Liver Flashcards
________ is a connective tissue covering that encapsulates the liver
Glisson’s capsule
What is the functional unit of the liver?
the lobule
In the liver, arterioles are called:
Terminal branches of either the hepatic artery or portal vein
In the liver, capillaries are called:
sinusoids
In the liver, venules are called:
the central vein
What is the acinus?
Another way of defining the functional units of the liver
What are the three zones of the acinus
Which cells remove bacteria from the liver?
Kupffer cells
Bile has three functions:
Absorbs fat soluble vitamins (DAKE)
Excretes bilirubin and other byproducts
alkalizes the duodenum
What is CCK?
Cholecystokinin
produced in the duodenum and released when large amounts of fat are present, stimulating gallbladder contraction and bile flow
How much lymph is produced in the liver?
About 50% of the lymph in the body
The liver receives ____% of the cardiac output
30%
The portal vein supplies _____% of total liver blood flow
75%
The portal vein supplies _____% of the liver’s oxygen delivery
50%
The hepatic artery supplies _____% of total liver blood flow
25%
The hepatic artery supplies ____% of the liver’s oxygen delivery
50%
How is portal blood flow autoregulated?
It isn’t. It’s completely dependent on splanchnic vascular resistance. Any increase in splanchnic resistance decreases liver flow
How is the hepatic artery autoregulated?
Whenever liver perfusion decreases from portal flow, the hepatic artery increases flow to compensate
The celiac artery supplies which three organs?
Liver
Stomach
Spleen
The liver produces all clotting factors except:
3
4
vWF
What are the vitamin K dependent clotting factors?
2
7
9
10
Proteins C & S
The liver produces all of the plasma proteins EXCEPT
immunoglobulins
Which factor is produced by sinusoids, NOT hepatocytes?
Factor 8
What does the liver do with unconjugated bilirubin?
Conjugates it with glucuronic acid for excretion in bile
Which form of bilirubin is neurotoxic?
Unconjugated
Which test is the most sensitive for acute hepatic injury?
PT, because the half life of factor 7 is only 4-6 hours
What is the half life of albumin?
21 days
An AST/ALT ratio greater than 2 suggests:
cirrhosis or alcoholic liver disease
Which forms of hepatitis can lead to cirrhosis?
B or C, but NOT a
Why does a tylenol overdose lead to liver failure?
Glutathione is the substrate for Tylenol’s toxic metabolite (NAPQ). Once glutathione stores are consumed, the liver is damaged by the overwhelming amount of NAPQ
Which beta blocker is helpful with portal hypertension?
Propanolol. It has the added benefit of constricting splanchnic vessels, which reduces blood delivery to the liver
What paralytic considerations are there for a patient with liver dysfunction?
May be reduced pseudocholinesterase production
Roc excretion will be delayed (biliary)
Large Vd because of low plasma proteins
Alcohol withdrawal begins at _____ hours and peaks at _____ hours
begins at 6-8
peaks at 24-36
Why does cirrhosis create portal hypertension?
Fibrotic cells do not have the same vascular supply, so blood entering the liver has fewer vessels to empty into, hence the back up
What is the treatment for alcohol withdrawal?
Alcohol
Precedex
Beta blockers
Does severe liver disease increase or decrease CO?
Increases
The liver is unable to clear vasodilating substances from the blood stream, leading to a drop in SVR and a hyperdynamic CO
What are the pulmonary effects of cirrhosis?
Ascites and pleural effusions create restriction
Hypoxemia from pulmonary vasodilation and pHTN leads to compensatory hyperventilation, causing resp alkalosis
What does a TIPS procedure do?
Shunts blood from the portal vein to the hepatic vein
What are some induction considerations for a patient receiving a liver transplant?
RSI. They’re all considered full stomach.
How is serum potassium effected during liver transplant?
When the new liver is perfused, K will spike and Ca will fall!
What is postreperfusion syndrome?
Systemic hypotension 30% or more below baseline for 1 of 5 minutes following reperfusion
glucagon increases the risk of:
PONV
What are the risk factors for halothane hepatitis?
Female
Age > 40
Genetic predisposition
Obesity
CYP2E1 inhibition
