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HA > Hepatic > Flashcards

Hepatic Flashcards

1
Q

how much blood does the liver store

A

1 L
highly vascular

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2
Q

How much does the liver weight

A

median weight of 1.8 kg in men and 1.4 kg in women.

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3
Q

Liver location

A

RUQ under rib cage = somewhat protected
hard to get exposure = steep trendelenberg

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4
Q

How much bile is produced by the gallbladder?

A

500 ml daily

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5
Q

problems with no gallbladder

A

don’t digest as well and problems in post bariatric sx and pregnant women

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5
Q

Gal bladder sythesizes ….

A

Fat
Cholesterol
Lipoproteins

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6
Q

what divides the liver?

A

falciform ligament

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7
Q

liver lobes

A

the right, left, caudate, and quadrate lobes

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8
Q

purpose of gal bladder

A

concentrate and storage for bile

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9
Q

blood supply for the gal bladder

A

cystic artery- ligated when taken out and if miss = large source of bleeding = put extra clips. X ray; kub or chest x ray will see 3-4 clips on the cycstic artery

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10
Q

cholecystitis and tx

A

inflammation of the gall bladder

tx; cholecystectomy

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11
Q

cholelithiasis and tx

A

Gallstones

tx cholecystectomy

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12
Q

choledocholithiasis and tx

A

stones in the common bile duct
- may be the result of inflammation of the pacreatic head w/ obstruct the common bile duct

tx; ERCP

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13
Q

Pain worsening with inspiration

A

murphys sign = gal bladder issues

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14
Q

Where does the majority of blood for the liver come from?

A

Portal vein

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15
Q

What percent of CO goes to the liver

A

20-30%

Average blood flow between 100-150- ml / min and. Half consumed in the liver

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16
Q

Venous drainage of liver

A

hepatic sinusoids -> central vein -> interlobar and sub lobular veins -> 3 hepatic veins -> IVC

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16
Q

Budd-Chiari syndrome

A

thrombosis of the major hepatic veins occurs

colateral blood flow through caudate veins

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17
Q

Portal htn

A

Portal vein receive blood that has already pass through the splachnic circulation

increase SVR = increase portal vein pressure

> 20-30 mmhg

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18
Q

normal portal vein pressure

A

7-10 mmhg

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19
Q

Hepatic artery perfusion pressure formula

A

Hepatic Artery Perfusion Pressure=MAP-Hepatic Vein Pressure

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20
Q

Vitamin K dependent factors

A

(2,7,9,10)

2= prothrombin

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21
Q

factors that increase hepatic blood flow

A

feeding
glucagon- dilates common bile duct
beta agonists
recumbent position
hepatocellular enzyme induction
hepatitis
hypercapnia

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22
Q

factors that decrease hepatic blood flow

A

anesthetic agents
surgical trauma
alpha agonists and beta blockers
PEEP, PPV
vasopressin - avoid boluses
hepatic cirrhosis
hypocapnia

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23
Q

Where does bilirubin come from

A

Degradation product of Hgb

Inc bilirubin = dec hb;

causes of hb to degrade; tissue, surgery, meds = inc bili

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24
Q

Where is unconjugated bilirubin stored?

A

Conjugated and stored in liver
Water soluble…..elimination

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25
Q

Normal billirubin levels and levels for dz processess

A

Normal <1mg/dL
3mg/dL ->scleral icterus
>4mg/dL ->jaundice

normal also; 0-11 units/L

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26
Q

Where are Aminotransferases involved?

A

Involved in gluconeogenesis

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27
Q

What is AST/ALT used for

A

Can signify hepatic injury

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28
Q

If AST/ALT BOTH elevated……

A

Ratio of <1: non-alcoholic liver disease; MASH
Ratio of 2-4: alcoholic liver disease;
Ratio of > 4: Wilson’s disease (hereditary)

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29
Q

Alkaline Phosphatase facts

A

Lack specificity

Serum ½ life 1 week

Increases…bile salt-induced damage of hepatocyte membranes

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30
Q

normal alkaline phosphate levels

A

30 to 100IU/L(liver and bone contributes more than 80 percent of the total value).

or 45-115 units/L

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31
Q

Normal total bilirubin value

A

is < 1mg/dl. Out of these, up to 0.3mg is conjugated bilirubin

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32
Q

Alanine transaminase
facts

A

Relatively liver specific
Cytosol
Zone 1>3
N.value O – 45 IU/L
Half life is 18hrs (beneficial for acute)

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33
Q

Aspartate transaminase
facts

A

Non specific
Cytosol and mitochondria
Zone 3>1
N.Value 0 – 35IU/L
Half life is 36hrs

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34
Q

International Normalized Ratio increases means….

A

Strong correlation with declining hepatic function
Impaired synthetic function of coag factors

35
Q

Where is albumin synthesized

A

Synthesized by hepatocytes
Impaired liver = don’t produce

36
Q

Albumin normal value

A

3.5 to 5.5gm/dl.

half life : 18-20 days

37
Q

Paracentesis replacement

A

1;1 fluid to albmumin replaces or 1/3 of fluid removed

38
Q

PT normal values

A

12-14 seconds

sensitive to acute injury,
prolonged by vitamin K deficiency

39
Q

ERCP

A

Ampula of Vater
Site of biliary obstruction
Balloon dilation, sphincterotomy, stenting
Multiple times -> stent = stone too big to fit through -> obstruct again

40
Q

Encephalopathy grades

A
  1. Changes in behavior; minimal change in LOC
  2. disorientation, drowsiness, inappropriate behavior
  3. marked confusion, incoherent speech, sleeping most of time
  4. comatose, unresponsive to pain, decorticate/decerebrate
41
Q

Encephalopathy exaggerated by….

A

infection, GI bleeding, TIPS

42
Q

treatment for encephalopathy

A

decrease ammonia; lactulose
and neomycin

43
Q

Coagulopathy labs and tx

A

INR > 1.5- w/ no other means

Tx; Vit K administration

Guided replacement
FFP
Cryo
Platelets
Calcium ( with blood products as well)

44
Q

what happens to the VOD with liver diseases

A

Increased volume of distribution

Decreased plasma protein binding

Decreased clearance of drugs

45
Q

Treatment of cerebral edema

A

Head up 30 degrees
- Head/neck neutral
- Muscle relaxants when intubated; sedatives and muscle relaxants because difficult to actual get to sleep
- Mannitol/hypertonic saline
- Hyperventilation
- Barbiturates coma till ICP resolves.
- Treat; Lactulose

46
Q

what is Acute Hepatitis and what causes it

A

Inflammation of the liver parenchyma

causes by virus , hepatotoxins, autoimmune response

Symptom free till late to disease…..malaise/jaundice

47
Q

Most common cause of liver cancer and most common indication for hepatic transplant

A

Hepatitis

48
Q

contraindication to elective surgery associated w/ liver

A

acute hepatitis

49
Q

Hepatitis A

A

vaccine
Common in countries without modern sanitation
Lasts few weeks to months

tx pooled gamma globulin

50
Q

leading cause of liver ca an tx

A

Hepatitis B- Blood, sexual

tx; : Hepatitis B immunoglobulin

51
Q

Leading cause of liver transplantation

A

Hepatitis C (non A, non B)

50% unaware
3 out 4 1945-1965
No vaccine
Parenteral drug use

Treatment; interferon with ribavirin (less effective)

52
Q

Cure for Hepatitis C

A

Sofosbuvir (Sovladi, Soforal)—–

Inhibits HCV RNA synthesis
In combo with ribavirin
12 weeks

53
Q

Hepatitis D

A

Occurs in conjunction with HBV; Coinfection or superinfection

54
Q

Hepatitis E

A

Oral/fecal route
Transplants on immunosuppressives (for chemo or transpants)
Treatment; unknown, supportive therapy leading to transplant

55
Q

Most common cause of acute liver failure in the US

A

acetaminophen Overdose >4g/day

56
Q

Halothane and hepatitis

A

VAA metabolized in the liver to Inorganic Fluoride and Trifluoroacetic Acid (TFA)- sticks around. Halothane produces 20%.

57
Q

Alcoholics and elective procedures

A

Chronic alcoholic patient should be abstinent from alcohol for at least 6 mon to undergo elective procedure.

58
Q

Meld score

A

Model of end stage liver diseases

creatinine, bilirubin, INR

59
Q

Meld score > 40

A

71.3% mortality

60
Q

MELD score 10-19

A

6.0% mortality

61
Q

Meld < 10

A

safely undergo elective surgery.

62
Q

Meld 10 -15

A

may undergo elective surgery after
optimization with caution.

63
Q

Meld > 15

A

contraindication for elective surgery.

64
Q

Treatment for cirrhosis

A

TIPS?
Renal Replacement Therapy to transplantation
Diuresis- get fluid out of lungs, or drainage
O2 administration

65
Q

Ammonia comes from…. and what causes it

A

Byproduct of nitrogen not processed out

causes; Neurotoxins, GABA, oxidative stress, inflammatory mediators, hyponatremia

66
Q

Treatment for ascites

A

Salt restriction
Diuretics
Paracentesis- replace with albumin
Albumin replacement … if >5L
Antibiotics- high risk sepsis/ infection

67
Q

Most common complications leading to hospitalization

A

ascites

68
Q

TIPS

A

Trans-jugular Intrahepatic Portosystemic Shunt

bypasses a portion of the hepatic circulation by shunting blood from the portal vein to the hepatic vein
This reduces portal pressure and minimizes the back pressure on the splanchnic organs thus reducing the volume of ascites and risk of varices. May also be a temporizing measure for hepatorenal syndrome

69
Q

what kinds of drugs are more markedly affected by changes to HBF

A

HIGH EXTRACTION RATIO= stick around for longer
Propofol
Fentanyl, Morphine, Meperidine
Lignocaine
Verapamil
Labetalol
Propanolol

70
Q

what are the metabolic functions of the liver

A

fat metabolism
carbohydrate metabolism
protein metabolism
rocuronium metabolism

71
Q

what part of the liver cleans the blood as it passes through

A

Kupffer cells

72
Q

The liver performs what tasks?

A

gluconeogenesis
forms many compounds from carbohydrate intermediaries
conversion of galactose and fructose to glucose
storage of large amount of glycogen

73
Q

most common cause of cirrhosis

A

etoh

74
Q

Cirrhosis results in ….

A

splenomegaly, esophageal varies, LHF

75
Q

cirrhotic patients should be rescucitated with….

A

colloids

76
Q

vitamin K is used to treat elevated PT which measures the ____pathway

A

extrinsic

77
Q

WEPT

A

warfarin, extrinsic pathway, measured w/ PT

78
Q

Plat count less than ____ requires preoperative replacement

A

75 K = plat before OR

79
Q

Chronic alcoholism increases MAC for _____and this is probably due to cross tolerance

A

isoflurane

80
Q

Anesthetic drugs may cause postoperative liver dysfunction to be_____

A

exaggerated

81
Q

plasma cholinesterase may be _____ in severe liver disease

A

decreased

82
Q

manifestation of alcohol w/d occur in ____ hours after receiving no alcohol intake

A

24-72 hrs

83
Q

hepatitis A is most commonly transmitted by_____

A

fecal contamination

84
Q

drugs that cause hepatitis include

A

analgesics
VAA
Anticonvulsants
Tranquilizers

85
Q

What surgical procedure is associated with the highest mortality?

A

Laparotomy

86
Q

normal INR

A

n healthy people an INR of 1.1 or below is considered normal. An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for certain disorders.

HA (15 decks)

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