotensinogen
thrombopoetin
14
Q
liver function: activation
A
activates T4 to T3
15
Q
liver function: inactivation
A
indactivates aldosterone
inactivates insulin
inactivates ADH
16
Q
breakdown of liver protein metabolism causes
A
ammonia buildup leading to jaundice
17
Q
how much albumin is produced daily
A
12-15 g/day
18
Q
how much total body protein produced per day
A
500g
19
Q
which coags are not produced by the lvier
A
Factor III
Factor IV
Factor VIII
20
Q
what should you anticipate in pts with hepatic deraingement?
A
potential for increased blood loss
21
Q
Protein S
A
cofactor for Proteinc C
22
Q
Protein C
A
inactivates Factor Viia-Va complexes
23
Q
Protein Z
A
facilitates defradations of Factor Xa
24
Q
Plasminogen Activator Inhibitor (PAI)
A
indirect inhibitor of fibrinolysis
25
Antithrobin III
inhibits coag
prevents clotting
26
how much of total heme is produced by the liver
20%
27
kupffer cell function
protect body from splanchnic blood contaminations
28
hepatic drug metabolism - phase 1
incr polarity of drug
- adding OH, NH2, SH
- remove lipophilic groups
29
hepatic drug metabolism - phase 2
incr polatiry by conjugating with water-soluble substrate
30
hepatic drug metabolism - phase 3
elimination step to excrete into bil
31
lab tests to evaluate liver
liver function tests
32
ALT
alanine aminotransferase
33
ALT normal
5-35 IU/L
34
ALT tells us
hepatocellular injury
gluconeogenesis
primary liver
35
AST
aspartate aminotransferase
36
AST normal
10-40 IU/L
37
AST tells us
hepatocellular injury
gluconeogenesisi
can be produced in other tissue beds
38
LDH
lactate dehydrogenase
39
LDH normal
122-222 IU/L
40
LDH tells us
hepatocelluar injury
not much different from ALT or AST
41
LDH trends similarly to
AST and ALT
42
serum albumin normal
3.5-5.5 g/dL
43
serum albumin tells us
hepatic protein synthesis
level of oncotic pressure
protein binding in plasma
44
PT
prothrombin time
45
PT normal
12-14 seconds
46
PT tells us
hepatic protein synthesis
shortage of procoagulants
47
ALP
alkaline serum phosphatase
48
ALP normal
10-30 IU/L
49
ALP tells us
cholestatic disorder
hepatic injury
malignancy
50
serum bilirubin normal
0.2-1.1 mg/dL
51
serum bilirubin tells us
hepatic excretory function
level of jaundice
52
halothane can cause what to liver
hepatitis with long-duration use
53
incr MAC will ______ total hepatic blood flow
incr MAC = decr THBF
54
incr MAC will ______ hepatic arterial O2 delivery
incr MAC = decr hepatic arterial O2 delivery
55
ESLD: CNS
hepatic encephalopathy
56
hepatic encephalopathy
confusion
personality changes
sleep disorder
coma
57
ESLD: CV
hyperdynamic states
cardiomyopathy
altered blood flow
portal HTN
58
hyperdynamic states
decr SVR
high CO
low BP
elevated HR
59
cardiomyopathy
CHF
60
altered blood flow
incr splanchnic flow
incr MvO2
61
portal HTN
ascites
varices
62
ESLD: pulmonary
hypoxemia
portopulmonary syndrome
63
hypoxemia
impaired HPV
incr atelectasis
hepatopulmonary syndrome
64
hepatopulmonary syndrome
intrapulmonary vascular dilation and shunting
65
portopulmonary syndrome
pulm HTN
portal HTN
multisystem organ failure
66
ESLD: renal
hepatorenal syndrome
edema
ascites
67
hepatorenal syndrome
pre-renal failure
severe cirrhosis
68
edema/ascites
portal HTN
Na/H2O retention
electrolyte abnormaliteis
69
ESLD: hematologic
coagulopathy
hypercoagulable
thrombocytopenia
70
coagulopathy/hypercoag
protein synthesis abnormalities
71
thrombocytopenia
portal HTN causes splenomegaly
plt sequestration
72
ESLD: nedocrine
abnormal glucose use
73
abnormal glucose use
insulin resistance
loss of glycogen
74
ESLD: GI
esophagela varices
75
esophageal varices
manifestations of portal HTN
variceal rupture
76
hepatic disease scoring systmes
child-pugh
MELD
77
MELD is
logarithmic
78
MELD predicts
3 month mortality from liver disease
79
hepatic pts are considered
full stomach
80
what agents confound encephalopathy
antihistamines
long-acting opioids
versed
atropine
scopalamine
81
TIPS
transjugular intrahepatic protosystemic shunt
82
TIPS is a shunt between
portal vein and hepatic vein
83
TIPS indication
ruptured variceal bleed
symptomatic ESLD
84
what happens with increased cirrhosis severity?
increased EBL
85
2 methods of fluid management in hepatic resection
liberal
or
restrictive
86
liberal
prepare for inadvertent blood loss by diluting blood
87
restrictive
recduce CVP to reduce EBL
88
which type of resection is associated with less blood loss
lobe
89
mugging
liver is manipulated in manner which impinges the IVC
90
mugging is more common on what side
right side
91
pringle maneuver
clamping the vascular pedicle to stop blood flow to liver
short duration only
92
how long should abx circulate before autologous transfusion
30 mins
93
how long after blood drawn do yo uhave to transfuse autologous blood?
8 hrs
94
portopulmonary syndrome
hypoxemia due to intrapulmonary vasculature during liver disease
95
portopulomary syndrome diagnosis
PaO2 < 80mmHg
A-a O2 >= 15mmHg
96
portorenal syndrome (hepatorenal syndrome)
acute renal failure due to acute or chronic hepatic failure
97
what causes hepatorenal syndrome
decreased blood supply to kindey
renal function remains in tact
98
do you have proteinuria in heopatorenal syndrome
no - kidney function is not compromised
99
renal autoregulation
80-180 mmHg
100
what drug impairs renal autoregulation
CCB
101
renal systems receives what % of CO
20%
102
renal system cannot tolerate _____ perfusion
hyperperfusion
103
anuric
0 mL/hr
104
oliguric
< 15 mL/hr
105
nonoliguric
15-80 mL/hr
106
polyuric
> 80mL/hr
107
perioperative oliguria
> 0.5 ml/kg/hr (IBW)
108
when is BUN unreliable
with hepatic deraingement
109
normal BUN
5-10 mg/dL
110
what BUN:Cr ratio is indicative of prerenal syndrom
20:1
111
production of urea is dependent on
hepatic function
nutrition
112
normal GFR
125 mL/min
113
when are renal symptoms seen
after GFR drops to 50%
114
symptoms after GFR drops to 30%
anemia
fatigue
volume overload
acidodis
115
ESRD is considered at what GFR
<10%
116
Cr normal
0.5-1.0 mg/dL
117
Cr changes are
exponential
118
doubling Cr results in
50% reduction in GFR
119
Cr is dependend on
cephalosporins
barbituates
ketoacidodis
cachexia
hydration
120
cachexia
muscle wasting
121
dehydration causes what change to Cr
false increase
122
renal vasoconstrictors
sympathoadrenal
RAS
aldosterone
ADH
123
renal vasoconstiction SE
decr RBF
decr GFR
decr Urine flow
decr Na excretion
124
renal vasodilators
prostaglandins
kinins
ANP
125
renal vasodilator SE
incr RBF
incr GFR
incr urine flow
incr Na excretion
126
chronic renal failure SE
hypervolemia
acidemia
hyperkalemia
pulm edema
anemia
CAD
127
chronic renal failure anion gap
large
128
decreased EPO causes
anemia
129
morphine metabolism
hepatic / renal
130
morphine metabolites
morphine3-lgucaronide
morphine 6 glucaronide
131
which metabolite of morphine is active
morphine 6
132
morphine 6 glucaronide complications
6x potency of morphine
==pulmonary complications
133
morphine excretion
kidney
134
meperidine metabolism
conjugated by the liver to normeperidine
135
normeperidine complications
2x more likely to cause seizure
retention in CRF pts
136
what compounds are nephrotoxic
free flouride compounds
137
free flouride compound metabolism
liver (some)
soda lime degradation
138
propofol complication
propofol infusion syndrome
139
PIS more likely with what dosing
4 mg/kg/hr > 48 hrs
140
PIS is caused by
phenols overloading kidney
141
does PIS have renal dysfunction
no
142
does sux have renal clearance
no
143
pancuronium clearance
40-50% renal
144
vecuronium clearnce
30% renal
145
CRF rocuronium effect
incr DOA by incr Vd
146
CRF colinesterase inhibitors effect
clearance of cholinesterase inhibitors is increased more than paralytics
== reparalyzation can occur in CRF
147
most effect method of renal replacement therapy
hemodialysis
148
hemodialysis flow rate
500mL/min
149
just dialyzed pts
hypovolemia induced hypotension
hypopnea
150
hypopnea
dec respiratory drive
151
what do you give for low BP in pts who were just dialyzed
ephedrine
152
needing dialysis pts
hyperkalemia
hypercalcemia
acidosis
fluid overload
153
peritoneal dialysis has ______ HD compromise
less HD compromise
154
which has lower complications peritoneal dialysis or hemodialysis
peritoneal dialysis
155
dialysis used in ICU
continuous renal replacement therapy (CRRT)
156
prostate irriguation should be
isotonic
electrically inert
nontoxic
transparent
inexpensive
easy to sterilize
157
TURP syndrome
large venous plexus results in absorption issues
158
TURP absorption rate
10-30 mL/min
159
most common solution for TURP
glycine
160
distilled water SE
hypotonic
hemolysis
volume overload
hypnatremia
161
glycine SE
transient blindness
162
mannitol 5% SE
pulm edema
163
glucose 2.5% SE
severe hyperglycemia
164
TURP syndrome SE: CNS
irritability
apprehension
confusion
headache
seizure
coma
165
TURP syndrome SE: CVS
negative inotropy
hypotension
dysrhytmias
wide QRS
elevated ST
166
TURP syndrome treatment
fluid restriction
loop diuretics
hypertonic saline (3%)
167
which nephrectomy has lower EBL
radical nephrectomy
168
renal sparing maneuvers
mannitol
dopamine
169
what should you expect from prostatectomy
open procedure will have large EBL
