Clinical Anesthesia | Liver

Question 1

Which of the following volatile anesthetics can induce liver pathology?

Answer 1

A. Halothane
B. Enflurane
C. Sevoflurane
D. Isoflurane
E. Both A&B

Ans: E. Both Halothane and Enflurane produce TFA intermediates which is hepatotoxic.

Question 2

True or False

Nitrous oxide increases hepatic blood flow and therefore can be safely used in Liver Cirrhosis?

Answer 2

FALSE
Due to its sympathomimetic effects, Nitrous Oxide can lead to decreased in hepatic blood flow and INHIBITION of Methionine synthase even in brief exposures.

Barash | 8th edition

Question 3

MELD Score is utilized to predict the outcome of Liver transplant?

TRUE or FALSE

Answer 3

FALSE
MELD Score appears to predict the perioperative mortality of cirrhotic patients.

Barash | 8th edit

Question 4

Modified Child-Pugh Score consists of which of the following parameters:

Answer 4

A. Albumin, PT, Ascites, Encephalopathy, Nutritional status
B. Albumin, PT, Creatinine, Ascites, Encephalopathy, Nutritional status
C. Albumin, PT, Ascites, Encephalopathy, Bilirubin
D. INR, Creatinine, Bilirubin, Albumin

Ans: C

Question 5

TRUE or FALSE

Cardiopulmonary bypass surgery can be safely performed in a patient with Child class B

Answer 5

Child class A and selected Child class B can safely undergo cardiac bypass surgery.

TRUE

Question 6

TRUE or FALSE

Elective cardiac and abdominal surgery should be cancelled until after liver transplant in a patient with Child’s C.

Answer 6

TRUE
Elective high-risk procedures (Abdominal and Cardiac surgery) in patients with Child C cirrhosis should be deferred until after lover transplant.

Question 7

TRUE or FALSE

Age more than 70 years old has an equivalent MELD Score of 3 points.

Answer 7

TRUE

other than MELD score, the other important predictors of perioperative mortality in cirrhotics are
age (>70 years old)
ASA IV or V

Question 8

TRUE or FALSE

ASA physical status > IV is equivalent to 5 MELD points.

Answer 8

TRUE

MELD score of less than 11 have a low post-operative mortality and represents an acceptable surgical risk.

Question 9

The elimination of REMIFENTANIL is independent of both hepatic function and duration of infusion.

Answer 9

TRUE

Barash | 9th edit

Question 10

This is the best NMB agent of choice for ESLD (End stage liver disease)?

Answer 10

CISATRACURIUM

This is due to its organ-independent elimination and lack of histamine release

Question 11

Vitamin K INDEPENDENT coagulation factors:

Answer 11

5, 11, 12, 13

Question 12

Which of the following coagulation factors are not affected in ADVANCED LIVER DISEASE:

Answer 12

A. II
B. V
C. VII
D. VIII

Ans: VIII - this factor is produced both by the liver and endothelial cells. It may be normal even if the liver disease is advanced.

Question 13

TRUE OR FALSE
Dopamine infusions at 0.5mcg to 2.5mcg/kg/min increase ls liver blood flow

Answer 13

TRUE