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Principles-Other > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

What is the largest internal organ?

A

Liver

Theliveris the largest organ in the body, contributing about 2 percent of the total body weight, or about 1.5 kilograms

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2
Q

What is the functional unit of the liver?

A

lobule

Hexagonal in cross-section- central vein at its center, portal veins at its 6 corners

The humanlivercontains 50,000 to 100,000 individual lobules.

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3
Q

bile is produced by what? and stored in what?

A

produced by hepatocytes and stored in the gall bladder

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4
Q

What supplies the blood to the liver?

A

Portal veins and Hepatic artery

1500-1800ml/min

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5
Q

What percent of the CO does the liver receive?

A

27% (1350mL/min)

high blood flow, low resistance

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6
Q

the liver functions as a:

A

Blood reservoir (normal blood volume is 450mL or almost 10% of the body’s total blood volume)

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7
Q

What is the most common cause of liver disease in many industrialized countries and is usually associated w obesity and type 2 diabetes?

A

nonalcoholic fattyliverdisease(NAFLD), is

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8
Q

What are the functions of the liver?

A

1.) Filtration and storage of blood

2.) metabolism of carbohydrates, proteins, fats, hormones, and foreign chemicals

3.) formation of bile

4.) formation of vitamins and iron

5.) formation of coagulation factors

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9
Q

What is the TIPS procedure for?

A

Unload portal hypertension

portal hypertension = esophageal varices

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10
Q

Cirrhosis of the liver_____ ________ resistance to blood flow

A

Cirrhosis of the liver greatly increases resistance to blood flow

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11
Q

What is bilirubin?

A

yellow bile pigment produced through the breakdown of the red blood cells, hemolysis

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12
Q

Unconjugated bilirubin is:

A

Insoluble in water

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13
Q

Conjugated bilirubin is:

A

water-soluble (does not require transport proteins, can be excreted out of the body)

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14
Q

Pre-hepatic jaundice is caused by:

A

increased hemolysis

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15
Q

hepatic jaundice is caused by:

A

liver impairment

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16
Q

Post-hepatic jaundice is caused by:

A

blockage of bile ducts

  • gallstones
    -hepatic tumors
    -pancreatic tumors

ERCP

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17
Q

What coagulation products dies the liver make?

A

-Fibrinogen
-prothrombin
-accelerator globulin
-Factor VII
ect

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18
Q

What is vitamin K required for?

A

Metabolic processes of the liver for the formation of:

-prothrombin
-factor 7, 9 and 10

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19
Q

How do you get Hepatitis A?

A

fecal, oral

20
Q

How do you get hepatitis B and C?

A

body fluids
-fever, malaise, jaundice

21
Q

What is ascites?

A

High hepatic vascular pressure = fluid transudation into the abdominal cavity from the liver and portal capillaries

Fluid is almost pure plasma (protein)

22
Q

How does cirrhosis affect cardiac output?

A

increases it –> high output failure–> decreased renal blood flow

23
Q

What does TIPS stand for?

A

Transjugular intrahepatic portosystemic shunt

A TIPS procedure involves creating a pathway through the liver that connects the portal vein (the vein that carries blood from the digestive organs to the liver) to a hepatic vein (one of three veins that carry blood from the liver to the heart).

portal vein to hepatic vein inferior vena cava

will need a-line, general

24
Q

What are the preferred agents for liver disease?

A

Isoflurane and Desflurane

Halothane= BAD! (halothane hepatitis)

25
Q

Hypercapnia and acidosis do what to hepatic blood flow?

A

INCREASE hepatic blood flow

26
Q

Hypocapnia and alkalosis do what to hepatic blood flow?

A

DECREASE hepatic blood flow

27
Q

Positive pressure ventilation do what to hepatic blood flow and CO?

A

decrease CO and hepatic blood flow

28
Q

How do opioids affect the sphincter of oddi?

A

Cause it to spasm
- fentanyl tolerated
Tx: glucagon

29
Q

Anesthesia considerations for Liver disease:

A
  • Consider RSI
    -Avoid Nitrous oxide (d/t distension)
  • succs prolonged (decreased plasma cholinesterase)
  • CISATRICURIUM DRUG OF CHOICE (d/t Hofmann elimination)
30
Q

What are gallstones made up of?

A

Hydrophobic cholesterol crystals
Calcium bilirubinate

31
Q

How much bile can the gallbladder hold?

A

30-50ccs

32
Q

What hormone regulates gallbladder contraction?

A

Cholecystokinin

VAGAL STIMULATION ALSO PLAYS A ROLE secondary to cholecystokinin

33
Q

What is the main function of bile?

A

Maintain duodenal alkalization

34
Q

Features of cholecystitis

A

Mid-epigastric pain- radiation to right abdomen
Murphys sign= inspiratory effort accentuates pain
Messed up labs

35
Q

What duct would be completely obstructed if someone is jaundiced?

A

Cystic duct

36
Q

5 Fs for cholecystitis

A

Fair, female, fat, fertile, 40

37
Q

What does a Nissen fundoplication treat?

A

GERD

38
Q

How is GERD managed?

A

PPIs
Histamine 2 (H2) blockers

(lower esophageal sphincter incompetence)

39
Q

Acid release in the stomach from the parietal cells is mediated by:

A

Gastrin release (g- cells respond to gastric distention)
Vagal stimulation (acetylcholine)
Histamine

40
Q

How to control gastric secretion?

A

H2 antagonists
Cimetidine
Ranitidine
H+/K+- ATP inhibitors
Omeprazole
Prostaglandins

Surgery:
Vagotomy
diminishes parietal-cell response to gastrin and histamine

41
Q

Whats the most common cause of peptic ulcer disease?

A

H. pylori

42
Q

treatment for peptic ulcer disease:

A

Sucralfate
Antibiotics
Misoprostol

43
Q

the pancreas

A

Endocrine and Exocrine functions

Exocrine Function
Secretes 1500-3000ml of pancreatic juice daily
Clear, colorless liquid with a pH of 8.3
Ionic composition is Na+, K+, bicarb, chloride
The principle function is to adjust duodenal pH
Promotes optimal function of pancreatic enzymes

Endocrine Function
Direct (non-ductal) production of insulin and glucagon to meet physiologic need

44
Q

What’s the Whipple procedure

A

A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.

45
Q

how long is the colon?

A

3-5 ft

46
Q

acute alcohol intoxication:

A

Acute intoxication:
Decreased requirement and MAC. Increased aspiration risks. Enhanced effect of benzodiazepines.

47
Q

The classic triad diagnostic of chronic pancreatitis consists of (select three)

A. Steatorrhea
B. Diabetes mellitus
C. Constipation
D. Decreased serum amylase
E. Addisonian crisis
F. Diabetes insipidus
G. Hypernatremia
H. Pancreatic calcification
A

A. Steatorrhea
B. Diabetes mellitus
H. Pancreatic calcification

Principles-Other (6 decks)

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