Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Health Assessment M > Hepatic > Flashcards

Hepatic Flashcards

1
Q

What are the 10 functions of the Liver?

A

S(3)M(2) DIPSA

Synthesize glucose via gluconeogenesis

Stores excess glucose as glycogen

Synthesize cholesterol and proteins into hormones and vitamins

Metabolizes fats, proteins, carbs to generate energy

Metabolizes drugs via CYP540

Detoxifies blood

Involved in acute phase of immune System

Process hgb and stores iron

Synthesizes coag except 3,4,8 vWF)

Aids in volume control as blood reservoir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Every organ is impacted by liver function T/F

A

T!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How many anatomy segments liver?

A

8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Right and L lobe are separated by what

A

Falciform Ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which hepatic veins empty into IVC

A

right, middle , and left hepatic veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bile ducts travel along

A

portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bile drains through

A

hepatic duct into gallbladder and common bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bile enters duodenum via

A

Ampulla of Vater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Liver perfusion is what percent?

A

25 percent
1.25-1.5 L per min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

_____ provides partially deoxygenated blood after it has left the stomach, intestines, spleen and pancreas.

A

Portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

O2 delivery is 50 percent /50?

A

50 portal vein
50 hepatic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where is the most hepatic blood flow

A

portal vein (arises from splenic and superior mesenteric vein)

75 percent!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Percent hepatic blood flow to hepatic artery

A

branches off aorta

25%!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Portal Hypertension Patho!!

A

Extra info
Hepatic arterial blood flow inversely r/t to portal venous flow
Hepatic blood flow is autoregulated - hepatic artery dilates in response to low portal venous flow to keep hepatic blood flow

**Portal venous pressure reflects splanchnic arterial tone and intrahepatic pressure

increase portal venous pressure backs up into the systemic circulation causing ESOPHAGEAL AND GASTRIC VARICES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is used to determine severity of portal hypertension?

A

Hepatic Venous Pressure Gradient

Normal 1-5

> 10 Portal htn, cirrhosis, & esophageal varices

> 12 VARICEAL RUPTURE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Later stages of liver only have __symstoms such as

A

sleep, decrease appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Risk Factors of Liver

A

Family hx
Heavy Alcohol Abuse
Lifestyle
DM
Obesity
Illicit Drug Use
Multiple Partners
Tattoos
Transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Physical Exam

A

Pruritis
Jaundice
Ascites
***Asterixis (flapping tremors)
Hepatomegaly
Splenomegaly
SPIDER NEVI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most liver specific enzyme?

A

ALT alamnine aminotransferase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Specific Hepato-bililary Function tests

A

PT/INR
AST asparate aminotransferase
Alanine aminotransferase

Bilirubin
Alkaline Phophastase
Y glutamul transferase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 3 groups of hepatobiliary disease

A

Hepatocellular Injury
Reduced synthetic function
Cholestatsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Types of hepatocellular injury

A

Acute Liver Failure
Alcoholic Liver
NAFLD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is cholelithiasis?

A

Gallstones

Gallbladder stores bile to deliver during meals

CBD secretes bile directly into the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the risk factors of cholelithiasis

A

OBESITY
increased cholesterol
DM
pregnancy
female
family history

80 percent symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cholesthiasis SS

A

RUQ pain going to shoulder
N/V
Fever with obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Surgical and treatment for Cholelithiasis

A

IVF, abx, pain management

Lap Cholecystectomy (most robotic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Choledocolithiasis Patho

A

Stone obstructing common bile duct –> BILIARY COLIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Choledocolithiasis SS

A

orginally like cholethisiasis
**cholangitis: FRJ
Fever,rigors, jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Choledocolithaisis Surgery

A

ERC
Endoscopic Retrograde Cholangiopancreatography

thread a guidewire through sphincter of Oddi into Ampulla Vater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Anesthetic plan for choledocolithiasis

A

General anesthesia

PRONE with ETT to left & turn head right

GLUCOAGON MAY BE REQUIRED INT THE EVENT ODDI SPASMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What happens with gallstones that end up in pancreatic duct?

A

cause pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is hyperbilirubinemia?

A

First what is bilirubin - end product of heme breakdown

Unconjugated “indirect” bilirubin is a protein bound to albumin, transported to liver, conjugated into its H20 soluble direct state –> excreted into bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the unconjugated(indirect) hyperbilirubinemia

A

imbalance between bilirubin synthesis and conjugation

examples

jaundice of prematurity
sepsis
drug induced
hemoglobin diorders sick cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is conjugated direct hyperbilirubinemia(direct)

A

caused by an obstruction causing reflex –> yellow

intrahepatic cholestasis
Hepatitis
cirrhosis
Dubin johson
Biliary atresia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Viral hepatitis how many types and which is the most common?

A

5 types
C most common but starting to be reduced due to hcv GENOTYPE 75 PERCENT TYPE 1 WITH 12 week course sofosbuvir, velpatasvir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

ALD Alcoholic Liver Disease Treatment

A

INITIALLY ASYMPTOAMIC

ABSTIENCE
management of liver failure
**Platelet count < 50,000 —> blood transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Whats the most common cause of cirrhosis/ top indicator of liver transplant (2 %_

A

Alcoholic Liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Alcoholic Liver Disease Symptoms

A

asymptomatic early

Malnutition
**muscle wasting
**parotid gland hypertrophy
jaundice
thrombocytopenia *
ascities
hepatosplenomegaly
Pedal edema*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When do symptoms of etoh WITHDRAWAL occur after stoping?

A

24-72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Lab Values with Alcoholic Liver Disease

A

Increase in all

Mean corpuscular volume (MCV)
Liver enzymes
Y glutamyl transferase
Bilirubin
Blood ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Non- Alcoholic Fatty Liver Disease Diagnosis

A

Hepatocytes greater than 5 percent

Imaging and histolgy

can progress to NASH, cirrhosis, and hepatocelllular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the gold standard to distinguish between NAFLD(non-alcoholic fatty liver disease) and other

A

Liver biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are risk factors for non-alcoholic fatty liver disease?

A

Obesity, insulin resistance, DM2, metabolic syndrome

RX: Diet and excercise
Transplant may be needed in extreme cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Autoimmune Hepatitis Cause

A

autoantibodies and hypergammaglobulinemia

AST/ALT 20 time norm

can be asymptomatic, acute or chronic

45
Q

Autoimmune heptatitis mostly affects

A

women

46
Q

Treatment for Autoimmune heptatitis

A

steriods, azathiprine

60-80 remission, RELAPSE IS COMMON

47
Q

Drug-Induced Liver Injury Most common cause

A

Acetaminophen OD
Reversible

48
Q

Inborn Errors of Metabolism

A

defects in the enzyme breadown and store protein, carbs and fatty acids

1 in 2500 birth

**most severe in neonatal w/ high degree mortality

49
Q

3 disorders of Errors of Metabolism

A

Wilsons Disease
Alpha 1 Antiripsin
Hemochromatosis

50
Q

what is Wilsons Disease

A

known as HEPATOLENTICULAR DEGENERATION

**impaired copper metabolism –> excessive copper leads to oxidative stress in liver and cornea

51
Q

Wilsons Disease SS

A

asymtpomatic to sudden onset live failure along with neuro & psych manifestations

52
Q

Wilsons Disease Diagnostics

A

Serum ceruloplasmin, aminotransferase,urine copper level

**LIVER BIOPSY FOR COPPER Level

53
Q

Wilson Disease Treatment

A

Copper Chelation Therapy and oral zinc to bind copper to GI tract

54
Q

Alpha 1 Antitrypsin Deficiency

A

alpha 1 atritrypson protect the liver and lung from neutrophil elastace

55
Q

What is neutrophil elastase

A

disruption of connective tissue, leading to inflammation, cirrhosis, and HCC

56
Q

What is the #1 genetic cause of liver transplant of children

A

Alpha 1 Antritrypsin Deficiency

57
Q

How is Antitrypsin Deficiency diagnosis

A

A-1 Antitrypsin phenotyping

58
Q

Alpha 1 Antitrypsin Deficiency Rx

A

Pooled a1 antritypsin works for pulmonary but not liver

LIVER transplant can be curative

59
Q

Hemochromatosis patho

A

excess iron leading to multi organ causing excessive intestinal absorption of iron

60
Q

What can cause hemochromatosis

A

Repetitive blood transfusions or high dose iron infusions

EXCESS IRON

61
Q

LABS FOR HEMOCHROMATOSIS

A

elevated AST/ALT, transferrin saturation, ferritin

62
Q

Diagnosis Hemochromatosis

A

Genetic test

Echo and MRI for cardioypathy

63
Q

Treatment for Hemochromatosis

A

Weekly phlebotomy, iron chelating drugs, liver transplant

64
Q

Primary Biliary Cholangitis

A

also known as biliary cirrhosis

65
Q

Patho for Primary Biliary Cholangitis

A

autoimmune, progressive destruction of bile ducts with periportal inflammation & cholestatsis

can lead to liver scarring

66
Q

Primary Biliary Cholangitis more commin in

A

female middle ages

67
Q

Cause Primary Biliary Cholangitis PBC

A

exposure to environmental toxins in genetically susceptible individuals

68
Q

Primary Biliary Cholangitis labs

A

Increase ALK phos, GGT, antimitochondrial antibodies

69
Q

Imaging Primary Biliary Cholangitis PBC

A

MRCP to r/o bile duct obstructions

Liver biopsy revelas bile duct destruction and infiltration w/ lymphocytes

70
Q

Primary Biliary Cholangitis RX

A

no cure but take EXOGENOUS BILE ACIDS

can errode if diabetic or gastropersis

71
Q

Primary Sclerosing Cholangitis

A

**AUTOIMMUNE of larger bile ducts

fibrosis in biliary tree –> stricture

more cmmon males in their 40s

71
Q

Primary Sclerosing Cholangitis Labs and Symptoms

A

↑alkaline phosphatase andɣ-glutamyl-transferase, +auto-antibodies

S/S fatigue, itching, ** DEFICIENCY OF FAT SOLUBLE VITAMINS ADEK, cirrohosis

72
Q

Primary Scelorsing Cholangitis Diagnosis Imagining

A

MRCP or ERCP showing biliary strictures with dilated bile ducts

BEADS ON A STRING

73
Q

Primary Scelorsing Cholangitis Treatment

A

No treament, only long term treatment

reoccurance is common after transplant

74
Q

Acute Liver Failure Patho

A

Life threatening severe liver injury occuring within 6 months after insult

Rapid increase AST, ALT, AMS, coagulopthaty

75
Q

Acute Liver Failure is almost _% of cases drug induced by

A

50 percent
acetaminophen

76
Q

Other causes of Acute Liver Failure

A

viral hepatitis, autoimmune, hypoxia, acute liver failure in pregnancy, HELLP

77
Q

Acute Liver Failure Patho

A

Massive hepatocyte necrosis→ cellular swelling &mbrndisruption

78
Q

Acute Liver Failure RX

A

Treat the cause, supportive care, liver transplant

79
Q

Acute Liver Failure SS

A

Sx: Jaundice, nausea, RUQ pain, cerebral edema, encephalopathy, multi-organ failure, death

80
Q

Cirrhosis

A

Final Stage of Liver disease

liver parenchyma replaced with scar tissue

81
Q

Cirrhosis SS

A

progress to jaundice, ascites, varices, coagulopathy, encephalopathy

82
Q

Cirrhosis Common Causes

A

Alcoholic fatty liver, NAFL, HCV, HBV

83
Q

Cirrhosis Elevated Lab

A

AST/ALT, bilirubin, Alk phosphatase, PT/INR

**Thrombocytopenia

84
Q

Cirrhosis ONLY CURE

A

transplant!!!

85
Q

Cirrhosis Complications

A

Portal HTN - increased vascular resistance with portal venous system

Ascites - Portal HTN leads to increase in blood volume & perotineal accumulation of fluid

Spontaneous Bacterial Peritonitis

Varices **present in 50 percent

Hepatic Encephalopathy
Buildup of nitrogenous waste d/t poor liver detoxification
cognitive, coma

86
Q

How to manage ascites?

A

decrease salt and albumin replacement

Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Reduces P-HTN and ascites

87
Q

What is the most common infection related to cirrhosis

A

Spontaneous Bacterial Peritonitis

88
Q

What is the most lethal complication of cirrhosis? Interventions to combat that?

A

Hemmorhage from varices

Beta blockers help reduce risk

Prophylactic endoscopic variceal banding and ligation

Refractory bleeding –> balloon tamponade

89
Q

Treatment for Cirrhosis Complication Hepatic enchephalopathy

A

Lactulose, Rifaximin to ↓ammonia-producing bacteria in gut

90
Q

Cirrhosis Complications Part 2 Syndrome

A

Hepatorenal Syndrome
Excess endogenous vasodilators (NO, PGs)→↓systemic MAP→↓RBF

Hepatopulmonary Syndrome
Triad of chronic liver dz, hypoxemia, intrapulmonary vascular dilation

Portopulmonary HTN
Pulmonary HTN accompanied by portal HTN
Systemic vasodilation triggers production of pulmonary vasoconstrictors

91
Q

How to treat Hepatorenal Syndrome r/t to complication of cirrhosis

A

Tx: Midodrine, Octreotide, Albumin

92
Q

Hepatopulmonary Syndrome Improvement

A

Platypnea is a descriptive term for breathing difficulty in the upright position that improves in the supine position.

Platypnea (hypoxemia when upright) d/t R to L intrapulmonary shunt

93
Q

Portopulmonary HTN
Rx related to cirrhosis

A

Tx: PD-I’s, NO, prostacyclin analogs, and endothelin receptor antagonists

Transplant only cure

94
Q

Anesthesia Liver Disease
Elective surgery is contraindicated in which diseases

A

acute hepatitis, severe chronic hepatitis, and ALF

95
Q

What are the 2 scoring system Scos to determine severity & prognosis of liver disease

A

Child-Turcotte-Pugh (CTP):points based on bilirubin, albumin, PT, encephalopathy, ascites
(BAPEA)

Model for End Stage Liver Disease (MELD): scorebased on bilirubin, INR, creatinine, sodium
(BICS)

96
Q
A
97
Q

Anesthesia in Liver Disease

A

↑Risks aspiration, HoTN, hypoxemia

*Colloids > crystalloids for resuscitation

Alcoholism increases MAC of volatile anesthetics

Drugs may have slow onset/prolongedDoA

Bleeding/coagulation management

Plasmacholinesterasemay be decreased in severe liver dz

98
Q

What paralytics are ideal for liver disease?

A

Succs and Cisatracurium are ideal (not liver-metabolized)

99
Q

What is Transjugular Intrahepatic Portosystemic Shunt?

A

a way to manage portal HTN

Stent or graft placed btw hepatic vein and portal vein

Shunts portal flow to systemic circulation

Reduces the portosystemic pressure gradient

100
Q

Transjugular Intrahepatic Portosystemic Shunt Indications

A

Refractory variceal hemorrhage
Refractory ascites

101
Q

Contraindications:
for A tranjugular Intrahepatic Portosystemic Shunt

A

Heart Failure
Tricuspid regurgitation
Severe pulmonary HTN

102
Q

Partial Hepatectomy

A

Resection to remove neoplasms, leaving adequate tissue for regeneration

103
Q

Anesthetic considerations:
partial hepactectomy

A

Invasive monitoring

Blood products available

Adequate vascular access for blood/pressors

Standard practice is to maintain low CVP by fluid restriction, prior to resection to reduce blood loss

Surgeon may clamp IVC or hepatic artery to control blood loss

104
Q

Post Op Partial Hepatocteomy

A

Need PCA

Liver resection often causes postop coagulation disturbances

105
Q

Liver Transplant

A

Definitive tx for ESLD

Alcoholic liver disease is the most common indication > Fatty liver, HCC

106
Q

Liver Transplant
Brain dead donors

A

kept HD stable to for organ perfusion

107
Q

Liver Transplant

A

Maintain hemodynamics (Pressors/Inotropes readily available)
A-line, CVC, PA cath, TEE
Control coagulation

108
Q

Cholestasis

A

↑AlkPhosphatase,↑GGT,↑bilirubin

109
Q

Reduced synthetic function:

A

↓Albumin, ↑PT/INR

110
Q

Hepatocellular injury:

A

↑AST/ALT (hepatocyte enzymes)
Acute Liver Failure (ALF): may be elevated 25x
Alcoholic Liver Dz (ALD): AST:ALT ratio usually at least 2:1
NAFLD: ratio usually 1:1

Health Assessment M (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions