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APEX: Flashcards > Liver > Flashcards

Liver Flashcards

1
Q

liver anatomy

A
  • receives SNS innervation from T3-11
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2
Q

liver lobule

A
  • functional unit of liver
  • arterioles = terminal branches of hepatic artery & portal vein
  • capillaries = sinusoids
  • venules = central vein
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3
Q

acinus

A
  • divided into 3 zones that correspond w/ distance from arterial O2 supply
  • zone 1 most oxygenated
  • zone 3 least oxygenated
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4
Q

kupffer cells

A

remove bacteria before blood flows into vena cava

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5
Q

bile is produced by

A

hepatocytes

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6
Q

bile is stored in

A

gallbladder

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7
Q

flow of bile

A

canaliculi (in liver) > bile duct > common hepatic duct + cystic duct (GB) = common bile duct > duodenum

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8
Q

sphincter of Oddi

A
  • controls flow of bile released from common hepatic duct
  • contraction increases biliary pressure
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9
Q

3 functions of bile

A
  • absorption of fat-soluble vit (DAKE)
  • excretory pathyway for bilirubin & prodcuts of metabolism
  • alkalinization of duodenum
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10
Q

cholecystokinin (CCK)

A
  • produced in duodenum
  • eating fat & protein increases CCK release & flow of bile from GB
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11
Q

lymph drainage

A
  • drains into space of disse
  • liver responsible for 1/2 of lymph production
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12
Q

liver receives ____% of CO

A

30%

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13
Q

hepatic artery

A
  • 25% liver blood supply
  • 50% O2 supply
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14
Q

portal vein

A
  • 75% liver blood supply
  • 50% O2 supply
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15
Q

liver blood flow

A
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16
Q

celiac artery provides blood flow to which 3 organs?

A
  1. liver
  2. spleen
  3. stomach
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17
Q

superior mesenteric artery provides blood flow to which 3 organs?

A
  1. pancreas
  2. small intestine
  3. colon
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18
Q

1 organ that receives blood flow from inferior mesenteric artery

A

colon

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19
Q

liver venous blood flow

A
  • portal vein receives blood that has passed through splanchnic circulation
  • not autoregulated
  • increased splanchnic vascular resistance decreased portal vein blood flow
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20
Q

portal perfusion pressure

A

= portal vein pressure / hepatic vein pressure

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21
Q

portal HTN

A
  • Dx:
    1. portal vein pressure > 20-30 mmHg
    2. sinusoids > 5 mmHg
  • back pressure to splanchnic organs
  • splenomegaly
  • varices: esophagus/stomach/intestine
  • risk of hemorrhage of varices
  • ascites
  • spider angiomas
  • hemorrhoids
  • encephalopathy
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22
Q

hepatic arterial flow

A
  • if portal vein blood flow decreases, hepatic arterial buffer response increases flow through hepatic artery
23
Q

hepatic artery perfusion pressure

A

= MAP - hepatic vein pressure

24
Q

Factors that reduce liver blood flow

A
  • GA
  • neuraxial
  • increased splanchnic vascular resistance (SNS stimulation, pain, hypoxia, propanolol)
  • increased CVP (PPV, excess hydration, CHF)
  • BB
  • intraabdominal surgery
  • laparoscopic surgery
25
Q

Hepatocytes produce

A
  • all coag factors except vWF, 3, 4, 8
  • thrombopoietin
  • A1acid glycoprotein
  • antithrombin
  • protein c, s
  • plasminogen
  • albumin
26
Q

Hepatocytes produce all coagulation factors except

A
  • vWF (produced by vascular endothelial cells)
  • factor 3 (same as above)
  • factor 4 (diet)
  • factor 8 (sinusoidal cells)
27
Q

Factor 8 is produced by

A

liver sinusoidal cells & endothelial cells

28
Q

liver metabolic functions

A

-glycogenesis/glycogenolysis/ gluconeogenesis
- converts ammonia to urea for elimination in kidneys
- storage of triglycerides
- synthesis of cholesterol, lipoproteins, phospholipids
- bilirubin conjugation

29
Q

LFTs that assess synthetic function

A
  • PT
  • albumin
30
Q

LFTs that assess hepatocellular injury

A
  • AST
  • ALT
31
Q

LFTs that assess hepatic clearance

A
  • bilirubin
32
Q

LFTs that assess biliary duct obstruction

A
  • alkaline phosphatase
  • Y glutamyl transpeptidase
  • 5’-nucleotidase
33
Q

very sensitive for acute liver injury

A

PT

34
Q

not sensitive for acute liver injury

A

albumin

35
Q

marked increase AST & ALT

A

hepatitis

36
Q

AST/ALT ratio > 2

A

cirrhoisis or alcoholism

37
Q

most sensitive for biliary obstruction

A

5’-nucleotidase

38
Q

hepatitis

A
39
Q

Drug-induced hepatitis

A
  • acetaminophen OD
  • halothane
  • alcohol
40
Q

most common cause of acute liver failure in US

A

acetaminophen OD

41
Q

acetaminophen OD

A
  • max dose Tylenol = 4 g/day
  • glutathione = substrate for phase 2 conjugation
  • tylenol produces toxic metabolite N-acetyl-p-benzoquinoneimine
  • tylenol OD consumes glutathione in liver
  • leads to hepatocellular injury
  • Tx = oral N-acetylcysteine w/i 8 hours OD
42
Q

Chronic hepatitis

A
  • > 6 mo
  • most common cause = alcoholism
  • 2nd most common = hep c
  • increased liver enzymes + bilirubin + histologic evidence of liver inflammation
  • S/S: jaundice, fatigue, thrombocytopenia, glomerulonephritis, neuropathy, arthritis, myocarditis
  • prolonged PT
  • decreased albumin
43
Q

anesthetic considerations for acute hepatitis

A
  • delay elective surgery until LFTs normal & s/s resolved
  • iso or sevo
  • avoid PEEP
  • normocapnia
  • IVFs
  • regional ok if no coagulopathy
  • AVOID: tylenol, halothane, amiodarone, PCN, tetracycline, sulfonamides
  • decreased pseudocholinesterase activity (sux)
  • decreased biliary excretion (roc)
  • larger Vd
44
Q

Anesthesia considerations alcoholism

A
  • MAC decreased in acute intoxication
  • MAC increased in chronic alcoholic
  • alcohol potentiates GABA
  • alcohol inhibits NDMA
  • aspiration risk
  • assume acutely intoxicated full stomach
45
Q

alcohol withdrawal syndrome

A
  • s/s 6-8 hrs after blood alcohol conc returns to near normal & peaks at 24-36 hrs
  • early s/s = tremors, hallucinations
  • late s/s = increased SNS, n/v, confusion, agitation
  • tx = alcohol, BB, A2 agonist

delirium tremens occur 2-4 days w/o alcohol
- s/s = SZ, tachycardia, hypo/hypertension, combative
- tx = benzos, BB

46
Q

Wernicke-Korsakoff syndrome

A
  • loss of neurons in cerebellum
  • vitamin B1 (thiamine) deficiency
47
Q

disulfiram

A
  • treatment for alcoholics in recovery
  • hepatotoxic
  • inhibits dopamine beta hydroxylase (NE synthesis) –hypotension
48
Q

Cirrhosis

A
  • cell death where healthy tissue is replaced by nodules & fibrotic tissue
  • reduced number of functional hepatocytes
49
Q

MELD risk

A
  • predicts 90 day mortality
  • uses bilirubin, INR, creatinine
  • low risk = < 10
  • intermediate risk = 10-15
    • high risk = > 15 (increased M&M)
50
Q

child-pugh score

A

Class C (10-15 points) = 80% risk periop mortality

51
Q

Patho ESLD

A

anesthetic considerations same as acute hepatitis

52
Q

TIPS procedure

A
  • bypasses portion of hepatic circulation by shunting blood from portal vein to hepatic vein
  • significant risk for hemorrhage
53
Q

liver transplant

A
  • most common indication = hep C
  • preop: blood products
  • RSI
54
Q

gallbladder

A
  • ## biliary stones can cause obstructive defect that impedes flow of bile as well as pancreatic enzymes. they back up into liver & pancreas

APEX: Flashcards (13 decks)

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