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NUNA 684 Advanced Pathophysiology > Exam II Liver Biliary Disease > Flashcards

Exam II Liver Biliary Disease Flashcards

1
Q

Alanine transaminase (ALT).Liver enzyme for ____ breakdown. Elevated with ____ damage.
___ to ____ U/L

A

protein
liver
7 to 55 U/L

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2
Q

Aspartate transaminase (AST).Liver enzyme, metabolizes _____ ____. Increased levels may indicate liver damage, disease or _____ damage.
___ to ___ U/L

A

amino acids
muscle
8 to 48 U/L

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3
Q

Alkaline phosphatase (ALP).Liver (and bone) enzyme for protein breakdown. Increased levels may indicate liver damage or disease, blocked ____ ____ or ____ disease.
___ to ___ U/L

A

bile duct or bone
40 to 129 U/L

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4
Q

Albumin and total protein._____ synthesized in the ____. Decreased levels may indicate liver damage or disease.
Albumin:___ to ___ g/dL
Total protein:____ to ____ g/dL

A

protein
liver
3.5 to 5.0 g/dL
6.3 to 7.9 g/dL

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5
Q

Bilirubin.Produced during the normal breakdown of ____, passes through the liver, excreted in _____. Elevated bilirubin/jaundice might indicate liver damage, disease or certain types of anemia.
0.1 to ___ mg/dL (3 mg/dL leads to ____ jaundice; >4 mg/dL leads to ____ jaundice)

A

RBCs
stool
1.2 mg/dL
scleral
generalized

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6
Q

Gamma-glutamyltransferase (GGT). Liver enzyme. Increased levels may indicate ___ or ___ ___ damage.
__ to __ U/L

A

liver or bile duct
8 to 61 U/L

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7
Q

_-______ _____ (__).Liver enzyme. Elevated levels may indicate liver damage but can be elevated in many other disorders.
___ to 222 U/L

A

L-lactate dehydrogenase (LD)
122

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8
Q

Prothrombin time (PT).Increased PT may indicate ____ damage but can also be elevated with _____.
___ to ___ seconds

A

liver
anticoagulants
9.4 to 12.5 seconds

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9
Q

International normalized ratio (INR). Prolonged correlates with impaired ____function, impaired non-specific _____ and reliably predicts liver disease ____.
≤ ___

A

liver
coagulation
survival
1.1

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10
Q

Benign postoperative intrahepatic cholestasis: usually after ____ procedure, increased incidence with ____, ____, ____.

A

long
hypotension, hypoxia, transfusion

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11
Q

Benign postoperative intrahepatic cholestasis: symptoms - ____ with increased ____, other labs normal

A

jaundice
bili

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12
Q

Benign postoperative intrahepatic cholestasis: usually resolves when ____ _____ improves

A

underlying condition

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13
Q

OTHER CAUSES OF POST-OP HEPATIC DYSFUNCTION/JAUNDICE (5)

A
  • hematoma, hemolysis, sepsis
  • drug-induced
  • autoimmune
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14
Q

Acute cholecystitis: obstructed ____ duct or ____ ____ duct leading to painful inflammation

A

cystic
common bile duct

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15
Q

Acute cholecystitis symptoms (3):

A
  • N/V
  • fever
  • RUQ pain that may radiate to the back
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16
Q

Acute cholecystitis treatment: ____, _____, _____, or ______

A

IVF, opioids, cholecystectomy (usually lap), or ERCP

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17
Q

Acute cholecystitis: trendelenburg + insufflation = increased _____ pressure which leads to decreased _____ and decreased ___ ____

A

abdominal
ventilation
venous return

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18
Q

Acute cholecystitis: opioids may cause ___ of ____ ____

A

sphincter of Oddi spasm

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19
Q

Hepatitis:
Viral: A (50%), B (35%), C (15%), D (only seen with Hep B), HSV, CMV, Epstein-Barr
Tx: _____
Prevention: Precautions (avoid ____, get _____)

A

symptomatic
exposure
vaccines

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20
Q

Hepatitis:
Drug Induced: ____ or dose-related
Common: ______ OD leads to toxicity and necrosis
Tx: Conjugate within 8 hours with _____

A

idiosyncratic
acetaminophen
N-acetylcysteine

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21
Q

Hepatitis:
Autoimmune: No ____ treatment. Can progress to failure with need for _____.
Tx: ______ for remission

A

curative
transplant
corticosteroids

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22
Q

Hepatitis:
Halothane: Form of autoimmune hepatitis after exposure. May cross-sensitize to other agents EXCEPT _____ (d/t to its different metabolites).

A

sevoflurane

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23
Q

Hepatitis:
Chronic: ___months, usually d/t _____, progresses to cirrhosis/multi-organ dysfunction

A

> 6 months
ETOH

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24
Q

Cirrhosis:
Parenchymal liver damage with regeneration leads to ____

A

nodules

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25
Q

Cirrhosis symptoms:
F____, m____, j____, a_____, g_____, testicular ____, ascites

A

Fatigue, malaise, jaundice, angiectasis, gynecomastia, testicular atrophy, ascites

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26
Q

Cirrhosis:
increased b____, LFTs, INR, t______, h_____, decreased a_____

A

increased bilirubin, LFTs, INR, thrombocytopenia, hypoglycemia, decreased albumin

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27
Q

Cirrhosis:
fibrosis leads to increased resistance, which causes ____ _____, ascites, ____megaly, ____megaly, peripheral edema

A

portal HTN
hepato
spleno

28
Q

Cirrhosis:
Ascites Tx: A____, low ____ diet, diuresis, p______, portosystemic shunt
Bacterial peritonitis d/t ascites has high ____&_____

A

albumin
sodium
paracentesis
M&M

29
Q

Cirrhosis:
Portal HTN leads to ____ ____ dilatation with potential heavy bleeding.
May require intubation for airway protection and aspiration prevention.
Tx: B____, s_____, β blockers, shunt (____ vein to ____ vein)

A

esophageal venous
banding
sclerotherapy
hepatic
portal

30
Q

Hepatic Encephalopathy
Failing liver causes ____ changes
Shunts can worsen (____/____ bypass hepatic clearance)
Tx: Low protein, drugs to ↓ ammonia absorption; avoid o____, s____, a_____

A

psych
ammonia/metabolites
opioids, sedatives, anesthetics

31
Q

Hyperdynamic Circulation
↓ ____ with ↑ _____
Cirrhosis can lead to ______ that is difficult to manage intraoperatively.

A

SVR
CO
cardiomyopathy

32
Q

Hepatopulmonary Syndrome
Approx. ___% of cirrhosis patients
Caused by intrapulmonary shunting, V/Q mismatch with dyspnea and hypoxia (worsens when ____)
Tx: _____

A

25%
upright
transplant

33
Q

Portopulmonary Hypertension (____ ____ HTN + ____ ____ HTN)
<4% of cirrhosis patients but high ____ with _____ life expectancy
Tx: Prostaglandins, NO. Transplant - but only if PAP <___ mmHg

A

portal vein
pulmonary artery
mortality
short
45

34
Q

Hepatorenal Syndrome (liver dz + renal failure)
Exact etiology unknown but probably d/t ↓ ____ and _____
Type 1 (acute) or Type 2 (chronic) – dependent on speed of onset/severity of ____ function changes
Tx: ____ ____ therapy, liver transplant

A

RBF
dehydration
renal
renal replacement

35
Q

Coagulopathy
Most coag factors and anticoagulant proteins synthesized by liver; liver clears ____ ____ factors.
Coag function must be determined _____.

A

activated coag
preoperatively

36
Q

Acute Liver Failure: 80-90% loss of liver function occurring in ___ ____ from appearance of 1st symptoms

A

< 4 weeks

37
Q

Fulminant liver failure: Failure within ___ ____ of 1st symptoms

A

8 days

38
Q

Acute Liver Failure: Mild encephalopathy causes _____ edema which leads to increased ___ and eventually ____ with high mortality

A

cerebral
ICP
coma

39
Q

Acute Liver Failure causes: _____ OD, ____ reaction, hepatitis, acute ____ liver of pregnancy, _____ dz, _____ syndrome

A

acetaminophen
drug
fatty
Wilson’s
Reye’s

40
Q

Acute Liver Failure Tx: Management of coagulopathies, renal failure, respiratory complications, metabolic abnormalities
Newer intervention: “___ ___”, Caution: ____ monitoring with coagulopathy

A

liver dialysis
ICP

41
Q

Acute Liver Failure: Without transplant, ___ ___. After transplant, ___ ___.

A

85% die
65% die

42
Q

____ of liver damage + type of _____ = perioperative risk

A

degree
surgery

43
Q

____-____ score for severity classification (5 variables. See Table 17.6, p. 354.)

A

Child-Pugh

44
Q

Nutrition/Metabolic
Pts are m______, v____ deficient, ↓ albumin, hypo_____, hyponatremia (with ↑ total body Na+), have altered drug metabolism.

A

malnourished
vitamin
hypoglycemic

45
Q

Encephalopathy
May or may not be relational to ____ damage
Investigate new onset ____ symptoms.
Preoperative encephalopathy = ↑ ____ & _____ risks

A

liver
neuro
surgical & anesthesia

46
Q

Pulmonary
Hepatopulmonary Syndrome? Portopulmonary HTN? Aspiration risk? Room air saturation? PFTs? PAP?
_____ = full stomach/delayed emptying with need for RSI

A

Ascites

47
Q

Renal
Hepatorenal syndrome
Beware of ↑ _____/↓ clearance and metabolic _____
B____, hypo____, nephrotoxic drugs increase risk

A

creatinine
acidosis
bleeding, hypotension

48
Q

Circulation
↓ ____ partially compensated with ↑ ____.
↓ ____ causes interstitial edema

A

SVR
CO
albumin

49
Q

Consider ___ ___, foley, pressors. _____, ____, and ____ common for transplants.

A

art line
phenylephrine, norepi, and vasopressin

50
Q

Coagulopathy
Thromboelastography (TEG®, ROTEM®) may be useful. Consider vitamin ____ with _____.

A

K
malnutrition

51
Q

Coagulopathy
Consider targeted ___, _____, ____ transfusions.
Citrate may not be metabolized. May need ____ treatment.

A

FFP, cryoprecipitate, platelets
Ca++

52
Q

Drug Metabolism
Affected by impaired liver metabolism, ↑ ___, ↓ ____ binding, ↓ ____.
Consider ______ class (metabolized without liver enzymes).

A

Vd
protein
clearance
benzylisoquinoline

53
Q

Postoperative
Most common cause of cirrhosis patient death: ___ ___
To ICU immediately post-op

A

liver failure

54
Q

liver transplant
>6,700 in U.S./year; >12,000 waiting; >56,000 in U.S. with transplanted liver
Most common disease: ____ ____

A

hepatitis C

55
Q

liver transplant
>90% are _____

A

cadaveric

56
Q

liver transplant
Peds: Lobe of liver has _____ results
Adults: Size-mismatching (small for size syndrome) is _____.

A

excellent
problematic

57
Q

liver transplant
Best results: Donor liver at least as ____ as native liver

A

large

58
Q

liver transplant
Former contraindications: A_____, chronic hepatitis (especially ___) and ____. Now most frequent indications.

A

alcoholism
C
cancer

59
Q

liver transplant
Model End-Stage Liver Disease (MELD) scores predict mortality probability within ___ ____ with ____ ____. MELD scores determine waiting list rankings.

A

90 days
NO transplant

60
Q

liver transplant
For ___ ___, Milan staging criteria used.

A

liver cancer

61
Q

transplant procedure 3 stages

A

1 dissection
2 anhepatic
3 reperfusion

62
Q

phase 1 dissection - Immobilizing vascular structures and native liver removal leading to _____ with ______ instability

A

hemorrhage
hemodynamic

63
Q

phase 2 Anhepatic – Hepatic artery and portal vein clamped; venovenous bypass used. Retractors cause decreased _____/_____. No liver function leads to ____ _____, ↓ drug metabolism, ____ toxicity. Ca++ often needed.

A

ventilation/oxygenation
metabolic acidosis
citrate

64
Q

phase 3 - Reperfusion (neohepatic) – After anastomosis of donor liver. Vascular _____ (reperfusion) leads to CV instability, d_____, b_____, hypo_____, hyper______ (highest risk phase).

A

unclamping
dysrhythmias
bradycardia
hypotension
hyperkalemia

65
Q

Drug metabolism resumes after ______.

A

reperfusion

66
Q

Coag factors given to normalize clotting. With good perfusion, ____ improve, _____ ____ reverses, oxygenation improves.
(Reperfusion/Neohepatic)

A

LFTs
hyperdynamic circulation

67
Q

___-_____ now being done in some transplant centers.

A

fast-tracking

NUNA 684 Advanced Pathophysiology (16 decks)

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