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AFN Health Assessment > Hepatic/Biliary > Flashcards

Hepatic/Biliary Flashcards

1
Q

Portal Triad

A

-hepatic arteriole

-portal venule

-bile duct

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2
Q

Zone 1 of liver receives O2 ______ blood

A

O2 rich

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3
Q

Zone 3 of liver recieves O2 ______ blood

A

O2 poor

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4
Q

Hypoxia effects which zone the most?

A

Zone 3

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5
Q

Liver receives ___% of CO

A

25%

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6
Q

Portal vein supplies ____% of hepatic blood flow

A

75%

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7
Q

Hepatic a. supplies ___% of hepatic blood flow

A

25%

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8
Q

Portal v. & hepatic a. each supply ____% of hepatic O2 supply

A

50%

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9
Q

Portal v. normally has ____ vasc. resistance

A

low

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10
Q

The liver, via __________ (large pores in endothelial lining), generates ____% of the bodies lymph

A

sinusoids

50%

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11
Q

Alpha 1 stimulation does what to hepatic vasculature?

A

Vasoconstricts

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12
Q

Beta 2 stimuation does what to hepatic vasculature?

A

Vasodilates

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13
Q

List some of the consequences of portal HTN

A

-Ascites

-hepatic enchephalopathy (d/t shunts limiting ammonia filtration/elimination)

-bacterial peritonitis

-hepatorenal syndrome

-splenomegaly

-varicies

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14
Q

What macrophage cells in the liver cleanse the blood of bacteria?

A

Kupffer cells

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15
Q

The liver removes ammonia via the formation of _______

A

Urea

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16
Q

The liver synthesizes all co-ag factors except…..

A

3, 4, 8

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17
Q

Vitamin K absorption, and therefore vitamin K coag factors depend on what?

A

Bile excretion

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18
Q

What are the vit K dependent factors?

A

2, 7, 9, 10

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19
Q

_________ abnormalities may be more common w/ liver disease

A

endocrine

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20
Q

The liver converts ______ to ______

A

T3 to T4

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21
Q

What 3 things does the liver do w/ bilirubin?

A
  1. absorbs it from blood stream
  2. conjugates it (makes it water soluble)
  3. excretes it via biliary system (bile duct)
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22
Q

Increased risk of post-op _________/_________ w/ liver disease

A

infection/sepsis

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23
Q

Presystemic elimination of drus given via the oral route

A

First-pass effect

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24
Q

3 main goals of hepatic biotransformation

A

-make drugs inactive

-make drugs water soluble

-make drugs ready to secrete

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25
Q

What phase reaction in hepatic biotransformation makes drugs hydrophilic/more polar

A

Phase 1

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26
Q

What phase reaction in hepatic biotrasformation is suseptible to inhibition by advanced age/hepatic dysfxn

A

Phase 1

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27
Q

What phase reaction in hepatic biotransformation is responsible for drug conjugation?

A

Phase 2

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28
Q

Big take away w/ hepatic pharmacokinetics?

A

Careful titration of meds!

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29
Q

What labs evaluate hepatocyte injury/necrosis?

A

ALT/AST/GST

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30
Q

What labs evaluate hepatic conjugation and excretion?

A

bilirubin/alkaline phosphatase/GGT

31
Q

What labs evaluate hepatic protein synthesis?

A

albumin/PT/INR

32
Q

Is albumin a good indicator for acute liver dz?

A

No (3 week 1/2 life)

33
Q

Sensitive indicators for acute liver dz?

A

PT/INR

34
Q

PT is dependent on __________ intake

A

Vit K intake

35
Q

With _________ _________, PT may be prolonged w/ preserved liver fx

A

biliary obstruction

36
Q

Primary screening exam for liver dz/obstructions

A

Ultrasonongraphy

37
Q

Originates from breakdown of Hgb

A

Bilirubin

38
Q

Disorder of bilirubin metabolism, hemolysis, hepatocyte dsfxn leads to increase in which kind of bilirubin?

A

Unconjugated

39
Q

Gallstones, biliary obstructions lead to what type of bilirubin increase

A

Conjugated

40
Q

Rarely see bilirubin > ___. Why?

A

35

Renal systems excretes it also

41
Q

IF bilirubin >35, what concominate disease do you have along with severe liver dz?

A

Renal failure

or sometimes,

hemolysis

42
Q

Alcoholic liver dz. usually beningn & resolves w/ abstinence

A

Steatosis

43
Q

Alcoholic hepatitis can progress to ________

A

Cirrhosis

44
Q

W/ alcoholic hepatitis, how long should you delay elective surg

A

12 weeks

45
Q

In alchoholic hepatitis, AST to ALT ratio is __:__

A

2:1

46
Q

NASH is another name for what disease

A

Fatty liver dz

47
Q

2 most common causes of cirrhosis

A

HepC & ETOH

48
Q

What is the halmark CV sypmtoms of Cirrhosis

A

Hyperdynamic circulation

49
Q

3 hemodynamic signs of hyperdynamic circulation

A
  • Increased HR

-Increased CO

-Decreased PVR

50
Q

2 Scoring systems that test risk of death from liver dz

A

MELD & Child-Pugh

51
Q

TIPS procedures helps tx what?

A

Portal HTN

52
Q

Hep transmitted via fecal/oral

A

Hep A

53
Q

Sexually & blood transmitted hep type

A

Hep B

54
Q

Blood borne only Hep types

A

Hep C&D

55
Q

Ischemia hepatitis is d/t what

A

Hypoperfusion leading to hypoxia

56
Q

What classification is used specifically for cirrhosis

A

child-pugh

57
Q

What classficiation is used specifically for liver transplant prioritization

A

MELD

58
Q

This classficiation system intrigrates weighted values of bilirubin, INR, & creatinine

A

MELD

59
Q

MELD < ___ and child class ___ means only slight increase risk periop M&M

A

<8

class A

60
Q

sexual activity risk of hep __

A

hep B

61
Q

travel risk of hep ___

A

hep A

62
Q

IV drug us risk of hep ___

A

hep C

63
Q

tatoo risk of hep ___

A

hep B

64
Q

Obesity/metabolic syndrome risk of what liver dz

A

NASH

65
Q

MELD score >___ used to stratify pts on waiting list for liver transplant

A

> 11

66
Q

Main takeaway w/ hepatic encephalopathy

A

decrease ICP

67
Q

What Na levels needed to maintain w/ hepatic encephalopathy

A

150-154

68
Q

Leading cause of post-transplant M&M

A

CV disease

69
Q

Which one is worse, HRS type 1 or 2?

A

1

70
Q

MELD score above ____ means you should avoid TIPS procedure

A

24

71
Q

Are acute pancreatitis pts surg candidates?

A

NOOO

72
Q

Whipple procedure is for what, and what it the main thing you need to remember regarding anesthesia management

A

Pancreas tumor removal

***Risk for blood loss/fluid shifts

***Use invasive monitoring

73
Q

Normal AST

A

10-40

74
Q

Normal ALT

A

10-60

AFN Health Assessment (12 decks)

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