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Fa: Sim 3 > 3. Hepatic / Renal > Flashcards

3. Hepatic / Renal Flashcards

1
Q

hepatic receives what % of CO

A

25%

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2
Q

hepatic arterial supply comes from

A

the aorta via the hepatic artery

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3
Q

hepatic BF intrinsic control

A

HABR
pressure-flow autoregulation
metabolic control

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4
Q

HABR

A

hepatic arterial buffer response

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5
Q

what is HABR

A

reciprocal flow between artery and portal vein

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6
Q

how much affect does pressure0flow autoregulation have on hepatic blood flow?

A

minimal because other methods have more significant effect

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7
Q

Hepatic BF extrinsic control

A

neural control
humoral control

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8
Q

neural contreol

A

potent regulation with autonomic fibers controlling blood flow through portal vein

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9
Q

sympathetic activity can shunt how much blood in dogs

A

400-500 mL

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10
Q

hepatic/splanchnic arteries have

A

a1
a2
b2

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11
Q

portal arteries have

A

a1
a2

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12
Q

liver functions: metabolism

A

protein metabolism
carb metabolism
lipid metabolism
bile metabolism

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13
Q

liver functions: production

A

heme production
bilirubin
angiotensinogen
thrombopoetin

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14
Q

liver function: activation

A

activates T4 to T3

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15
Q

liver function: inactivation

A

indactivates aldosterone
inactivates insulin
inactivates ADH

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16
Q

breakdown of liver protein metabolism causes

A

ammonia buildup leading to jaundice

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17
Q

how much albumin is produced daily

A

12-15 g/day

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18
Q

how much total body protein produced per day

A

500g

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19
Q

which coags are not produced by the lvier

A

Factor III
Factor IV
Factor VIII

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20
Q

what should you anticipate in pts with hepatic deraingement?

A

potential for increased blood loss

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21
Q

Protein S

A

cofactor for Proteinc C

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22
Q

Protein C

A

inactivates Factor Viia-Va complexes

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23
Q

Protein Z

A

facilitates defradations of Factor Xa

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24
Q

Plasminogen Activator Inhibitor (PAI)

A

indirect inhibitor of fibrinolysis

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25
Q

Antithrobin III

A

inhibits coag
prevents clotting

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26
Q

how much of total heme is produced by the liver

A

20%

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27
Q

kupffer cell function

A

protect body from splanchnic blood contaminations

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28
Q

hepatic drug metabolism - phase 1

A

incr polarity of drug
- adding OH, NH2, SH
- remove lipophilic groups

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29
Q

hepatic drug metabolism - phase 2

A

incr polatiry by conjugating with water-soluble substrate

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30
Q

hepatic drug metabolism - phase 3

A

elimination step to excrete into bil

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31
Q

lab tests to evaluate liver

A

liver function tests

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32
Q

ALT

A

alanine aminotransferase

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33
Q

ALT normal

A

5-35 IU/L

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34
Q

ALT tells us

A

hepatocellular injury
gluconeogenesis
primary liver

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35
Q

AST

A

aspartate aminotransferase

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36
Q

AST normal

A

10-40 IU/L

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37
Q

AST tells us

A

hepatocellular injury
gluconeogenesisi
can be produced in other tissue beds

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38
Q

LDH

A

lactate dehydrogenase

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39
Q

LDH normal

A

122-222 IU/L

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40
Q

LDH tells us

A

hepatocelluar injury
not much different from ALT or AST

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41
Q

LDH trends similarly to

A

AST and ALT

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42
Q

serum albumin normal

A

3.5-5.5 g/dL

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43
Q

serum albumin tells us

A

hepatic protein synthesis
level of oncotic pressure
protein binding in plasma

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44
Q

PT

A

prothrombin time

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45
Q

PT normal

A

12-14 seconds

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46
Q

PT tells us

A

hepatic protein synthesis
shortage of procoagulants

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47
Q

ALP

A

alkaline serum phosphatase

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48
Q

ALP normal

A

10-30 IU/L

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49
Q

ALP tells us

A

cholestatic disorder
hepatic injury
malignancy

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50
Q

serum bilirubin normal

A

0.2-1.1 mg/dL

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51
Q

serum bilirubin tells us

A

hepatic excretory function
level of jaundice

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52
Q

halothane can cause what to liver

A

hepatitis with long-duration use

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53
Q

incr MAC will ______ total hepatic blood flow

A

incr MAC = decr THBF

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54
Q

incr MAC will ______ hepatic arterial O2 delivery

A

incr MAC = decr hepatic arterial O2 delivery

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55
Q

ESLD: CNS

A

hepatic encephalopathy

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56
Q

hepatic encephalopathy

A

confusion
personality changes
sleep disorder
coma

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57
Q

ESLD: CV

A

hyperdynamic states
cardiomyopathy
altered blood flow
portal HTN

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58
Q

hyperdynamic states

A

decr SVR
high CO
low BP
elevated HR

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59
Q

cardiomyopathy

A

CHF

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60
Q

altered blood flow

A

incr splanchnic flow
incr MvO2

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61
Q

portal HTN

A

ascites
varices

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62
Q

ESLD: pulmonary

A

hypoxemia
portopulmonary syndrome

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63
Q

hypoxemia

A

impaired HPV
incr atelectasis
hepatopulmonary syndrome

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64
Q

hepatopulmonary syndrome

A

intrapulmonary vascular dilation and shunting

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65
Q

portopulmonary syndrome

A

pulm HTN
portal HTN
multisystem organ failure

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66
Q

ESLD: renal

A

hepatorenal syndrome
edema
ascites

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67
Q

hepatorenal syndrome

A

pre-renal failure
severe cirrhosis

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68
Q

edema/ascites

A

portal HTN
Na/H2O retention
electrolyte abnormaliteis

69
Q

ESLD: hematologic

A

coagulopathy
hypercoagulable
thrombocytopenia

70
Q

coagulopathy/hypercoag

A

protein synthesis abnormalities

71
Q

thrombocytopenia

A

portal HTN causes splenomegaly
plt sequestration

72
Q

ESLD: nedocrine

A

abnormal glucose use

73
Q

abnormal glucose use

A

insulin resistance
loss of glycogen

74
Q

ESLD: GI

A

esophagela varices

75
Q

esophageal varices

A

manifestations of portal HTN
variceal rupture

76
Q

hepatic disease scoring systmes

A

child-pugh
MELD

77
Q

MELD is

A

logarithmic

78
Q

MELD predicts

A

3 month mortality from liver disease

79
Q

hepatic pts are considered

A

full stomach

80
Q

what agents confound encephalopathy

A

antihistamines
long-acting opioids
versed
atropine
scopalamine

81
Q

TIPS

A

transjugular intrahepatic protosystemic shunt

82
Q

TIPS is a shunt between

A

portal vein and hepatic vein

83
Q

TIPS indication

A

ruptured variceal bleed
symptomatic ESLD

84
Q

what happens with increased cirrhosis severity?

A

increased EBL

85
Q

2 methods of fluid management in hepatic resection

A

liberal
or
restrictive

86
Q

liberal

A

prepare for inadvertent blood loss by diluting blood

87
Q

restrictive

A

recduce CVP to reduce EBL

88
Q

which type of resection is associated with less blood loss

A

lobe

89
Q

mugging

A

liver is manipulated in manner which impinges the IVC

90
Q

mugging is more common on what side

A

right side

91
Q

pringle maneuver

A

clamping the vascular pedicle to stop blood flow to liver
short duration only

92
Q

how long should abx circulate before autologous transfusion

A

30 mins

93
Q

how long after blood drawn do yo uhave to transfuse autologous blood?

A

8 hrs

94
Q

portopulmonary syndrome

A

hypoxemia due to intrapulmonary vasculature during liver disease

95
Q

portopulomary syndrome diagnosis

A

PaO2 < 80mmHg
A-a O2 >= 15mmHg

96
Q

portorenal syndrome (hepatorenal syndrome)

A

acute renal failure due to acute or chronic hepatic failure

97
Q

what causes hepatorenal syndrome

A

decreased blood supply to kindey

renal function remains in tact

98
Q

do you have proteinuria in heopatorenal syndrome

A

no - kidney function is not compromised

99
Q

renal autoregulation

A

80-180 mmHg

100
Q

what drug impairs renal autoregulation

A

CCB

101
Q

renal systems receives what % of CO

A

20%

102
Q

renal system cannot tolerate _____ perfusion

A

hyperperfusion

103
Q

anuric

A

0 mL/hr

104
Q

oliguric

A

< 15 mL/hr

105
Q

nonoliguric

A

15-80 mL/hr

106
Q

polyuric

A

> 80mL/hr

107
Q

perioperative oliguria

A

> 0.5 ml/kg/hr (IBW)

108
Q

when is BUN unreliable

A

with hepatic deraingement

109
Q

normal BUN

A

5-10 mg/dL

110
Q

what BUN:Cr ratio is indicative of prerenal syndrom

A

20:1

111
Q

production of urea is dependent on

A

hepatic function
nutrition

112
Q

normal GFR

A

125 mL/min

113
Q

when are renal symptoms seen

A

after GFR drops to 50%

114
Q

symptoms after GFR drops to 30%

A

anemia
fatigue
volume overload
acidodis

115
Q

ESRD is considered at what GFR

A

<10%

116
Q

Cr normal

A

0.5-1.0 mg/dL

117
Q

Cr changes are

A

exponential

118
Q

doubling Cr results in

A

50% reduction in GFR

119
Q

Cr is dependend on

A

cephalosporins
barbituates
ketoacidodis
cachexia
hydration

120
Q

cachexia

A

muscle wasting

121
Q

dehydration causes what change to Cr

A

false increase

122
Q

renal vasoconstrictors

A

sympathoadrenal
RAS
aldosterone
ADH

123
Q

renal vasoconstiction SE

A

decr RBF
decr GFR
decr Urine flow
decr Na excretion

124
Q

renal vasodilators

A

prostaglandins
kinins
ANP

125
Q

renal vasodilator SE

A

incr RBF
incr GFR
incr urine flow
incr Na excretion

126
Q

chronic renal failure SE

A

hypervolemia
acidemia
hyperkalemia
pulm edema
anemia
CAD

127
Q

chronic renal failure anion gap

A

large

128
Q

decreased EPO causes

A

anemia

129
Q

morphine metabolism

A

hepatic / renal

130
Q

morphine metabolites

A

morphine3-lgucaronide
morphine 6 glucaronide

131
Q

which metabolite of morphine is active

A

morphine 6

132
Q

morphine 6 glucaronide complications

A

6x potency of morphine
==pulmonary complications

133
Q

morphine excretion

A

kidney

134
Q

meperidine metabolism

A

conjugated by the liver to normeperidine

135
Q

normeperidine complications

A

2x more likely to cause seizure
retention in CRF pts

136
Q

what compounds are nephrotoxic

A

free flouride compounds

137
Q

free flouride compound metabolism

A

liver (some)
soda lime degradation

138
Q

propofol complication

A

propofol infusion syndrome

139
Q

PIS more likely with what dosing

A

4 mg/kg/hr > 48 hrs

140
Q

PIS is caused by

A

phenols overloading kidney

141
Q

does PIS have renal dysfunction

A

no

142
Q

does sux have renal clearance

A

no

143
Q

pancuronium clearance

A

40-50% renal

144
Q

vecuronium clearnce

A

30% renal

145
Q

CRF rocuronium effect

A

incr DOA by incr Vd

146
Q

CRF colinesterase inhibitors effect

A

clearance of cholinesterase inhibitors is increased more than paralytics
== reparalyzation can occur in CRF

147
Q

most effect method of renal replacement therapy

A

hemodialysis

148
Q

hemodialysis flow rate

A

500mL/min

149
Q

just dialyzed pts

A

hypovolemia induced hypotension
hypopnea

150
Q

hypopnea

A

dec respiratory drive

151
Q

what do you give for low BP in pts who were just dialyzed

A

ephedrine

152
Q

needing dialysis pts

A

hyperkalemia
hypercalcemia
acidosis
fluid overload

153
Q

peritoneal dialysis has ______ HD compromise

A

less HD compromise

154
Q

which has lower complications peritoneal dialysis or hemodialysis

A

peritoneal dialysis

155
Q

dialysis used in ICU

A

continuous renal replacement therapy (CRRT)

156
Q

prostate irriguation should be

A

isotonic
electrically inert
nontoxic
transparent
inexpensive
easy to sterilize

157
Q

TURP syndrome

A

large venous plexus results in absorption issues

158
Q

TURP absorption rate

A

10-30 mL/min

159
Q

most common solution for TURP

A

glycine

160
Q

distilled water SE

A

hypotonic
hemolysis
volume overload
hypnatremia

161
Q

glycine SE

A

transient blindness

162
Q

mannitol 5% SE

A

pulm edema

163
Q

glucose 2.5% SE

A

severe hyperglycemia

164
Q

TURP syndrome SE: CNS

A

irritability
apprehension
confusion
headache
seizure
coma

165
Q

TURP syndrome SE: CVS

A

negative inotropy
hypotension
dysrhytmias
wide QRS
elevated ST

166
Q

TURP syndrome treatment

A

fluid restriction
loop diuretics
hypertonic saline (3%)

167
Q

which nephrectomy has lower EBL

A

radical nephrectomy

168
Q

renal sparing maneuvers

A

mannitol
dopamine

169
Q

what should you expect from prostatectomy

A

open procedure will have large EBL

Fa: Sim 3 (10 decks)

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