Exam 3 - Hepatic/Biliary Systems Flashcards
Functions of the liver?
- Glucose synthesis (gluconeogenesis)
- Storage of glucose as glycogen
- Synthesis of hormones and vitamins from cholesterol
- Metabolism to create energy and drug metabolism (CYP450)
- Iron storage
- Makes coag factors (except III, IV, VIII, and vWF)
- Blood reservoir
How many segments are there in the liver? What creates them?
What seperates the 2 lobes?
- 8 segments (each has a branch of the portal vein and hepatic artery)
- Falciform ligament
What veins return blood from the liver to the IVC?
Right, middle, and left hepatic veins
How does bile travel through and out of the liver?
Via bile ducts that travel along portal veins
Drains through hepatic duct into CBD and GB
Enters duodenum via Ampulla of Vater
The liver recieves how much of the CO?
25% or 1.25-1.5 L/min, highest portion of CO of all organs
The portal vein provides ____ of hepatic blood flow and is partially ____
75%, deoxygenated
The hepatic artery branches off the ____ and provides ____ of the hepatic blood flow
aorta, 25%
The liver obtains ____ of oxygen from both portal vein and hepatic artery
50%
How is hepatic blood flow regulated?
What can happen when this fails?
Hepatic blood flow is autoregulated; Hepatic artery dilates when portal blood flow is low
When portal venous pressure increases blood backs up in the systemic circulation and can cause varices
What is a normal HPVG?
1-5 mmHg
What HVPG correlates with cirrohsis and esophageal varices?
HVPG > 10 mmHg
What can happen at an HVPG >12 mmHg?
Variceal rupture
What risk factors may lead to liver disease?
- Family hx
- EtOH abuse
- DM
- Obesity
- Illicit drug use
- Multiple partners
Someone with liver failure may have what physical findings?
- Pruritis (bilirubin excess)
- Jaundice
- Ascites
- Asterixis (flapping tremor)
- Hepatomegaly
- Spleenomegaly
- Spider nevi
What are the 3 groups of hepatobiliary disorders?
- Bilirubin overload
- Hepatocellular injury
- Cholestasis
What abnormal lab findings are found with bilirubin overload?
- Unconjugated bilirubin predominants
- BUN may be slightly increased
What abnormal lab findings are found with hepatocellular injury?
- Incrased aminotrasferases (AST/ALT)
- Decreased albumin
- Prolonged PT
- Retention of dye
What abnormal lab findings are found with cholestasis?
- Increased alkaline phosphatase
- Increased Ɣ-Glutamyl transpeptidase
Risk factors, S/S, and treatments for cholelithiasis
Risk factors: Obesity, ↑cholesterol, DM, preganancy, female, family hx
S/S: RUQ pain referred to shoulders, N/V, indegestion, fever
Tx: IVF, abx, lap cholecystectomy
What is choledocolithiasis?
Stone obstructs the CBD causing retrograde flow of bile
Sx of choledocolithiasis?
N/V, cramping, RUQ pain
Can progress to cholangitis → fever, rigors, jaundice
Treatment for choledocolithiasis?
ERCP - Endoscopic Retrograde Cholangiopancreatography
Guidewire threaded through Sphincter of Oddi into Ampulla of Vater to retrieve stone
Anesthesia concerns for ERCP?
- Pt is under GA
- Usually prone with left tilt (tape ETT to the left)
- Glucagon may be needed if sphincter of oddi spasm
What is bilirubin and the different forms?
Bilirubin - end product of heme breakdown
Unconjugated (indirect) bilirubin - protein bound to albumin; conjugated in the liver to “direct” state and excreted into bile (now water soluble)