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Anesthesia Principles 2 > Exam 3: Hepatic > Flashcards

Exam 3: Hepatic Flashcards

1
Q

_____ is the largest solid organ in the body

A

Liver

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2
Q

the liver is _______% of adult body weight and ____% of neonate body weight

A

2; 5

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3
Q

the liver weighs about ________ g

A

1500

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4
Q

the liver sits in the thoracic portion of the abdominal cavity from ribs ______ - _______

A

7; 11

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5
Q

______________ is what divides the liver into the left and right lobes

A

falciform ligament

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6
Q

What are the different anatomic lobes of the liver?

A
  1. right lobe
  2. left lobe
  3. caudate lobe
  4. quadrate lobe
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7
Q

T/F: the liver is the only organ with a dual blood supply

A

True

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8
Q

surgical liver anatomy has __________ segments

A

8 (1-8)

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9
Q

Why is knowing the hepatic segments important as an anesthetist?

A

This becomes extremely important when we are doing segmental resections of the liver

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10
Q

What is the portal triad?

A
  1. Bile Duct
  2. Hepatic Artery
  3. Portal Vein
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11
Q

The liver receives approximately _____% of cardiac output via a dual arterial and venous blood supply

A

25-30

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12
Q

The _____and ______ enter the liver and progressively branch until terminating in the hepatic sinusoids.

A

hepatic artery ; portal vein

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13
Q

Changes in hepatic artery or portal vein blood flow may not result in an overall change in total hepatic flow due to the _______

A

hepatic artery buffer response (HABR)

- This response is a semireciprocal autoregulatory mechanism whereby changes in portal flow inversely affect hepatic arterial flow

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14
Q

the hepatic artery supplies _____% of blood to the liver, and the hepatic portal vein supplies ____% of blood to the liver; however, both supply ____% of O2

A

20-25 ; 70-75 ; 50

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15
Q

if the portal vein supplies 70-75% of blood flow to the liver, why does it only supply 50% of Oxygen?

A

blood in hepatic portal vein is partially deoxygenated and nutrient rich 2/2 blood coming into it from splanchnic circulation

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16
Q

the hepatic artery comes from the _____________ artery

A

celiac

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17
Q

the portal vein comes from the ____________ & __________ veins

A

splenic vein; inferior mesenteric vein

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18
Q

what should your hepatic artery pressure be?

A

should be the same as the SBP bc it comes right off the Ao

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19
Q

What is the pressure in the hepatic portal vein?

A

7-10 mmHg

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20
Q

O2 sat of the hepatic portal vein

A

85%

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21
Q

the low pressure system of the hepatic portal vein allows for what ?

A
  1. large venous reservoir in the liver
  2. allows to compensate 25% of volume loss
  3. can hold 1 L of volume
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22
Q

SNS innervation to the liver

A

T3-T11

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23
Q

parasympathetic innervation to the liver

A

R/L vagus nerves
R phrenic nerve

24
Q

what are the vasoconstricting receptors of the hepatic artery?

A

alpha 1 adrenergic

25
Q

what are the vasoconstricting receptors of the portal vein?

A

alpha 1 adrenergic
D1 dopaminergic

26
Q

what are the vasodilating receptors of the hepatic artery

A
  1. B2 adrenergic
  2. D1 dopaminergic
  3. cholinergic
27
Q

the D1 dopaminergic receptor causes _____________ in the hepatic artery, but causes ________________ in the portal vein

A

vasodilation; vasoconstriction

28
Q

_________________ is the functional unit of the liver

A

hepatic lobule

29
Q

there are approximately _________________ hepatic lobules in a normal liver

A

50,000 - 100,000

30
Q

what is in the center of each hepatic lobule

A

central vein

31
Q

all hepatic veins course through the hepatic lobule draining into the ____________, which then drains into the _______________

A

central vein; IVC

32
Q

describe the hepatic blood flow

A
  1. in from hepatic artery and portal vein
  2. through the sinusoids
  3. into the central veins
  4. Hepatic veins
  5. then into the IVC
33
Q

how long does it take for blood to flow from the portal vein to the central vein?

A

8-9 seconds

34
Q

______________ is on each side of the hepatocyte which allows for large proteins to come through

A

fenestrated endothelium

35
Q

what is the fx of bile canaliculi

A

they collect the bile that the hepatocyte is producing –> bile duct

36
Q

What are the different functions of the liver? (Vasculature and metabolic)

A

vasculature:
1. blood reservoir
2. blood cleansing via kupffer cells

metabolic liver fx:
1. bile formation and excretion
2. protein synthesis
3. glycogen storage
4. protein metabolism
5. insulin clearance
6. lactate conversion into glucose
7. drug metabolism
8. biotransformation

37
Q

The normal blood volume in the liver = __________, but can hold up to __________

A

450 mL; 1 L

38
Q

_____ cells line the sinusoids and function to cleanse the blood

A

kupffer cells

39
Q

_____ is stored glucose

A

Glycogen

40
Q

To maintain a steady blood glucose level, the liver moderates _______ and _______.

A

gluconeogenesis; glycogenolysis

41
Q

________ is the formation of glucose from the noncarbohydrate molecules lactate and pyruvate, as well as amino acids, all of which are products of anaerobic and catabolic metabolism. It is stimulated by ____________________.

A

Gluconeogenesis; a decrease in glycogen stores

42
Q

During periods of fasting, the liver maintains blood glucose at relatively normal levels through __________.

A

glycogenolysis

43
Q

Initiated by epinephrine and glucagon, _______ is the process of liberating glucose from glycogen stores found in the liver (and skeletal muscle).

A

glycogenolysis

44
Q

________ may be encountered in patients with severe liver disease due to dysfunctions in insulin clearance, a decrease in glycogen capacities, and impaired gluconeogenesis.

A

Hypoglycemia

45
Q

_____ is the formation of of glycogen from glucose

A

Glycogenesis

46
Q

Most proteins are synthesized by the liver EXCEPT ________

A

immunoglobulins

47
Q

What is the MOST important protein produced by the liver?

A

Albumin

48
Q

What happens to protein synthesis as a result of liver dysfunction?

A

Decreased albumin
- Decreased plasma oncotic pressure
- Ascites
- Increased Vd –> Increased NMB

Decreased drug binding
- Exaggerated effect of some drugs (Barbiturates)

Decreased plasma pseudocholinesterase
- Prolonged succs action

49
Q

______ is a breakdown product of heme metabolism and is often classified as unconjugated or conjugated.

A

Bilirubin

50
Q

Explain the process of bilirubin metabolism

A

Heme is converted to unconjugated bilirubin in the reticuloendothelial cells of the spleen. This unconjugated bilirubin is not soluble in water and is neurotoxic at sufficiently high levels. It is then bound to albumin and transported to the liver. Once in the liver, the unconjugated bilirubin is conjugated with glucuronic acid. Bilirubin is then incorporated into the bile and secreted into the intestine, where it is metabolized by bacterial enzymes and predominantly excreted in the feces.

51
Q

Bile is created in the _____

Bile is stored and concentrated in the ______

A

Liver ; Gallbladder

52
Q

Bile is released from the gallbladder in response to ______

A

to the intestinal hormone cholecystokinin (CCK)

53
Q

_______ assists in the absorption of fat and fat-soluble vitamins (vitamins A, D, E, and K).

A

Bile secretion

54
Q

What are the fat-soluble vitamins?

A

A, D, E, K

All Dogs Eat Kats

55
Q

Liver disease may result in impaired bile production or flow, leading to…

A
  • steatorrhea
  • vitamin K deficiency
  • delayed removal of active drug metabolites
56
Q

All clotting factors are produced by the liver except

A

VIII and vWF

57
Q

What are the Vitamin-K-dependent clotting factors?

A

II, VII, IX, X

Anesthesia Principles 2 (4 decks)

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