GI

Question 1

Liver Failure Symptoms

Answer 1

Varices, ascites
jaundice
peripheral edema
gynecomastia
hepatic encephalopathy - toxin accumulation
hepatopulmonary syndrome - AV shunts, RLD, effusions, reduced FRC
portal hypertension
High output cardiac failure

Question 2

Liver Failure - Abnormal Lab Values

Answer 2

Hypoalbuminemia
Hyponatremia
Coagulopathy
Anemia
Thrombocytopenia
CKD/ESRD

Question 3

Liver Transplant - Preanhepatic Phase

Answer 3

Incision to portal vein, hepatic artery and IVC clamping
Risks: variceal bleed, CV decompensation from ascites decompression

Question 4

Liver Transplant - Anhepatic Phase

Answer 4

Clamping of portal vein, hepatic artery and IVC until unclamping
Risks: Worsening coagulopathy, fibrinogen deficiency, thrombocytopenia, acidosis, no lactate metabolism, decreased preload

Question 5

Liver Transplant - Neohepatic Phase

Answer 5

Unclamping of portal vein, then IVC
Risks: Hypotension, decreased SVR, arrythmias, hypothermia, hyperkalemia (CaCl), acidemia (bicarb)

Question 6

Induction in Liver Failure

Answer 6

RSI after aspiration prophylaxis (delayed gastric emptying & ascites)
OK to use succinylcholine but may be prolonged reduced cholinesterases 2/2 liver failure

Question 7

PONV Risk Factors

Answer 7

Patient Factors: hx motion sickness, female, non smokers, younger, dehydration/hypotension

Anes Factors: Opioids, volatiles, NO, gastric distension

Surg Factors: Laparoscopic, cholecystectomies, gyn, ENT, eye, bariatric, major breast sx

Question 8

PONV Treatment/Prevention

Answer 8

5HT3 Receptor Antagonists - ondansetron
NK1 Antagonists - Aprepitant - 48 hrs (back up BC)
Corticosteroids -
Dopamine Antagonists - Metoclopramide, haldol, phenergan
Antihistamines - Dyphenhydramine
Anticholinergics - Scopolamine patch
Ephedrine (IM)

Question 9

Postoperative Jaundice

Answer 9

Pre-hepatic - increased hemolysis, increased indirect bili, nl ALT, high LDH & AST
- hemolysis (transfusion), hematoma resorption, G6PD, CPB/cross clamping, Gilbert’s

Hepatic - Decreased clearance - hypoperfusion - high TB and conjugated bili, AST/ALT,LDH,

Post Hepatic - obstructive/cholestatic jaundice, itching, pale stools, high TB, direct & unconjugated bili, Alk phos high, bile salts in urine

usually inflammatory response of surgery