Liver Flashcards
which structure is responsible for eliminating bacteria from the liver?
Kupffer cell
Functional unit of liver
Lobule (also states acinus elsewhere - apparently is referenced as smallest functional unit of liver)
Where are kupffer cells located
Sinusoids
Collect bile? This bile is produced by ?
Canaliculi
Hepatocytes
Zone of lobule with highest concentration of CYP450 enzymes
zone 3
Function as arterioles
Terminal branches of:
- Hepatic artery
- Portal vein
Capillaries of Lobule
Sinusoids
Venules of Lobule
Central vein
Lobule anatomy
Lymph and proteins drain into:
The space of Disse (between hepatocyte and sinusoid)
The liver is responsible for about _____ the lymph production in the body
half
Blood flow/oxygenation to the liver:
- % Cardiac output:
- The hepatic artery provides:
- The portal vein provides:
- 30%
- The hepatic artery provides: 25% flow, 50% O2
- The portal vein provides: 75% flow, 50% O2
Increased splanchnic vascular resistance _______ portal vein blood flow. Increased Splanchnic VR Caused by:
Reduces
- SNS stim
- pain
- hypoxia
- hypercarbia
Severe liver disease ______ the hepatic arterial buffer response to inadequate blood flow
Abolishes
Perioperative factors that reduce Liver blood flow:
- Increased Splanchnic vascular resistance
- Increased CVP
- Some B.Blockers - propanolol reduces CO and increases Splanchnic VR
- Intraabdominal surgeries
- Laparoscopic procedures
Coagulation factors Not produced by hepatocytes:
Which one is still produced in liver but not by hepatocytes?
- Factor 3
- Factor 8 (still in liver by sinusoids)
- vWf
- Also calcium is a clotting factor not from liver
The liver produces all the plasma proteins except?
Immunoglobulins (gamma gobulins)
AST/ALT: values indicate?
- Both elevated: Hepatitis
- AST/ALT ratio >2: Cirrhosis or alcoholic liver disease
Values most indicitive of Biliary duct obstruction
5-nucleotidase
(enzymes spill into circulation when obstruction, will see alkaline phos and y-glutamylpeptidase too)
Pre-hepatic liver disease labs?
elevated Bilirubin (unconjugated)
Most common cause of Hepatits? Second?
Most common ETOH
Second: Hep C
What is depleted in Acetaminophen toxicity and what depletes it?
Glutathione is depleted
NAPQI (N-Acetyl-p-benzoquinoneamine) depletes it, a metabolite of Acetominophen
Hepatotoxic drugs:
- Halothane
- Acetominophen
- Amiodarone
- Antibiotics: PCN, Tetracycline, Sulfonamides
MELD (Model of end-stage Liver disease) classification: Numbers and criteria
Low risk: < 10
Int risk: 10-15
High risk: > 15
BIC
Bilirubin, INR, Cr
(predicts 90-day mortality)
Child-Pugh score risk numbers, and Factors:
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
pre-anhepatic phase
- ends with cross-clamping
- Aspiration risk high
Anhepatic phase
- significantly reduced preload and CO
- worsening coagulopathy/bleeding
Neohepatic phase
key complications:
- hyperkalemia
- hypocalcemia
- cytokine release
- lactic acidosis
- embolic debris
- hypovolemia
- hypotension
- pulm HTN
- hypothermia
- cardiac arrest
Post-reperfusion syndrome
Defined as:
- hypotension >30% below baseline for at least 1 min in first 5 min of reperfusion
- Common: 10-60% incidence
LFTs: Synthetic function of Liver
- PT (very sensitive)
- Albumin (not sensitive)
LFTs: Hepatocellular Injury
- ALT
- AST
LFTs: Hepatic clearance of Liver
Bilirubin
LFTs: biliary duct obstruction
- Alkaline Phos (not sensitive)
- Y-Glutamyl transpeptidase (more sensitive)
- 5-nucleotidase (most sensitive)
