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BioScience II > Hepatobillary PPT-Josh > Flashcards

Hepatobillary PPT-Josh Flashcards

1
Q

this is my last ppt for this test I am going to go through it and only grab the highlights!!!

A

I cant look at this shit anymore

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2
Q

what is the largest solid organ in the body?

A

liver

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3
Q

Liver:

is made up of 50,000-100,000 discrete anatomic units called what?

A

lobules

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4
Q

Liver:

how many portal tracts are there?

A

4-5

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5
Q

what are the 2 types of cells that line the sinusoids?

A

endothelial

kupffer cells (macrophages)

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6
Q

Hepatic blood flow:

dual afferent blood supply equal to __% of CO

A

25%

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7
Q

Hepatic blood flow:

70% of blood is spplied via the ____

A

Portal vein

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8
Q

Hepatic blood flow:

30% suppied via the _______

A

hepatic artery

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9
Q

Hepatic blood flow:

is how many ml/min

A

1500 mL/min

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10
Q

Hepatic blood flow:

arterial flow is autoregulated based on what?

A

O2 consumption

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11
Q

Hepatic blood flow:

a decrease in either hepatic arterial or portal venous flow results in what?

A

compensatory increases in the other

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12
Q

what is teh normal hepatic blood volume?

A

450 mL

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13
Q

Fuctions of LIver?

A

Reservoir

Blood cleansing

metabolic

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14
Q

Blood cleansing fx:

blood from the gut contains large amounts of colonic bacilli, cleansing is performed by the ___ cells that line the hepatic sinus

A

Kupffer cells

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15
Q

____ cells lint the hepatic sinuc and permit diffusion of large plasma proteins and other substances into extravascular spaces in the liver, resulting in a large quanity of lymph that is nearly equal in protein concentration to plasma

A

endothelial

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16
Q

Metabolic Functions of liver

what re the 4 main metabolic fxns?

A
  1. Carbohydrate metabolism
  2. Fat metabolism
  3. Protein metabolism
  4. Drug metabolism
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17
Q

Metabolic Functions of liver

what are the 3 ways the liver does carbohydrate metabolism

A
  1. Gylcogenesis
    • process of glycogen synthesis
  2. Glycogenolysis
    • Release of glucose form glycogen
  3. Gluconeogenesis
    • Conversion of fats/proteins to glucose
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18
Q

Metabolic Functions of liver

what are the final products of Carbohydrate metabolism

A

glucose

frutose

galactose

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19
Q

Metabolic Functions of liver

what are the 2 ways of fat metabolism

A
  1. Lipogenesis
    • synthesis of cholesterol and proteins and carbs from fat
  2. Lipolysis
    • breakdown of lipids
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20
Q

Metabolic Functions of liver

how does it do protein metabolism

A
  • Deamination of proteins
  • Deamination of excess amino acids
  • Synthesis of lipoproteins
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21
Q

Metabolic Functions of liver

how does it do Drug metabolism

A

phase I and II biotransformation

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22
Q

Metabolic Functions of liver

what are the vitamins it stores?

A

A,D,E,K

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23
Q

Metabolic Functions of liver

the liver does synthesis of coagulation factors and inhibitors, in fact it does most all clotting factors except???

A

Factor VIII

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24
Q

Metabolic Functions of liver

how it is responsible for phagocytosis?

A

filtration and destruction of bacteria and debris in blood

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25
Q

Metabolic Functions of liver

what minerals is it responsible for?

A

iron hemostasis

copper regulation

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26
Q

LFTs:

normal Albumin

A

3.5-5.5 g/dL

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27
Q

LFTs:

normal AST

A

10-40 U.mL

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28
Q

LFTs:

normal ALT

A

5-35 U.mL

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29
Q

LFTs:

normal Alk phosphate

A

45-115 u/L

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30
Q

what is an inflammatory disease of the liver parenchyma

A

Hepatitis

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31
Q

Hepatitis:

what is teh most common form?

A

A (50%)

32
Q

Hepatitis:

how are each form transmitted?

  1. A
  2. B
  3. C
  4. D
A
  1. fecal-oral (sewage)/ shellfish
  2. Percutaneous/ sex
  3. Percutaneous
  4. percutaneous

Reacap B by sex

A by shit

33
Q

what is hepatic inflammation due to idiosyncratic reaction, dose related toxicity, or a combination of the 2

A

Drug induced hepatitis

34
Q

Drug induced hepatitis

what is teh most common type?

A

Alcoholic hepatitis

35
Q

Drug induced hepatitis

acetamiinophen ingestion of >_____ can cause this

A

25G

36
Q

Drug induced hepatitis

the onset is ___ weeks post exposure but can be up to six months

A

2-6 weeks

37
Q

what are the stages of alcohol induced liver damage?

A
  • fatty liver
  • Liver fibrosis
  • Cirrhosis
38
Q

which VAA can cause hepatitis?

A

halothane

called halothane hepatisis

39
Q

what is it called when normal liver parenchyma is replaced w/ fibrous and nodular tissie

A

Cirrhosis

40
Q

Cirrhosis:

what are early S/S

A

fatique

Malaise

jaundice

41
Q

Cirrhosis:w

hata re late S/S

A

spider angiomata

gynecomastia

testicular atrophy

ascites

42
Q

Cirrhosis:

why is hypogycemia common?

A

due ti inadequate gluconeogenesis

43
Q

Manisestations of Cirrhosis:

GI

A
  • PORTAL HTN
  • ascites
  • esophageal varies
  • Hemorrhoids
  • GI bleeding
44
Q

Manisestations of Cirrhosis:

circulatory

A
  • High CO
  • Systemic ateriovenous shunts
  • Low SVR
  • cirrhotic cardiomyopathy
45
Q

Manifestations of Cirrhosis:

Pulmonary

A
  • increased intrapulmonary shunting
  • Decreased FRC
  • Pleural effusion
  • Restrictive ventilatory defect
  • Resp alkolosis
46
Q

Manifestations of Cirrhosis

Renal

A
  • Increased reabsorption of Na+
  • Impaired free water clearance
47
Q

Manifestations of Cirrhosis:

Hematological

A
  • Anemia
  • Coagulopathy
48
Q

Manifestations of Cirrhosis:

infections

A

spontaneous bacterial peritonitis

49
Q

Manifestations of Cirrhosis:

Metabolic

A
  • HYPO Na+
  • HYPO K+
  • HYPO Mg++
  • HYPO albumin
  • HYPOglycemia
50
Q

Manifestations of Cirrhosis:

neuro

A

encephalopathy

51
Q

what disease is caused by obesity when there is an excess of intraheptic triglycerides, impaired insulin activity, and additional release of inflammatory cytokines

A

Non-alcoholic Fatty liver disease (NAFLD)

also called Nonalcoholic steatohepatitis

52
Q

NAFLD

___% of severly obese adults have this?

A

85%

53
Q

Anesthesia for pts w/ decreased liver function:

they are increased rick of what?

A

bleeding

infection

hepatic decompensation

death

54
Q

Anesthesia for pts w/ decreased liver function:

intraop what should you monitoe

A

BGL

55
Q

Anesthesia for pts w/ decreased liver function:

why to they get hypotensive?

A

low SVR and relative hypovolemia

56
Q

Anesthesia for pts w/ decreased liver function:

what do u need to do with NDMBD?

A

increase dose

57
Q

Anesthesia for pts w/ decreased liver function:

what do u need to do w/ propofol dose?

A

decrease

58
Q

Anesthesia for pts w/ decreased liver function:

why may SCh be prolonged?

A

b/c plasma cholinesterase is produced in the liver and may also be deficient

59
Q

Anesthesia for pts w/ decreased liver function:

VAAS and regional both decrease HBF by ____% in absence of stimulation

A

30%

60
Q

Anesthesia for pts w/ decreased liver function:

what 3 VAAs undergo minimal hepatic metabolism and can be regarded as safe

A

Iso

sevo

des

61
Q

Anesthesia for the drunk:

do they need more or less anesthesia

A

less (additive depressant effect)

62
Q

Anesthesia for the drunk:

why do u need aspiration precautions?

A

slowed gastric emptying

decreased LES tone

63
Q

Anesthesia for the drunk:

why may there be increased surgical bleeding

A

interferance w/ plt aggrigation

64
Q

Anesthesia for the drunk:

is the brain more or less tolerant to hypoxia?

A

less

65
Q

Anesthesia for the drunk:

what happens to circulating catecholamines

A

increased (labile VS and exaggerated responses to drugs and stimuli)

66
Q

Gallbladder:

capable of holding how much fluid

A

30-50 ml

67
Q

Gallbladder:

how is the common bile duct formed?

A
  • Bile ducts from hepatic Lobules join eventually forming the RIGHT and LEFT HEPATIC DUCTS
  • which combine to form the HEPATIC DUCT
  • which together with the CYSTIC DUCT from gallbladder become the COMMON BILE DUCT
68
Q

Gallbladder:

At the termination of these ducts is an envolope of smooth muscle called what, which provides a barrier to intestinal bacteria

A

Sphinter of Oddi

69
Q

Both the billary and pancreatic tracts empty into the duodenum via what?

A

ampulla of vater

70
Q

Gallbladder:

what provides the blood supply?

A

Cystic artery

71
Q

What is bile made of?

A
  • 97% water
  • <1% bile salts
  • inorganic salts
  • Lipids
  • Lecithin
  • Alkaline phosphate
  • Conjugated Bilirubin
72
Q

what is the functions of bile?

A
  • emulsify and enhance absorption of ingested fats and fat-soluble vitamins
  • provide excretatory pathway for drugs and toxins
  • maintain duodenal alkalization
73
Q

Bile:

hepatocytes in each lobule continuolsly secrete bile into bile canaliculi at a rate of ___ L/day

A

1

74
Q

what causes constraction of the gallbladder, relaxation of the sphinter of oddi, and propulsion of bile into the duodenum

A

CHOLECYSTOKIN

75
Q

what is the primary end product of Hgb metabolism and is formed from the degradation of the heme ring in the kupffer cells?

A

bilirubin

76
Q

Anesthesia for Billary Disease:

what opiod is most associated w/ spasms of the sphincter of oddi

A

morphine

77
Q

by far the award for the worst PPT goes to AMY WTF this shit was retarded and not to mention she filled up every single inch of the fucking ppt slides

A

really what the fuck????

BioScience II (39 decks)

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