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ST Health Assessment > Grayson's Deck: Hepatic Diseases (Exam III) > Flashcards

Grayson's Deck: Hepatic Diseases (Exam III) Flashcards

1
Q

How much blood is contained in the liver at any given time?

A

1L

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2
Q

What positioning is often necessary to gain access to liver? (imaging, biopsy, etc.)

A

Trendelenburg

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3
Q

How much bile is produced by the gallbladder daily?

A

500mls

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4
Q

What is the consequence of not having a gallbladder?

A

Digestion problems

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5
Q

What patient populations most often have their gallbladder removed?

A
  • Pregnant
  • Obese
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6
Q

What anatomical feature divides the left and right lobes of the liver?

A

Falciform Ligament

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7
Q

What reasons would one have for doing an open cholecystectomy vs a laparscopic cholecystecotomy?

A
  • Necrotic gallbladder
  • Surgeon practice (lol)
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8
Q

What is the most serious source of local bleeding encountered in cholecystectomies?

A

Cystic Artery

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9
Q

What are common s/s of gallbladder disease?

A
  • Murphy’s sign (big deep breath in, pain will be worse in RUQ)
  • RUQ pain
  • ↑WBCs
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10
Q

T/F. Most of the liver’s blood flow comes from the hepatic artery.

A

False. Most of the liver’s blood flow comes from the portal vein.

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11
Q

What is Bud-Chiari syndrome?

What are the s/s?

A

Obstruction of the venous outflow of the liver.

  • ABD pain
  • Ascites
  • Hepatomegaly
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12
Q

What is a normal portal vein pressure?

A

7-10 mmHg

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13
Q

What pressure is seen with portal vein hypertension?

A

> 20-30 mmHg

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14
Q

What is a normal pressure in the venous sinusoids?

A

0 mmHg

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15
Q

What pressure is seen in the venous sinusoids of a portal hypertension patient?

A

5 mmHg

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16
Q

How is hepatic artery perfusion pressure calculated?

A

HAPP = MAP - HVP

HAPP = hepatic artery perfusion pressure
HVP = Hepatic vein pressure

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17
Q

What blood coagulation factors are dependent on vitamin K for synthesis?

A

7, 9, 10, 2

SNOT makes you CLOT
Seven Nine 1O Two*

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18
Q

What is the name of factor two?

A

Prothrombin

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19
Q

What clotting factors are produced by the liver?

A

2, 3, 4, 5, 7, 8, 9, 10

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20
Q

What is the name of factor 3?

A

Tissue thromboplastin

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21
Q

What is the name of factor 8?

A

vWf (von Willebrand factor)

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22
Q

What is the name of factor 4?

A

Calcium

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23
Q

What drug is given intra-operatively that “opens up” the gallbladder?

A

Glucagon

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24
Q

What factors increase hepatic blood flow?

A
  • Eating
  • Glucagon
  • β-agonists
  • Recumbent position
  • Acute hepatitis
  • Hypercapnia
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25
Q

What factors decrease hepatic blood flow?

A
  • Anesthetics
  • Surgical trauma
  • α-agonists
  • β-blockers
  • PEEP
  • Vasopressin boluses
  • Cirrhosis
  • Hypocapnia
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26
Q

This molecule is a degradation product of Hgb.

A

Bilirubin

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27
Q

What are normal bilirubin levels?

A

< 1mg/dL

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28
Q

At what bilirubin level would one see scleral icterus?

A

3 mg/dL

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29
Q

At what bilirubin level would one see jaundice?

A

> 4 mg/dL

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30
Q

The liver aminotransferases are primarily involved in what?

A

Gluconeogenesis

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31
Q

If AST/ALT are both elevated and there is a ratio of < 1 then what is indicated?

A

Non-alcoholic liver disease

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32
Q

If AST/ALT are both elevated and there is a ratio of 2-4 then what is indicated?

A

Alcoholic liver disease

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33
Q

If AST/ALT are both elevated and there is a ratio of >4 then what is indicated?

A

Wilson’s disease

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34
Q

What is Wilson’s disease?

A

Inherited disorder where your body accumulates copper (especially in the liver).

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35
Q

What is the normal value of Alkaline Phosphate?

What contributes to more than 80% of the total ALP?

When is alkaline phosphatase elevated?

A

30 to 100 IU

Liver and Bone

When bile-salt-induced liver damage has occurred.

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36
Q

Which liver transaminase is more specific to the liver?

A

ALT (alanine transaminase)

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37
Q

Which liver transaminase is found in mitochondria and the cytosol?

A

AST (aspartate transaminase)

ALT is only found in the cytosol

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38
Q

Which of the liver transaminases has a longer half-life?

A

AST (36hrs)

ALT (18hrs)

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39
Q

What would be considered a minor increase in AST & ALT?
What would be indicated by this?

A

< 100 IU

  • Hep B & C
  • Non-alcoholic disease
  • Fatty liver
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40
Q

What would be considered a moderate increase in AST & ALT?
What would be indicated by this?

A

100 - 300 IU

  • Alcoholic hepatitis
  • Autoimmune hepatitis
  • Acute viral hepatitis
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41
Q

What would be considered a marked/severe increase in AST & ALT?
What would be indicated by this?

A

> 300 IU

  • Drugs/Toxins
  • Acute viral hepatitis
  • Ischemia
  • Extrahepatic cholestasis
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42
Q

AST/ALT ratio of greater than ___ but less than ______ is suggestive of cirrhosis or alcoholic liver disease.

A

Greater than 2, Less than 4

43
Q

What are normal AST values?
ALT?

A

AST = 10 - 40 IU/L
ALT = 10 - 50 IU/L

44
Q

What is a normal prothrombin time?

A

12 - 14 seconds

45
Q

What liver lab is sensitive for acute injury?

A

PT (prothrombin time)

46
Q

What liver lab is not sensitive for acute injury?

A

Albumin

47
Q

What are the normal values of albumin?

A

3.5 - 5.0 g/dL

48
Q

What are the four grades of encephalopathy?

Encephalopathy is exaggerated by infection and GI bleeding. What will be the only temporizing measure for these patients?

A
  1. Behavioral changes, minimal LOC changes.
  2. Disorientation, drowsiness, inappropriate behavior.
  3. Marked confusion, incoherence, somnolent.
  4. Comatose.

TIPS procedure

49
Q

What are the s/s of hepatorenal syndrome?

Cause?

A
  • H₂O retention
  • Azotemia
  • ↓ Na⁺ (d/t water retention)
  • Oliguria

Cause: Under perfusion

50
Q

What pharmacokinetic changes in liver patients necessitate decreases in drug dosing?

A
  • ↑ VD
  • ↓ plasma-protein binding (decease albumin level)
  • ↓ drug clearance
51
Q

How is Hepatitis A spread?

A

Fecal matter contact w/ food and water.
Restaurants

52
Q

What are the s/s of Hep A?

A

Asymptomatic to acute liver failure

Does not progress chronic disease.

53
Q

How is Hep A treated?

A

Pooled gamma globulin

54
Q

What is the leading cause of liver cancer?

A

Hepatitis B

55
Q

How is Hepatitis B spread?

A
  • Sex
  • Blood
56
Q

Who most often develops chronic infection from hepatitis B?

A

Children

57
Q

What is the treatment for Hep B?

A

Hepatitis B immunoglobulin

58
Q

What is the leading cause for liver transplantation?

A

Hepatitis C

59
Q

How is Hepatitis C spread?

A
  • Sex
  • Blood
  • Parenteral drug use
60
Q

How is Heptatitis C treated?

A
  • Sofosbuvir
  • Interferon w/ ribavirin
  • other antivirals
61
Q

Hepatitis D occurs in conjuction with what?

A

Hepatitis B

62
Q

How is Hepatitis E spread?

A
  • Oral/Fecal
63
Q

What treatments exist for Hepatitis E?

A

NO treatments, usually self-limiting

64
Q

What is the most common cause of acute liver failure in the US?

A

Acetaminophen greater than 4 g/day

65
Q

How is acetaminophen-induced acute liver failure treated?

A

N-acetylcysteine within 8 hours

66
Q

What compound(s) of halothane metabolism contributes to hepatocellular injury?

A
  • TFA (trifluroacetic acid)
  • Fluoride
67
Q

Summarize all the hepatitis pathologies.

This card is just here so I can consistently look at the graphic.

A
68
Q

What is the MELD score?

A

Model for End-Stage Liver Disease (predicts mortality based on symptomology).

69
Q

A MELD score of > 40 means what?

A

100% mortality in the hospitalized patient.

70
Q

A MELD score < 10 is indicative of what for a preoperative patient?

A

Safe to undergo elective surgery.

71
Q

A MELD score 10-15 is indicative of what for a preoperative patient?

A

Needs optimization to undergo elective surgery.

72
Q

A MELD score >15 is indicative of what for a preoperative patient?

A

Elective surgery is contraindicated.

Acute hepatitis is also a contraindication to elective surgery.

73
Q

Cirrhosis is characterized by ____________ death.

What are the coagulative effects of cirrhosis?

A

Hepatic cell death (this means meds will stick around longer, patients will have encephalopathy d/t increased ammonia, etc.)

Clots will rapidly develop and then break down.
Impaired ability to synthesize clotting factors.
Thrombocytopenia.
Decrease levels of Protein C and Anti-thrombin III

74
Q

What are the cardiac effects of cirrhosis?

A
  • Portal HTN
  • ↓ circulating volume
75
Q

What are the renal effects of cirrhosis?

A
  • Hepatorenal Syndrome
  • ↑ H₂O and Na⁺ retention
76
Q

What are the pulmonary effects of cirrhosis?

Treatments?

A

Chronic Lung Disease and SOB from fluid retention and ascites.

Treatments: Diuresis and give O2

77
Q

What occurs with hepatic encephalopathy?

A

Accumulation of ammonia

78
Q

Give the causes for each etiology of liver cirrhosis.

A
79
Q

What is the goal Hgb for acute variceal bleeding?

A

Hgb = 8 mg/dL

80
Q

What volatile is best for liver surgeries?

A

Sevoflurane

81
Q

What result does hypocapnia have on hepatic blood flow?
Hypercapnia?

A

↓ PaCO₂ = ↓ HBF

↑ PaCO₂ = ↑ HBF

82
Q

What portion of the clotting cascade does warfarin affect? What test measures warfarin effect?

A
  • Warfarin
  • Extrinsic pathway
  • Prothrombin
  • Time
83
Q

Which of the following are the metabolic functions of the liver?

A. Carb Metabolism
B. Fat Metabolism
C. Protein Metabolism
D. Rocuronium Metabolism

A

All of the choices are correct.

The liver can metabolize all your macromolecules and muscle relaxants, with the exception of atracurium, nimbex, and Sch.

84
Q

What part of the liver cleans the blood as it passes through?

A

Kupffer Cells

85
Q

The liver performs the following:
A. Form many compounds from carb intermediaries.
B. Gluconeogenesis
C. Conversion of galactose/fructose to glucose
D. Storage of a large amount of glycogen

A

All of the choices are correct.

Liver disease will cause wide spread vitamin deficiencies, hypoalbuminemia, and hypoglycemia.

86
Q

What is the most common cause of cirrhosis?

A

EtOH

87
Q

Cirrhosis results in _______, ________, and _________.

A

Splenomegaly
Esophageal Varices
Right Heart Failure

88
Q

Cirrhotic patients should be resuscitated with what kind of fluids?

A

Colloids (Albumin)

89
Q

Vitamin K is used to treat an elevated PT, which measures the ________ pathway.

A

Extrinsic

Warfarin Extrinsic PT, WEPT

90
Q

A platelet count less than ______ should receive platelets before going to the OR.

A

75K

91
Q

Chronic alcoholism _____ MAC for isoflurane and this is probably due to cross-tolerance.

A

Increases

92
Q

Anesthetic drugs may cause postoperative liver dysfunction to be ___________.

A

exaggerated

93
Q

Plasma cholinesterase may be __________ in severe liver disease.

A

decreased

94
Q

Manifestation of EtOH withdrawal occurs in ______ hours (range) after receiving no alcohol intake.

A

24 - 72 hours

95
Q

Which of these drugs can cause hepatitis?
A. Analgesics
B. Anticonvulsants
C. Volatile Anesthetics
D. Tranquilizers

A

All choices are correct

96
Q

What surgical procedure is associated with the highest mortality for patients with hepatic disease?

A

Laparotomy

97
Q

Which Liver Function test is the most specific indicator of biliary duct obstruction? (Hint: These are the enzymes that spill into the systemic circulation)

A

5’-Nucleotidase

98
Q

Medication to reduce blood ammonia levels.

A

Lactulose and Neomycin

99
Q

When INR is above ___________ (not on anti-coagulation), consider giving Vitamin K.

What are some guided replacements to decrease INR?

A

INR above 1.5

FFP, Cryo, Plt, Calcium

100
Q

Why are patients with liver disease considered high-risk aspiration?

A

Increase gastric volumes
Delayed gastric emptying
Portopulmonary Hypertension mPAP> 35 mmHg

101
Q

What medication will not work if there is an anti-thrombin III deficiency?

What is given to increase AT-III?

A

Heparin

FFP

102
Q

What can be given to treat portal hypertension?

A

NO

103
Q

What is a TIPS procedure?

A

Trans-jugular Intrahepatic Portosystemic Shunt is a procedure to create new connections between the hepatic and portal veins to relieve pressure for late-stage liver disease.

104
Q

Clearance of drugs with ______ hepatic extraction ratio is markedly affected by changes in hepatic blood flow.

A

High hepatic extraction ratio

High Extraction Ratio Drugs are cleared through the liver.
(Propofol, Opioids, Lidocaine, Verapamil, Beta-blockers).
This drugs will stick around longer with impaired HBF.

ST Health Assessment (26 decks)

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