Hepatobillary Flashcards
What are the functions of the liver?
- Synthesizes: glucose via gluconeogenesis and stores excess glucose as glycogen
- Synthesizes: cholesterol & proteins into hormones and vitamins
- Synthesizes: coagulation factors (all except factors III, IV, VIII, vWF)
- Metabolizes: fats, proteins, carbs to generate energy
- Metabolizes: drugs via CYP-540 and other enzyme pathways
- Blood: Detoxifies
- Blood: Processes Hgb and stores iron
- Blood: Aids in volume control as a blood reservoir
- Involved in the acute-phase of immune support
slide 2
Nearly every organ is impacted by ____.
liver function- Liver dysfunction can lead to multi-organ failure
slide 2
how many segments are in the liver?
8 segments
Based on blood supply & bile drainage
slide 3
what are the R&L lobes separated by?
falciform ligament
slide 3
____ vein and ____ artery branch into each segment
- portal vein
- hepatic artery
slide 3
what 3 veins empty into IVC?
Right, Middle, Left hepatic veins
slide 3
- Bile ducts travel along ____.
- Bile drains through the ____ into Gallbladder & Common Bile Duct
- Bile enters duodenum via ____.
- portal veins
- hepatic duct
- Ampulla of Vater
slide 3
Liver recieves ____% of COP. which is about ____ L/min.
- Receives 25% of COP
- 1.25-1.5 liters per min
highest proportionate COP of all organs
slide 4
portal vein arises from ____ vein and ____ ____ vein
- splenic vein
- superior mesenteric vein
slide 4
portal vein blood is deoxygenated from ?
- GI organs
- pancrease
- spleen
slide 4
portal vein provides ____% of HBF
75%
slide 4
Which artery branches off the aorta?
hepatic artery
hepatic artery provides ____% of HBF
25%
slide 4
how does the liver get O2?
- 50% viaPortal vein (deoxygenated)
- 50% via Hepatic artery
slide 4
hepatic arterial blood flow is inversely related to
portal venous blood flow
slide 5
how is hepatic blood flow autoregulated?
Hepatic art. dilates in response to low portal venous flow, keeping consistent HBF
slide 5
Portal venous pressure reflects ____ tone and ____ pressure
splanchnic arterial tone and intrahepatic pressure
slide 5
increased portal venous pressure causes
blood backsupinto to systemic circulation resulting in esophageal and gastric varices
slide 5
hepatic venous pressure gradient is used to determine severity of?
portal hypertension
slide 6
what is a normal Hepatic venous pressure gradient (HVPG)?
1-5 mmhg
slide 6
this HVPG is clinically significant portal hypertension(cirrhosis, esophageal varicies)
> 10
slide 6
this HVPG can see vriceal rupture
> 12
slide 6
pts are often ____ until late-stage liver disease
asymptomatic
slide 8
in later stages pts may only have??
vague s/s like disrupted sleep, and decreased appetite
slide 8
liver function assessment relies heavily on
risk factors for degree of suspicion
slide 8
Risk factors for impaired liver function (9)
Family hx
Heavy ETOH
Lifestyle
DM
Obesity
Illicit Drug use
Multiple partners
Tattoos
Transfusion
slide 8
physical findings for impaired liver function (7)
Pruritis
Jaundice
Ascites
Asterixis (flapping tremor)
Hepatomegaly
Splenomegaly
Spider nevi
slide 8
what labs are assessed for hepato-biliary function?
- BMP, CBC
- PT/INR
- Aspartate aminotransferase (AST)
- Alanine aminotransferase (ALT) most liver-specific enzymes
- Bilirubin
- Alkaline Phosphatase
- ɣ-glutamyl-transferase (GGT)
slide 9
what imaging is used for hepato-biliary function?
- Ultrasound
- Doppler U/S (Portal bld flow)
- CT
- MRI
slide 9
what are the 3 groups of hepatobiliary disease per stoling?
- hepatocellular injury
- reduced synthetic function
- cholestasis
slide 10
what do you see with hepatocellular injury?
- ↑AST/ALT (hepatocyte enzymes)
- Acute Liver Failure (ALF): may be elevated 25x
- Alcoholic Liver Dz (ALD): AST:ALT ratio usually at least 2:1
- NAFLD: ratio usually 1:1
slide 10
what do you see with reduced synthetic function?
- ↓Albumin
- ↑PT/INR
slide 10
what do you see with cholestasis?
- ↑AlkPhosphatase
- ↑GGT (gamma glutamyl transpeptidase)
- ↑bilirubin
slide 10
what do blood test look like for bilirubin overload (hemolysis)?
* amnotrasferase
* serum albumin
* prothrombin time
* bilirubin
* alkaline phhatase
* gamma gluamyl tranpeptidase
* blood urea nitrogen
* BSP/ICG (dye)
- amnotrasferase: normal
- serum albumin: normal
- prothrombin time: normal
- bilirubin: unconjugated
- alkaline phhatase: normal
- gamma gluamyl tranpeptidase: normal
- blood urea nitrogen: normal
- BSP/ICG (dye): normal
slide 11
what do blood test look like for hepatocellular injury?
* amnotrasferase
* serum albumin
* prothrombin time
* bilirubin
* alkaline phhatase
* gamma gluamyl tranpeptidase
* blood urea nitrogen
* BSP/ICG (dye)
- amnotrasferase: increased
- serum albumin: decreased
- prothrombin time: prolonged
- bilirubin: conjugated
- alkaline phhatase: normal
- gamma gluamyl tranpeptidase: normal
- blood urea nitrogen: normal
- BSP/ICG (dye): retention of dye
slide 11
what do blood test look like for cholestasis?
* amnotrasferase
* serum albumin
* prothrombin time
* bilirubin
* alkaline phhatase
* gamma gluamyl tranpeptidase
* blood urea nitrogen
* BSP/ICG (dye)
- amnotrasferase: normal
- serum albumin: normal
- prothrombin time: normal
- bilirubin: conjugated
- alkaline phhatase: increased
- gamma gluamyl tranpeptidase: increased
- blood urea nitrogen: normal
- BSP/ICG (dye): normal or retention of dye
slide 11
haptocytes secrete bile through bile duct into ____ which goes to ____ and ____
CHD→ GB & CBD
slide 12
____ stores bile to deliver during meals, and ____ secretes bile directly into duodenum
- GB
- CBD
slide 12
risk facotrs for cholelithiasis? ____% are asymptomatic.
- Obesity
- ↑cholesterol
- DM
- pregnancy
- female
- family hx
80% asymptomatic
slide 12
s/s of cholelithiasis
- RUQ pain, referred to shoulders
- N/V, indigestion
- fever (acute obstruction)
slide 12
tx for cholelithiasis
- IVF,
- abx,
- pain management
- Lap Cholecystectomy
slide 12
2 types of cholecystectomy
- laparoscopic
- open
slide 13
Choledocolithiasis
* cause
* initial s/s
* cholangitis s/s:
* Tx:
- Stone obstructing CBD→ biliary colic
- Initial sx: N/V, cramping, RUQ pain
- Cholangitis sx: fever, rigors, jaundice
- Tx: Endoscopic removal of stone via ERCP
Endoscopic Retrograde Cholangiopancreatography
slide 14
how to perform endoscopic retrograde cholaniopancreatogrophy
Endoscopist threads guidewire through Sphincter of Oddi, into Ampulla of Vaterto retrieve stone from pancreatic duct or CBD
slide 14
what position is ERCP normally positioned and what type of anesthesia do we use?
- usually prone w/left tilt (tape ETT to left)
- GA
slide 14
what medication may be required to treat oddi spasm
glucogon
slide 14
what is bilirubin
end product of heme-breakdown
slide 17
what is hyperbilirubinemia
Unconjugated “indirect”bilirubin is protein bound to albumin, transported to liver, conjugated into to its H20-soluble “direct” state, excreted into bile
slide 17
verify this
what is unconjugated (indirect) hyperbilirubinemia
imbalance between bilirubin synthesis & conjugation
slide 17
what is conjugated (direct) hyperbilirubinemia:
caused by anobstruction, causing reflux of conjugated bilirubin into the circulation
slide 17
5 most common types of viral hepatitis
- a
- b
- c
- d
- e
slide 18
overal viral hepatitis is on the decline d/t vaccinees and newer treatment, however ____ and ____ are more chronic.
- b and c
slide 18
what is the most common VH requiring liver transplant in US
Hepatitis C Virus
slide 18
what tx has reduced HCV in USA?
- Treatment based on HCV genotype (75% type 1), HCV stage, +/- cirrhosis
- 12 week course Sofosbuvir/Velpatasvir
- Provides 98-99% clearance of genotype 1A/1B
slide 18
charecterisitc features of viral hepatiis
- B & C are bloodborne
- B & C are chronic
- C is the most chronic (75%)
- Long incubation periods
slide 20
Alcoholic liver disease (ALD) is ____ in America and the ____ cause of cirrhosis.
- increasing
- most common
slide 21
what is the top indication for liver transplants US
ALD
national prevalence liver transplant for ALD is 2%
slide 21
what is treatment for ALD?
- Treatment centered around abstinence
- Management symptomes of liver failure
- Platelet count < 50,000 requires blood transfusion
- Liver transfusion an option if criteria is met
slide 21
s/s of ALD (8)
- Malnutrition
- Muscle wasting
- Parotid gland hypertrophy
- Jaundice
- thrombocytopenia
- Ascites
- Hepatosplenomegaly
- Pedal edema
*Sx of ETOH withdrawal may occur 24-72h after stopping
John Makes Me Paranoid At Home Through Phonecalls
slide 22
lab values for ALD
- ↑Mean corpuscular volume (MCV)
- ↑Liver enzymes
- ↑ɣ-glutamyl-transferase (GGT)
- ↑Bilirubin
- Blood ethanol (acuteintox)
slide 22
Non-alchoholic fatty liver disease is when hapatocytes contain ____% fat and is r/t what 4 things?
- > 5% fat
- Obesity, Insulin resistance, DM2, Metabolic syndrome
slide 23
NAFLD progresses to
NASH (nonalcoholic steatohepatitis), cirrhosis, hepatocellular carcinoma
NAFLD & NASH have become additional leading causes of liver transplant in US
slide 23
NAFLD:
* diagnose:
* Tx:
Dx: Imaging and histology
- Liver biopsy= gold standard in distinguishing NAFLD from other liver dx
Tx: Diet, exercise
- Liver transplant is indicated for advanced fibrosis, cirrhosis, related complications
slide 23
autoimmune hepatitis predominantly effects ____ and may be ____, ____, or ____.
- women
- asymptomatic, acute, or chronic
slide 26
pt with autoimmune hepatitis have _ & _
AST/ALT may be ____ in acute AIH
- +autoantibodies & hypergammaglobulinemia
- 10-20x more than normal
slide 26
Autoimmune Hepatitis treatment
steroids, azathioprine
slide 26
in AIH ____% achieve remission but relapse is common. Refactory disease requires ____. When is liver transplant indicated?
- 60-80% achieve remission; relapse is common
- Refractory disease requires immunosuppression
- Liver transplant indicated when tx fails or acute liver failure ensues
slide 26
Drug induced liver injury is most commonly caused by and is normally reversable after ____?
- Most common cause:Acetaminophen OD
- Normally reversable after drug is removed
slide 26
- what is inborn errors of metabolism
- Group of rare, genetically inherited disorders that lead to a defect in the enzymes that breakdown and store protein, carbohydrates &fatty acids
slide 27
inborn errors of metabolism occurs in
1: 2500 births
slide 27
inborn errors of metabolism onset varies from birth to adolescenst but when do the most severe forms appear?
Most severe forms appear in the neonatal period and carry a high degree of mortality
slide 27
what 3 specific disorders cause inborn errors of metabolism?
- Wilsons Disease
- Alpha-1 Antitrypsin Deficiency
- Hemochromatosis
slide 27
What is wilsons disease AKA hepatolenticular degeneration
- Autosomal recessive disease characterized by impaired copper metabolism
- Excessive copper buildup leads to oxidative stress in the liver,basal ganglia, and cornea
slide 28
Wilsons disease:
* S/s:
* Dx:
* TX:
- Sx: range from asymptomatic to sudden-onset liver failure along with neurologic & psychiatricmanifestations
- Dx: Lab tests (serum ceruloplasmin, aminotransferases, urine copper level) Possible liver biopsy for copper level
- Tx: Copper-chelation therapy & oral zinc to bind copper in the GI tract
slide 28
what is alpha 1 antitrypsin deficiency?
Gentetic disorder resulting in a defectiveα-1 antitrypsin protein
slide 29
α-1 antitrypsin proteins protect the liver & lungs from ____ which isan enzyme that causes disruption of connective tissues, leading to inflammation, cirrhosis, and HCC
- neutrophil elastase: an enzyme that causes disruption of connective tissues, leading to inflammation, cirrhosis, and HCC
slide 29
what is the incidence of alpha-1 antitrypsin deficiency?
Incidence1: 16,000 to1: 35,000, although it is likely underdiagnosed
slide 29
what disorder is the number 1 genetic cause of liver transplant in childer
α-1 antitrypsin deficiency is the #1 genetic cause of liver transplant in children
slide 29
alpha 1 antitrypsin deficiency:
* dx
* tx
- Dx: confirmed w/α-1 antitrypsin phenotyping
- Tx: pooledα-1 antitrypsin is effective for pulmonary symptoms; however, it doesn’t help with liver disease
Liver transplant is the only curative treatment for liver disease inα-1 antitrypsin deficiency
slide 29
what is hemochromatosis
- Disorder assoc w/ excess iron in the body, leading to multi-organ dysfunction
- May be genetic, causing excessive intestinal absorption of iron
- May also be caused by repetitive blood transfusions or high-dose iron infusions
- Excess iron accumulates in organs and causes damage to the tissues
slide 30
pts with hemochromatosis may present with
cirrhosis, heart failure,diabetes, adrenal insufficiency,or polyarthropathy
slide 30
what will labs show with hemochromatosis?
Labs reveal elevated AST/ALT, transferrin saturation, and ferritin
slide 30
Hemochromatosis:
* dx:
* tx:
- Dx: genetic mutation testing, Echocardiogram & MRI diagnose cardiomyopathies and liver abnormalities
- Liver bx may quantify iron levels in the liver and assess the level of damage
- Tx: weekly phlebotomy, iron-chelating drugs, liver transplant
slide 30
What is primary biliary cholangitis (PBC), previously known as biliary cirrhosis
- Autoimmune, progressive destruction of bile ducts withperiportal inflammation & cholestasis
- Can lead to liver scarring, fibrosis, cirrhosis
- Females > Males; often dx’d in middle-ages
- Thought to be complicated by exposure to environmental toxins in genetically susceptible individuals
slide 31
PBC:
* s/s
* labs
* imaging
* tx:
- Sx: jaundice, fatigue,& itching
- Labs: ↑Alk Phos,↑GGT, + Antimitochondrial antibodies
- Imaging: CT,MRI, & MRCP to r/o bile duct obstructions
- Liver biopsy reveals bile duct destruction andinfiltration w/lymphocytes
- Tx: No cure, but exogenous bile acids slow progression
slide 31
what is primary sclerosing cholangitis (PSC)
- Autoimmune, chronic inflammation of the larger bile ducts
- Intrahepatic and extrahepatic
- Fibrosis in biliarytree→strictures (beads on string appearance)→ cirrhosis, ESLD
- Males>Females, onset ̴40’s
slide 32
PSC:
* s/s
* labs
* dx
* liver biopsy
* drug tx
- Sx: Fatigue, itching, deficiency of fat-soluble vitamins (A,D,E,K), cirrhosis
- Labs:↑alkaline phosphatase andɣ-glutamyl-transferase, +auto-antibodies
- Dx: MRCP or ERCP showing biliary strictures w/ dilated bile ducts
- Liver biopsy reinforces dx, but isn’t always performed
- No drug treatments are proven to be effective
- Liver transplant is only long term treatment
- Re-occurrence is common after transplant d/t autoimmune nature
slide 32
Easy way to differentiats between Primary Sclerosing and Primary Biliary Cholangitis
- Primary Sclerosing: “beads on a string” from fibrosis, also Intra AND extrahepatic
- Primary Biliary: intrahepatic ducts affected only
this is a life-threatening severe liver injury occurring within days to 6 months after insult and has a rapid increase in AST/ALT, AMS, coagulopathy
acute liver failure
slide 34
how many cases of acute liver failure are drug inced?
50% (majority tylenol)
slide 34
other causes of acute liver failure (5)
- Viral hepatitis,
- autoimmune
- hypoxia,
- ALF of pregnancy,
- HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelets)
slide 34
how does acute liver failure happen?
Massive hepatocyte necrosis→ cellular swelling &membranedisruption
slide 34
acute liver failure:
- s/s
- tx:
- Sx: Jaundice, nausea, RUQ pain, cerebral edema, encephalopathy, multi-organ failure, death
- Tx: Treat the cause, supportive care, liver transplant
slide 34
this is the final stage of liver disease where normal liver parenchyma is replaced with scar tissue, and is often asymtomatic in early stages
cirrhosis
slide 35
s/s of cirrhosis
- jaundice
- ascites
- varices
- coagulopathy
- encephalopathy
slide 35
most common causes of cirrhosis
Alcoholic fatty liver, NAFL, HCV, HBV
slide 35
Chirrhosis:
- labs
- tx:
- Elevated labs: AST/ALT, bilirubin, Alk phosphatase, PT/INR
Thrombocytopenia - Transplant is only cure
slide 35
complications of cirrhosis (8)
- portal HTN
- ascites
- spontaneous bacterial peritonitis
- varices
- hepatic encephalopathy
- hepatorenal syndrome
- hepatopulmonary syndrome
- portopulmonary HTN
slide 36-38
this has HVPG >5 and ↑vascular resistance within the portal venous system
portal htn
slide 36
this is the most common complication of cirrhosis, where portal-HTN leads to ↑blood volume & peritoneal accumulation of fluid. It is managed with ↓Salt diet, albumin replacement or Transjugular Intrahepatic Portosystemic Shunt (TIPS).
ascities
TIPS- Reduces P-HTN and ascites
slide 36
this is the most common infection r/t cirrhosis and requires abx
Spontaneous Bacterial Peritonitis
slide 36
this is present in ̴50% cirrhosis pts
varices
slide 37
Hemorrhage is most lethal complication of cirrhosis, what can be done to help prevent this/treat it?
- Beta blockers help reduce risk
- Prophylactic endoscopic variceal banding & ligation
- Refractory bleeding → balloon tamponade
slide 37
this is a buildup of nitrogenous waste d/t poor liver detoxification. It has neuropsychiatric symptoms (cognitive impairment → coma).
hepatic encephalopathy
slide 37
tx for hepatic encephalopathy
- Lactulose, Rifaximin to ↓ammonia-producing bacteria in gut
slide 37
what is hepatorenal syndrome and what is it tx?
- Excess endogenous vasodilators (NO, PGs)→↓systemic MAP→↓RBF
- Tx: Midodrine, Octreotide, Albumin
slide 38
hepatopulmonary syndrome has a triad of chronic liver disease which is?
- hypoxemia
- intrapulmonary vascular dilation
- platypnea (hypoxemia when upright) d/t R to L intrapulmonary shunt
slide 38
what is portopulmonary HTN? what is its tx?
- Pulmonary HTN accompanied by portal HTN. Systemic vasodilation triggers production of pulmonary vasoconstrictors
- Tx: PD-I’s, NO, prostacyclin analogs, and endothelin receptor antagonists. Transplant is only cure
slide 38
for anesthesia with liver disease pts when is elective surgery contraindicated?
- acute hepatitis
- severe chronic hepatitis
- ALF
slide 39
what are the 2 scoring systems to determine severity and prognosis of liver disese?
- Child-Turcotte-Pugh (CTP):
- Model for End Stage Liver Disease (MELD)
slide 39
what is Child-Turcotte-Pugh (CTP)
points based on bilirubin, albumin, PT, encephalopathy, ascites
Ask Bill, Al, Pete, and Brian (Brain=brain/encephalopathy)
slide 39
what is the Model for End Stage Liver Disease (MELD):
scorebased on bilirubin, INR, creatinine, sodium
double date for Bill, Iris, Craig and Sarah
slide 39
here is aguide on whether or not to proceed or cancel surgery for pts with liver disease
slide 40
what preop labs should be performed in pts with liver disease?
- CBC
- BMP
- PT/INR
slide 41
Liver disease has a ____ threshold for invasive moniotoring, and an increased risk for?
- Low threshold
- increased risk for aspiration, hypotension, hypoxemia
slide 41
what is better for resuscitation for liver disease?
colloids > crystalloids
slide 41
how does alcholism effect MAC?
increases MAC of volatile anesthetics
slide 41
with liver disease what should be considered with medications? And what anesthesia meds are ideal?
- drugs may have a slow onset or a prolonged duration of action
- Succs and cisatricurium are ideal because they are not liver metabolized
slide 41
what may be decreased in severe liver disease?
plasma cholineterase
slide 41
what should be controlled in pts with liver disease
bleeding/coagulation
slide 41
What is Transjugular Intrahepatic Portosystemic Shunt (TIPS_
- procedure to manage portal HTN
- Stent or graft placed btw hepatic vein and portal vein
- Shunts portal flow to systemic circulation
- Reduces the portosystemic pressure gradient
slide 41
what are the indications for TIPS procdure?
contraindications?
Indications:
* Refractory variceal hemorrhage
* Refractory ascites
Contraindications:
* Heart Failure
* Tricuspid regurgitation
* Severe pulmonary HTN
slide 42
This is a resection to remove neoplasms, leaving adequate tissue for regeneration. It has a tolerable amount of resection d/o preexisting liver disease and function, and up to 75% removal is tolerated in pts with normal liver function
partial hepatectomy
slide 43
anesthesia considerations for a partial hepatectomy
- Invasive monitoring
- Blood products available
- Adequate vascular access for blood/pressors
slide 43
what may a surgeron due to control blood loss during a partial hepatectomy?
- clamp IVC or hepatic artery
slide 43
what is stardard practice for a partial hepatectomy to reduce blood loss?
Standard practice is to maintain low CVP by fluid restriction, prior to resection to reduce blood loss
slide 43
what do pts often require in PACU after a partial hepatectomy?
PCA postoperatively
slide 43
postop coagulation disturbances are caused by
liver resection
slide 43
what is a definitive treatmeant for ESLD?
liver transplant
slide 44
what is the most common indication for a liver transplant? what are other reasons for one?
- alcoholic liver disease most common
- fatty liver
- Hepatocellular carcinoma (HCC)
slide 44
why do we time living donor liver transplants at the same time?
minimal ischemia time
slide 44
what is done with a liver that is harvested from brain dead donor
liver is kept hemodynamically stable for organ to perfuse
slide 44
what is the intraoperative management for a liver transplant?
- Maintain hemodynamics (Pressors/Inotropes readily available) A-line, CVC, PA cath, TEE
- Control coagulation
slide 44
Surgical and anesthesia considerations for liver transplant: (this is mostly an FYI for practice)
* preoperative
* disection
* anhepatic
* reperfusion
* posttransplantation
- Preoperative: Surgical - transplantation evaluation Anesthetic - preop eval, vascular access, blood availability
- Dissection: Surgical - incision, mobilization of liver and vascular structures Anesthetic - hemodynamic compromise from fluid loss
- Anhepatic: surgical - clamping of hepatic artery, portal vein, removal of diseased liver, anastomosis of IVC. Anesthetic - hemodynamic compromise from full or partial IVC clamping, metabolic acidosis from citrate intoxication
- Reperfusion: Surgical - anastomosis of hepatic artery Anesthesia - hemodynamic instability, dysrhythmias, hyperkalemia, acidosis
- Posttransplantation: surgical - hemostasis, eval graft, US. Anesthesia - ICU admission, early or late extubation, management of hemodynamics
slide 45
t/f The liver is the largest internal organ in the body
True
kahoot
What are the metabolic functions of the liver?
a. Carbohydrate metabolism
b. Protein metabolism
c. Fat metabolism
d. Rocuronium metabolism
kahoot
What part of the liver cleans the blood as it passes through
Kupffer cells
kahoot
The liver performs which of the following
a. Forms many compounds from carbohydrate intermediaries
b. Conversion of galactose and fructose to glucose
c. Glucogenesis
d. Storage of large amount of glycogen
all of them
kahoot
The most common cause of cirrhosis is?
ETOH
kahoot
t/f Cirrhosis results in splenomegaly, esophageal varices and left heart failure
False, its right heart failure
kahoot
Cirrhotic patients should be resuscitated with
Colloids
kahoot
vitamin k is used to treat an elevated PT which measures the ____ pathway
Extrinsic
kahoot
A platelet count less than ____ requires preoperative replacement
a. 100K, 150K, 50K, 75K
all of them
kahoot
bri is confused by this
t/f
Anesthetic drugs may cause postoperative liver dysfunction to be exaggerated
True
kahoot
t/f Chronic alcoholism increases MAC for iso and this probably due to cross tolerance
True
kahoot
Marlea is confused by this - direct contradiction to Kane
Ashley is also confused by this…:(
Plasma cholinesterase may be ____ in severe liver disease
Decreased
kahoot
Manifestation of alcohol withdrrawl occur in ____ hours
after receiving no alcohol intake
24-72 hrs
kahoot
T/F Hepatitis is the most commonly transmitted blood borne pathogen
False
kahoot
Drugs that can cause hepatitis include
- Analgesics
- Anticonvulsants
- VAA’s
- Tranquilizers
kahoot
What surgical procedure is associated with the highest mortality
a. Bka
b. Orif of the tibia
c. Laparotomy
d. Coronary angioplasty
C. laparotomy
kahoot
