Ch. 28 Renal, Liver, and Biliary Tract Disease

Question 1

What does AKI stand for?

Answer 1

Acute Kidney Injury

Question 2

The kidneys account for about ___% of total body weight and account for about ___% of cardiac output.

Answer 2

0.5%; 20%

Question 3

(autoregulation) Renal blood flow and GFR remain relatively constant at renal arterial pressures of ___-___mmHg.

Answer 3

80-180mmHg

Question 4

When might the renal autoregulation range be different?

Answer 4

chronic HTN

Question 5

Any decrease in renal blood flow will initiate the release of _____.

Answer 5

renin

Question 6

Roughly what percent of fluid that flows through glomeruli is reabsorbed?

Answer 6

~90%

Question 7

What is normal GFR?

Answer 7

125cc/min

Question 8

Renin may be released in response to any of three conditions - name them

Answer 8

SNS stimulation, decreased renal perfusion pressure, decreased sodium delivery to distal convoluted tubule

Question 9

Prostaglandins may be released in response to any of three conditions - name them

Answer 9

sympathetic stimulation, HoTN, increased levels of angiotensin II

Question 10

What is arginine vasopressin (AVP)?

Answer 10

ADH

Question 11

Where does AVP bind?

Answer 11

V2 receptors in collecting duct

Question 12

AVP has what effect on serum and urine osmolality?

Answer 12

decreases serum osmolality; increases urine osmolality

Question 13

Which are more efficiently filtered at the glomerulus - drugs that are highly protein-bound drugs or those that are not?

Answer 13

drugs that are not highly protein-bound

Question 14

What kind of drugs undergo passive reabsorption in the proximal and distal tubules?

Answer 14

un-ionized acidic drugs and basic drugs

Question 15

What are the flaws in using serum Cr concentration as a measure of GFR?

Answer 15

concentration is dependent upon muscle mass

Question 16

What are the flaws in using BUN as a measure of GFR?

Answer 16

influenced by protein metabolism and flow through renal tubules

Question 17

Formula for determining GFR from serum Cr?

Answer 17

GFR = (140 - age) x kg wt/serum Cr x 72

Question 18

Which method for determining GFR requires urinalysis and blood gas analysis?

Answer 18

creatinine clearance testing

Question 19

Can proteins travel through the glomerulus?

Answer 19

yes, small ones can

Question 20

What is proteinurea?

Answer 20

high levels of protein in the urine

Question 21

Proteinurea is caused by what?

Answer 21

abnormally high filtration of protein, exercise, fever, or CHF

Question 22

Which diuretics cause hypokalemic, hypochloremic metabolic alkalosis?

Answer 22

thiazides and loop diuretics

Question 23

Which diuretics cause hyperglycemia?

Answer 23

loop diuretics (somewhat) and thiazides

Question 24

What are side effects associated with diuretic-induced hypokalemia?

Answer 24

skeletal muscle weakness, risk of digitalis toxicity, enhancement of non-depolarizing NMBD

Question 25

What is the most commonly administered osmotic diuretic?

Answer 25

mannitol (a six-carbon sugar)

Question 26

Fluid overload secondary to cirrhosis is often treated with what diuretic?

Answer 26

spironolactone

Question 27

What is the predominant cause of death in patients with ESRD?

Answer 27

cardiovascular disease

Question 28

What are two of the most common reasons for systemic HTN in ESRD pts?

Answer 28

hypervolemia and excess activation of the renin-angiotensin-aldosterone system

Question 29

Patients with prerenal oliguria have decreased/increased levels of Na+ in the urine? Why?

Answer 29

decreased. Low kidney perfusion due to hypovolemia or poor cardiac output - kidneys trying to conserve volume.

Question 30

Patients with intrinsic renal disease have decreased/increased levels of Na+ in the urine? Why?

Answer 30

increased. Tubules ineffective at reabsorbing Na+.

Question 31

The liver receives what percent of CO?

Answer 31

~25%

Question 32

Most of the blood to the liver comes via the _____ with the rest supplied by the ______.

Answer 32

portal vein; hepatic artery

Question 33

How is hepatic blood flow determined?

Answer 33

MAP or (portal vein P - hepatic vein pressure) and splanchnic vascular resistance

Question 34

What is the main organ for the storage and release of glucose?

Answer 34

liver

Question 35

In what form is glucose stored? What hormone releases glucose from its stored form back into the bloodstream? What is the process called?

Answer 35

glycogen; glucagon; gluconeogenesis

Question 36

Hepatocytes are responsible for the synthesis of the majority of procoagulent proteins as well as regulators except for which factor?

Answer 36

factor VIII

Question 37

Hepatic metabolism of drugs is characterized by the conversion of _____-soluble drugs to _____-soluble drugs.

Answer 37

lipid; water

Question 38

What are the three phases of hepatic metabolism of drugs?

Answer 38

polarization, conjugation, excretion

Question 39

What percentage of erythrocyte production occurs in the liver (in adults)?

Answer 39

~20%

Question 40

Heme degradation results in what end product?

Answer 40

bilirubin

Question 41

In the liver, bilirubin is turned into what?

Answer 41

bile

Question 42

Does the liver store dietary fat as triglycerides, cholesterol and phospholipids?

Answer 42

yes it does!

Question 43

What is hepatic encephalopathy?

Answer 43

worsening brain function when the liver is no longer able to get rid of toxic substances (i.e. ammonia)

Question 44

What is physiologic shunting?

Answer 44

passage of blood from the arterial to venous side of circulation without effectively traversing a capillary bed (i.e. spider veins)

Question 45

Gastric varices can develop as a result of what?

Answer 45

high resistance of blood flow through liver (characteristic of ESLD)

Question 46

What drug has been shown to decrease symptoms of hepatic encephalopathy?

Answer 46

flumazenil

Question 47

With severe liver disease, highly protein bound drugs are more likely to be found in the _____ form.

Answer 47

unbound

Question 48

What is ascites?

Answer 48

buildup of fluid between lining of abdomen and abdominal organs

Question 49

Inhaled anesthetics and regional anesthesia both _____ hepatic bloodflow __-__% in the absence of surgical stimulation.

Answer 49

decrease; 20-30%

Question 50

What is a pre-operative test the can be used to assess liver function?

Answer 50

a liver function test

Question 51

The Child-Pugh score is used to assess what?

Answer 51

severity of liver dysfunction

Question 52

The MELD score is used to assess what?

Answer 52

severity of liver dysfunction

Question 53

Why might liver disease be exposed during surgery?

Answer 53

The liver has large reserves, so when part of it is damaged, it won't necessarily show up on a liver function test. The decrease in liver function during anesthesia exposes it.

Question 54

Patients with what condition may bleed when a TEE probe is placed?

Answer 54

esophageal varices

Question 55

IV anesthetics have what effect on hepatic blood flow?

Answer 55

minimal

Question 56

Sympathetic stimulation has what effect on hepatic blood flow?

Answer 56

decreases

Question 57

Which volatile anesthetic can cause hepatotoxicity?

Answer 57

halothane

Question 58

Alcohol has what effect on gastric emptying?

Answer 58

slows

Question 59

What is the treatment for alcohol withdrawal?

Answer 59

benzos

Question 60

How common are gallstones in men and women between ages of 55-65?

Answer 60

men ~10%, women ~20%

Question 61

What are the reasons for using an OG or NG tube during laparoscopic surgery?

Answer 61

decompression of stomach decreases risk for visceral puncture at time of needle insertion; also improves visualization