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Health Assessment (2) > Hepatic Diseases (Exam III) > Flashcards

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

what does the liver store?

A

blood, B12, D, A, iron (ferritin)

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4
Q

How much bile is produced by the gallbladder daily?

A

500mls

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5
Q

What is the consequence of not having a gallbladder?

A

Digestion problems

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6
Q

What patient populations most often have their gallbladder removed?

A
  • Pregnant
  • Obese
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7
Q

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

A

Falciform Ligament

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8
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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9
Q

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

A

Cystic Artery

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10
Q

What are common s/s of gallbladder disease?

A
  • Murphy’s sign
  • RUQ pain
  • ↑WBCs
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11
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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12
Q

What is Bud-Chiari syndrome?

What are the s/s?

A

Obstruction of the venous outflow of the liver.
thrombosis of the major hepatic veins … leads to collateral blood flow through caudate veins to IVC
- ABD pain
- Ascites
- Hepatomegaly

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13
Q

What is a normal portal vein pressure?

A

7-10 mmHg

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14
Q

What pressure is seen with portal vein hypertension?

A

> 20-30 mmHg

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15
Q

What is a normal pressure in the venous sinusoids?

A

0 mmHg

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16
Q

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

A

5 mmHg

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17
Q

How is hepatic artery perfusion pressure calcuated?

A

HAPP = MAP - HVP

HAPP = hepatic artery perfusion pressure
HVP = Hepatic vein pressure

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18
Q

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

A

2, 7, 9, 10

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19
Q

What is the name of factor two?

A

Prothrombin

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20
Q

What clotting factors are produced by the liver?

A

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

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21
Q

What is the name of factor 3?

A

Tissue thromboplastin

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22
Q

What is the name of factor 8?

A

vWf (von Willebrand factor)

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23
Q

What is the name of factor 4?

A

Calcium

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24
Q

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

A

Glucagon

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25
Q

What factors increase hepatic blood flow?

A
  • Eating
  • Glucagon
  • β-agonists
  • Recumbent position
  • Acute hepatitis
  • Hypercapnia
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26
Q

What factors decrease hepatic blood flow?

A
  • Anesthetics
  • Surgical trauma
  • α-agonists
  • β-blockers
  • PEEP
  • Vasopressin boluses
  • Cirrhosis
  • Hypocapnia
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27
Q

This molecule is a degradation product of Hgb.

A

Bilirubin

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28
Q

What are normal bilirubin levels?

A

< 1mg/dL

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29
Q

At what bilirubin level would one see scleral icterus?

A

3 mg/dL

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30
Q

At what bilirubin level would one see jaundice?

A

> 4 mg/dL

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31
Q

The liver aminotransferases are primarily involved in what?

A

Gluconeogenesis

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32
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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33
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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34
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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35
Q

What is Wilson’s disease?

A

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

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36
Q

When is alkaline phosphatase elevated?

A

When bile-salt induced liver damage has occurred.

37
Q

Which liver transaminase is more specific to the liver?

A

ALT (alanine transaminase)

38
Q

Which liver transaminase is found in mitochondria and the cytosol?

A

AST (aspartate transaminase)

39
Q

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

A

AST (36hrs)

ALT (18hrs)

40
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
41
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
42
Q

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

A

> 300 IU

  • Drugs
  • Acute viral hepatitis
  • Ischemia
  • Extrahepatic cholestasis
43
Q

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

A

2

44
Q

What are normal AST values?
ALT?

A

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

45
Q

What is a normal prothrombin time?

A

12 - 14 seconds

46
Q

Due to short half life of ____, these labs can be reliably used to evaluate residual hepatic function

A

clotting factors, INR or PT ratio

47
Q

What liver lab is sensitive for acute injury?

A

PT (prothrombin time)

48
Q

drugs that are more effected by changes in HBF

these have high hepatic extraction ratio

A

prop, fent, morphine, meperedine, lidocaine, CCB, -olol,

49
Q

What is th best IV induction agent

A

propofol (it doesn’t disrupt HABR)

50
Q

which medications can a liver pt have decreased response to?

A

endogenous vasoconstrictions (angio II, NE)
they also have a poor circulatory response to EPI NE

51
Q

What liver lab is not sensitive for acute injury?

A

Albumin

52
Q

how quickly can someone progress from jaundice to 80-90% liver loss?

A

4 weeks

53
Q

What are the four grades of encephalopathy?

A
  1. Behavioral changes, minimal LOC changes.
  2. Disorientation, drowsiness, inappropriate behavior.
  3. Marked confusion, incoherence, somnolent.
  4. Comatose.
54
Q

What are the s/s of hepatorenal syndrome?

A
  • H₂O retention
  • Azotemia
  • ↓ Na⁺
  • Oliguria
55
Q

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

A
  • ↑ VD
  • ↓ plasma-protein binding
  • ↓ drug clearance
56
Q

How is Hepatitis A spread?

A

Fecal matter contact w/ food and water.

57
Q

What are the s/s of Hep A?

A

Asymptomatic to full liver failure

58
Q

How is Hep A treated?

A

Pooled gamma globulin

59
Q

What is the leading cause of liver cancer?

A

Hepatitis B

60
Q

How is Hepatitis B spread?

A
  • Sex
  • Blood
61
Q

Who most often develops chronic infection from hepatitis B?

A

Children

62
Q

What is the treatment for Hep B?

A

Hepatitis B immunoglobulin

63
Q

What is the leading cause for liver transplantation?

A

Hepatitis C

64
Q

How is Hepatitis C spread?

A
  • Sex
  • Blood
  • Parenteral drug use
65
Q

How is Heptatitis C treated?

A
  • Sofosbuvir
  • Interferon w/ ribavirin
  • other antivirals
66
Q

Hepatitis D occurs in conjuction with what?

A

Hepatitis B

67
Q

How is Hepatitis E spread?

A
  • Oral/Fecal
68
Q

What treatments exist for Hepatitis E?

A

NO treatments, usually self-limiting

69
Q

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

A

Acetaminophen

70
Q

How is acetaminophen-induced acute liver failure treated?

A

N-acetylcysteine within 8 hours

71
Q

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

A
  • TFA (trifluroacetic acid)
  • Fluoride
72
Q

Summarize all the hepatitis pathologies.

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

A
73
Q

What is the MELD score?

A

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

74
Q

A MELD score of > 40 means what?

A

100% mortality in the hospitalized patient.

75
Q

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

A

Safe to undergo elective surgery.

76
Q

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

A

Needs optimization to undergo elective surgery.

77
Q

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

A

Elective surgery is contraindicated.

78
Q

What are the coagulative effects of cirrhosis?

A

Hemostasis → clotting

79
Q

What are the cardiac effects of cirrhosis?

A
  • Portal HTN
  • ↓ circulating volume
80
Q

What are the renal effects of cirrhosis?

A
  • Hepatorenal Syndrome
  • ↑ H₂O and Na⁺ retention
81
Q

What are the pulmonary effects of cirrhosis?

A

Chronic Lung Disease and SOB from fluid retention and ascites.

82
Q

What occurs with hepatic encephalopathy?

A

Accumulation of ammonia

83
Q

What is an overall summary of cirrhosis?

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

A
84
Q

What is the goal Hgb for acute variceal bleeding?

A

Hgb = 8 mg/dL

85
Q

What volatile is best for liver surgeries?

A

Sevoflurane

86
Q

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

A

↓ PaCO₂ = ↓ HBF

↑ PaCO₂ = ↑ HBF

87
Q

What is TIPS?

A

Trans Julgular INtrahepatic Portosystemic Shunt

bypass of hepatic circulation by taking blood from portal vein to hepatic vein to reduce back pressure

for late stage liver disease

88
Q

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

A
  • Warfarin
  • Extrinsic pathway
  • Prothrombin
  • Time

Health Assessment (2) (22 decks)

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