Hepatobiliary and GI distrubances and Anesthesia Flashcards
The liver receives about ________of the cardiac output via a dual blood supply
The liver receives about 25% of the cardiac output (1,500 mL/min) via a dual blood supply
The portal vein provides____of the total liver blood flow and provides ____ of the liver’s oxygen supply.
The hepatic artery provides ___ of the total liver blood flow and provides ____ of the liver’s oxygen supply
The portal vein provides 75% of the total liver blood flow and provides 50% of the liver’s oxygen supply.
The hepatic artery provides 25% of the total liver blood flow and provides 50% of the liver’s oxygen supply
True or False: Portal blood flow is autoregulated, and decreased splanchnic vascular resistance reduces portal vein flow.
false
Portal blood flow is not autoregulated, and increased splanchnic vascular resistance reduces portal vein flow
When there’s a reduction in portal vein blood flow, the hepatic arterial buffer response compensates by ________ through the hepatic ________.
__________ impairs this response, making the diseased liver even more susceptible to hypoperfusion
When there’s a reduction in portal vein blood flow, the hepatic arterial buffer response compensates by increasing flow through the hepatic artery.
Severe liver disease impairs his response, making the diseased liver even more susceptible to hypoperfusion.
__________ and __________ anesthesia reduce _______ and _________.
This can reduce liver blood flow in a dose-dependent fashion.
Both general and neuraxial anesthesia reduces MAP and cardiac output.
This can reduce liver blood flow in a dose-dependent fashion.
Liver function
Protein synthesis
Drug biotransformation
Vital role in carbohydrate, protein, and lipid metabolism
Synthesis of fibrinolytics like plasminogen and thrombopoietin, which stimulate platelet production
Regulator of serum glucose. It also clears insulin from the circulation.
Which clotting factors the liver produces?
The liver produces all the clotting factors except for factor 3, factor 4, and von Willebrand.
Vitamin K-dependent clotting factors include
factors 2, 7, 9, 10, as well as proteins C, S, and Z (anticoagulants)
Factor 8 is produced by
Factor 8 is produced by the liver sinusoidal cells and endothelial cells (not by hepatocytes).
Patients with liver failure are at risk of
Hypoglycemia
Identify the Liver function.
The liver produces all the plasma proteins except for _______________
The liver produces all the plasma proteins except for immunoglobulins
The most abundant plasma protein
Albumin
Which protein serves as a blood reservoir for acidic drugs, but it will also bind with basic drugs?
Albumin
Which protein is a blood reservoir for basic drugs?
Alpha-1 acid glycoprotein
Reduced pseudocholinesterase production _________ the duration of __________ and possibly increases the duration of _________ local anesthetics.
This is only a problem with _____________.
Reduced pseudocholinesterase production increases the duration of succinylcholine and possibly increases the duration of ester-type local anesthetics.
This is only a problem with severe liver disease.
_________ is a byproduct of protein metabolism
Ammonia
Failure to clear ammonia leads to
Failure to clear ammonia (hepatic failure or portosystemic shunting) leads to hepatic encephalopathy.
________ byproduct of hemoglobin metabolism
Bilirubin
Which type of bilirubin is neurotoxic?
Unconjugated bilirubin
Phase 1 and Phase 2 of drug metabolism in the liver
Liver function test: Synthetic function
PT and Albumin
Liver function test: Hepatocellular Injury
ASL and ALT
Liver function test: Hepatic Clearance
Bilirubin