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Fa: Coexisting 2 > 3. Liver > Flashcards

3. Liver Flashcards

1
Q

largest internal organ

A

liver

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2
Q

liver weight

A

1.5 kg

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3
Q

liver location

A

upper right quadrant

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4
Q

liver segments

A

8

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5
Q

liver CO

A

25%

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6
Q

blood flow to liver

A

portal vein - 75%
hepatic artery - 25%

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7
Q

O2 delivery to liver is through

A

50% portal vein
50% hepatic artery

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8
Q

hepatic artery and portal venous flow

A

inverse relationship

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9
Q

what modulates portal venous flow

A

arterial tone of splanchnic vessels

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10
Q

major function of liver

A

filter and transform substances in blood

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11
Q

portosystemic shunts

A

arise in portal HTN and allow blood flow to bypass liver

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12
Q

liver disease incr risk of

A

bleeding
thrombosis

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13
Q

markers for hepatocellular injury

A

AST
ALT
ALP
bilirubin
albimin

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14
Q

where is albumin synthesized

A

liver

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15
Q

which hepatitis causes chronic complications

A

Hep B
Hep C

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16
Q

most common viral hepatitis causes neede for liver transplant

A

HCV

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17
Q

HCV genotype 1 treatment

A

12 weeks of
sofosbuvir
velpatasvir

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18
Q

main reason for liver transplant

A

ALD
or NAFLD

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19
Q

signs during early ALD

A

none

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20
Q

ALD treatment

A

alcohol abstinence
liver failyre management

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21
Q

NAFLD

A

excessive fat accumulation without clear cause of alcohol use

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22
Q

NAFLD associated with

A

obesity
insulin resistance
T2D
metabolic syndrome

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23
Q

NAFLD diagnosis

A

imaging
biopsy

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24
Q

NAFLD treatment

A

weight loss
exercise

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25
Q

which pt population is most affected by autoimmune hepatitis?

A

women

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26
Q

autoimmune hepatits

A

inflammatory diseas of liver
autoantibodies
hypergammaglobulinemia

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27
Q

autoimmune hepatitis labs

A

AST/ALT 10-20x normal

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28
Q

autoimmune hepatitis treatment

A

steroids

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29
Q

most common cause of drug induced liver injury

A

acetamiophen

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30
Q

acetominophen toxic overdose reversal

A

N-Acetycysteine

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31
Q

wilsons disease

A

impaired copper metabolism

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32
Q

a-antitrypsin deficiency

A

transplant is cure
COPD
emphysema

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33
Q

hemochromatosis

A

excess iron that leads to multiorgan dysfunction

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34
Q

ALF timeline

A

severe hepatic injury in less than 26 weeks

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35
Q

ALF S+S

A

incr AST/ALT
altered mental status
coag abnomalties
jaundice
nasuea
RUQ pain
encepalopathy

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36
Q

ALF causes

A

acetominophen
drugs
viral

37
Q

ALF treatment

A

treat underlying cause
supportive
transplant

38
Q

final stage of chronic liver disease

A

cirrhosis

39
Q

cirrhosis

A

replacement of normal liver pernchyma with scar tissue

40
Q

cirrhosis S+S

A

jaundice
ascites
bruising
encephalopathy
variceal hemorrhage

41
Q

what causes encepalopathy

A

ammonia

42
Q

cirrhosis labd

A

incr ALT/AST
inc bilirubin
incr ALP
incr PT/INR

43
Q

gold standard for cirrhosis diagnosis

A

liver biopsy

44
Q

portal HTN

A

incr vascular resistance in portal venous system

45
Q

HPVG

A

difference between hepatic venous pressure and hepatic wedge pressure

46
Q

normal HPVG

A

1-5 mmHg

47
Q

elevated portal HTN HPVG

A

> 10 mmHg

48
Q

variceal rupture HPVG

A

> 12 mmHg

49
Q

most common complication of cirrhosis

A

acites

50
Q

acites management

A

low salt diet
diuretics
paracentesis
TIPS

51
Q

what presents in 50% of cirrhosis pts

A

gastroesophageal varices

52
Q

most lethal complication of cirrhosis

A

variceal hemorrhage

53
Q

what HPVG lead to variceal rupture

A

> 12 mmHg

54
Q

varices treatment

A

nonselective beta blocker (propranolol)
variceal banding

55
Q

hepatic encephalopathy treatment

A

lactulose
rifaximin

56
Q

hepatorenal syndrom

A

decr renal blood flow
splanchnic artery vasodilation

57
Q

hepatorenal treatment

A

midodrine
ocreotide
albumin
hemodialysis

58
Q

hepatopulmonary syndrome triad

A

chronic liver disease (portal HTN)
hypoxemia PaO2 < 70 mmHg
intrapulmonary vasodilation

59
Q

HPS is a state of

A

V/Q mismatch due to HPV inhibition

60
Q

HPS treatment

A

transpant

61
Q

portopulmonary hypertension

A

pulmonary HTN
portal HTN

systemic vasodilation with local production of pulm vasoconstrictors

62
Q

PPHTN diagnosis

A

MAP > 25 mmHg at rest

63
Q

PPHTN treatment

A

pulmonary vasodilators
- PDE inhibitors
- NO
- prostacyclin
- endothelin

64
Q

CI to elective surgery

A

acute hepatitis
ALF
severe chronic liver disease

65
Q

score to stratify risk in liver pts

A

child-pugh
MELD

66
Q

liver pts are at incr risk of _____ on induction

A

aspiration
hypotension
hypoxemia

67
Q

which muscle relaxants dont require hepatic metabolism

A

sux
cisatracurium

68
Q

TIPS indication

A

portal HTN

69
Q

TIPS

A

connects portal vein and hepatic vein

70
Q

TIPS outcome

A

reduces portosystemic pressure gradient
- decr engorged vein bleeding
- decr ascites

71
Q

TIPS CI

A

HF
severe tricuspid regurge
severe pulm HTN

72
Q

TIPS may worsen

A

hepatic encepalopathy

73
Q

how much of the liver can be removed and it will still regenerate

A

75%

74
Q

can you due an epidural for liver transplant

A

not -really
CI for hematoma risk

75
Q

median time to transplant

A

11 months

76
Q

5 year transplant survival rate

A

50-60%

77
Q

preanhepatic stage

A

liver dissected until only attached to IVC and portal vein

78
Q

anhepatic stage

A

portal vein clamped
IVC clamped

donor liver anastamosed to supra and infrahepatic vena cava
portal vein attached

79
Q

neohepatic phase

A

hypotension
hepatic artery anastamosis
bile duct attached

80
Q

MR for liver transplant

A

cisatracurium

81
Q

preanhepatic effects

A

hypovolemia
blood loss

82
Q

anhepatic effects

A

decr venous return
decr preload
hypocalcium
acidosis
air embolism

83
Q

neohepatic effects

A

incr K+
incr preload
decr SVR
hypothermia
hyperfibrinolysis

84
Q

postreperfusion syndrom

A

hypotension
pulm HTN

85
Q

cholecystitis

A

inflammation of gall bladder
bile elimination is blocked

86
Q

cholelithiasis

A

hardening of bile into stones

87
Q

choledocholithiasis

A

gallstones obstruct common bile duct

88
Q

what can cause sphincter of odi spasm

A

opiates (morphine)

89
Q

relax sphincter of odi spasm

A

glucagon
naloxone
nitrates

Fa: Coexisting 2 (7 decks)

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