Hepatic and Biliary Systems (Exam III) AI flashcards Flashcards by Amanda M.

What is the primary function of the liver in synthesizing glucose?

Synthesizes glucose via gluconeogenesis

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What does the liver store excess glucose as?

Glycogen

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What substances does the liver synthesize?

Cholesterol & proteins into hormones and vitamins

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How does the liver generate energy?

Metabolizes fats, proteins, carbs

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What pathway does the liver use to metabolize drugs?

CYP-450 and other enzyme pathways

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What is one of the key detoxification roles of the liver?

Detoxifies blood

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What does the liver process and store that is crucial for blood health?

HGB and iron

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Which coagulation factors does the liver synthesize?

All except factors III, IV, VIII, vWF

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What is the role of the liver as a blood reservoir?

Aids in volume control

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What can liver dysfunction lead to?

Multi-organ failure

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How many segments does the liver have?

8 segments

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What separates the right and left lobes of the liver?

Falciform Ligament

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What are the three hepatic veins that empty into the IVC?

Right hepatic vein
Middle hepatic vein
Left hepatic vein

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What do bile ducts travel along?

Portal veins

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What is the function of the portal vein?

Arises from the splenic vein and superior mesenteric vein

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What percentage of cardiac output does the liver receive?

25%

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What is the typical blood flow rate to the liver?

1.25-1.5 liters/min

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What does an increase in portal venous pressure lead to?

Blood backs up into the systemic circulation

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What are common signs of portal hypertension?

Esophageal varices
Gastric varices

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What is the initial assessment for liver function often reliant on?

Risk factors for degree of suspicion

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What is the AST/ALT ratio in Alcoholic Liver Disease (ALD)?

Usually at least 2:1

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What is the AST/ALT ratio in Non-Alcoholic Fatty Liver Disease (NAFLD)?

Usually 1:1

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What does cholestasis indicate in liver function tests?

Increased Alk Phosphatase, GGT, bilirubin

What is the most common type of viral hepatitis requiring liver transplant in the US?

HCV

What is the treatment duration for HCV with Sofosbuvir/Velpatasvir?

12-week course

What is the primary cause of Alcoholic Liver Disease (ALD)?

Alcohol consumption

What is the most common cause of cirrhosis in the US?

Alcoholic Liver Disease (ALD)

What is the gold standard for diagnosing Non-Alcoholic Fatty Liver Disease (NAFLD)?

Liver biopsy

What is Wilson's Disease characterized by?

Impaired copper metabolism

What is the typical incidence of Alpha-1 Antitrypsin Deficiency?

1:16,000 to 1:35,000

What is the primary treatment for Hemochromatosis?

Weekly phlebotomy and iron-chelating drugs

What is Primary Sclerosing Cholangitis (PSC)?

Autoimmune chronic inflammation of the larger bile ducts

What is Primary Biliary Cholangitis (PBC) characterized by?

Destruction of bile ducts with periportal inflammation & cholestasis

What are the common symptoms of acute liver failure?

* Jaundice * Nausea * RUQ pain

What is the final stage of liver disease?

Cirrhosis

What are common complications of cirrhosis?

* Portal HTN * Ascites * Bacterial Peritonitis * Varices

What is the treatment for hepatic encephalopathy?

Lactulose and Rifaximin

What is the TIPS procedure used for?

Manage portal hypertension

What does the Child-Turcotte Pugh (CTP) scoring system assess?

Severity & prognosis of liver disease

What is the impact of alcoholism on volatile anesthetics?

Increases MAC

What is the ideal muscle relaxant for patients with liver disease?

Succs and Cisatracurium

What does circulation do in relation to portosystemic pressure?

Reduces the portosystemic pressure gradient ## Footnote This is crucial in managing conditions like variceal hemorrhage.

What are the indications for circulation?

Refractory variceal hemorrhage and/or ascites ## Footnote These conditions require careful management of blood flow.

What are the contraindications for circulation?

HF, tricuspid regurg, severe pulmonary HTN ## Footnote These conditions can complicate circulation procedures.

What is the purpose of partial hepatectomy?

Resection to remove neoplasms -> adequate tissue for regeneration ## Footnote This procedure helps in treating liver tumors while preserving function.

How much liver tissue can be removed in patients with normal liver function?

Up to 75% removal is tolerated ## Footnote This tolerance is crucial for planning surgical interventions.

What anesthetic considerations are there for partial hepatectomy?

Invasive monitoring, blood products ## Footnote These are essential for patient safety during the procedure.

What may a surgeon do to control blood loss during a partial hepatectomy?

Clamp IVC or hepatic artery ## Footnote This technique helps minimize intraoperative bleeding.

What should be maintained prior to surgery to reduce blood loss?

Low CVP (fluid restriction) ## Footnote This approach aims to decrease venous pressure during the procedure.

What do patients often require postoperatively after liver resection?

Post op PCA ## Footnote Pain control is crucial for recovery after surgery.

What is a common complication after liver resection?

Postop coagulation disturbances ## Footnote Monitoring and management of coagulation is essential post-surgery.

What is the definitive treatment for ESLD?

Liver Transplant ## Footnote This procedure addresses end-stage liver disease effectively.

What is the most common indication for liver transplant?

Alcoholic liver disease > fatty liver, HCC ## Footnote This highlights the prevalence of alcoholic liver disease in transplant cases.

What is a key consideration for living donor liver transplant?

Surgeries timed together, minimal ischemic time ## Footnote Coordination is vital to ensure the viability of the liver.

What is important for brain dead donors during liver transplant?

Kept HD stable for organ perfusion ## Footnote Hemodynamic stability is crucial for successful organ transplantation.

What must be maintained during liver transplant?

Hemodynamics (Pressors/Inotropes, A-line, CVC, PA, TEE) ## Footnote This monitoring ensures the patient remains stable throughout the surgery.

What must be controlled during liver transplant?

Coagulation ## Footnote Proper coagulation management is critical to avoid excessive bleeding.