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*My APEX > Liver > Flashcards

Liver Flashcards

1
Q

which structure is responsible for eliminating bacteria from the liver?

A

Kupffer cell

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2
Q

Functional unit of liver

A

Lobule (also states acinus elsewhere - apparently is referenced as smallest functional unit of liver)

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3
Q

Where are kupffer cells located

A

Sinusoids

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4
Q

Collect bile? This bile is produced by ?

A

Canaliculi

Hepatocytes

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5
Q

Zone of lobule with highest concentration of CYP450 enzymes

A

zone 3

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6
Q

Function as arterioles

A

Terminal branches of:

  • Hepatic artery
  • Portal vein
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7
Q

Capillaries of Lobule

A

Sinusoids

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8
Q

Venules of Lobule

A

Central vein

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9
Q

Lobule anatomy

A
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10
Q

Lymph and proteins drain into:

A

The space of Disse (between hepatocyte and sinusoid)

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11
Q

The liver is responsible for about _____ the lymph production in the body

A

half

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12
Q

Blood flow/oxygenation to the liver:

  • % Cardiac output:
  • The hepatic artery provides:
  • The portal vein provides:
A
  • 30%
  • The hepatic artery provides: 25% flow, 50% O2
  • The portal vein provides: 75% flow, 50% O2
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13
Q

Increased splanchnic vascular resistance _______ portal vein blood flow. Increased Splanchnic VR Caused by:

A

Reduces

  • SNS stim
  • pain
  • hypoxia
  • hypercarbia
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14
Q

Severe liver disease ______ the hepatic arterial buffer response to inadequate blood flow

A

Abolishes

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15
Q

Perioperative factors that reduce Liver blood flow:

A
  • Increased Splanchnic vascular resistance
  • Increased CVP
  • Some B.Blockers - propanolol reduces CO and increases Splanchnic VR
  • Intraabdominal surgeries
  • Laparoscopic procedures
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16
Q

Coagulation factors Not produced by hepatocytes:

Which one is still produced in liver but not by hepatocytes?

A
  • Factor 3
  • Factor 8 (still in liver by sinusoids)
  • vWf
  • Also calcium is a clotting factor not from liver
17
Q

The liver produces all the plasma proteins except?

A

Immunoglobulins (gamma gobulins)

18
Q

AST/ALT: values indicate?

A
  • Both elevated: Hepatitis
  • AST/ALT ratio >2: Cirrhosis or alcoholic liver disease
19
Q

Values most indicitive of Biliary duct obstruction

A

5-nucleotidase

(enzymes spill into circulation when obstruction, will see alkaline phos and y-glutamylpeptidase too)

20
Q

Pre-hepatic liver disease labs?

A

elevated Bilirubin (unconjugated)

21
Q

Most common cause of Hepatits? Second?

A

Most common ETOH

Second: Hep C

22
Q

What is depleted in Acetaminophen toxicity and what depletes it?

A

Glutathione is depleted

NAPQI (N-Acetyl-p-benzoquinoneamine) depletes it, a metabolite of Acetominophen

23
Q

Hepatotoxic drugs:

A
  • Halothane
  • Acetominophen
  • Amiodarone
  • Antibiotics: PCN, Tetracycline, Sulfonamides
24
Q

MELD (Model of end-stage Liver disease) classification: Numbers and criteria

A

Low risk: < 10

Int risk: 10-15

High risk: > 15

BIC

Bilirubin, INR, Cr

(predicts 90-day mortality)

25
Q

Child-Pugh score risk numbers, and Factors:

A

Class A (5-6 points) - 10% risk perioperative mortality

Class B (7-9 points) - 30%

Class C (10-15 points) - 80%

AB-APE

Albumin, Bilirubin, Ascites, PT, Encephalopothy

26
Q

pre-anhepatic phase

A
  • ends with cross-clamping
  • Aspiration risk high
27
Q

Anhepatic phase

A
  • significantly reduced preload and CO
  • worsening coagulopathy/bleeding
28
Q

Neohepatic phase

A

key complications:

  • hyperkalemia
  • hypocalcemia
  • cytokine release
  • lactic acidosis
  • embolic debris
  • hypovolemia
  • hypotension
  • pulm HTN
  • hypothermia
  • cardiac arrest
29
Q

Post-reperfusion syndrome

A

Defined as:

  • hypotension >30% below baseline for at least 1 min in first 5 min of reperfusion
  • Common: 10-60% incidence
30
Q

LFTs: Synthetic function of Liver

A
  • PT (very sensitive)
  • Albumin (not sensitive)
31
Q

LFTs: Hepatocellular Injury

A
  • ALT
  • AST
32
Q

LFTs: Hepatic clearance of Liver

A

Bilirubin

33
Q

LFTs: biliary duct obstruction

A
  • Alkaline Phos (not sensitive)
  • Y-Glutamyl transpeptidase (more sensitive)
  • 5-nucleotidase (most sensitive)

*My APEX (10 decks)

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