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Apex > Liver > Flashcards

Liver Flashcards

1
Q

________ is a connective tissue covering that encapsulates the liver

A

Glisson’s capsule

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2
Q

What is the functional unit of the liver?

A

the lobule

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3
Q

In the liver, arterioles are called:

A

Terminal branches of either the hepatic artery or portal vein

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4
Q

In the liver, capillaries are called:

A

sinusoids

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5
Q

In the liver, venules are called:

A

the central vein

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6
Q

What is the acinus?

A

Another way of defining the functional units of the liver

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7
Q

What are the three zones of the acinus

A
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8
Q

Which cells remove bacteria from the liver?

A

Kupffer cells

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9
Q
A
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10
Q
A
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11
Q

Bile has three functions:

A

Absorbs fat soluble vitamins (DAKE)

Excretes bilirubin and other byproducts

alkalizes the duodenum

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12
Q

What is CCK?

A

Cholecystokinin

produced in the duodenum and released when large amounts of fat are present, stimulating gallbladder contraction and bile flow

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13
Q

How much lymph is produced in the liver?

A

About 50% of the lymph in the body

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14
Q

The liver receives ____% of the cardiac output

A

30%

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15
Q

The portal vein supplies _____% of total liver blood flow

A

75%

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16
Q

The portal vein supplies _____% of the liver’s oxygen delivery

A

50%

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17
Q

The hepatic artery supplies _____% of total liver blood flow

A

25%

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18
Q

The hepatic artery supplies ____% of the liver’s oxygen delivery

A

50%

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19
Q

How is portal blood flow autoregulated?

A

It isn’t. It’s completely dependent on splanchnic vascular resistance. Any increase in splanchnic resistance decreases liver flow

20
Q

How is the hepatic artery autoregulated?

A

Whenever liver perfusion decreases from portal flow, the hepatic artery increases flow to compensate

21
Q

The celiac artery supplies which three organs?

A

Liver
Stomach
Spleen

22
Q

The liver produces all clotting factors except:

A

3
4
vWF

23
Q

What are the vitamin K dependent clotting factors?

A

2
7
9
10
Proteins C & S

24
Q

The liver produces all of the plasma proteins EXCEPT

A

immunoglobulins

25
Q

Which factor is produced by sinusoids, NOT hepatocytes?

A

Factor 8

26
Q

What does the liver do with unconjugated bilirubin?

A

Conjugates it with glucuronic acid for excretion in bile

27
Q

Which form of bilirubin is neurotoxic?

A

Unconjugated

28
Q

Which test is the most sensitive for acute hepatic injury?

A

PT, because the half life of factor 7 is only 4-6 hours

29
Q

What is the half life of albumin?

A

21 days

30
Q

An AST/ALT ratio greater than 2 suggests:

A

cirrhosis or alcoholic liver disease

31
Q

Which forms of hepatitis can lead to cirrhosis?

A

B or C, but NOT a

32
Q

Why does a tylenol overdose lead to liver failure?

A

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

33
Q

Which beta blocker is helpful with portal hypertension?

A

Propanolol. It has the added benefit of constricting splanchnic vessels, which reduces blood delivery to the liver

34
Q

What paralytic considerations are there for a patient with liver dysfunction?

A

May be reduced pseudocholinesterase production

Roc excretion will be delayed (biliary)

Large Vd because of low plasma proteins

35
Q

Alcohol withdrawal begins at _____ hours and peaks at _____ hours

A

begins at 6-8

peaks at 24-36

36
Q

Why does cirrhosis create portal hypertension?

A

Fibrotic cells do not have the same vascular supply, so blood entering the liver has fewer vessels to empty into, hence the back up

37
Q

What is the treatment for alcohol withdrawal?

A

Alcohol
Precedex
Beta blockers

38
Q

Does severe liver disease increase or decrease CO?

A

Increases

The liver is unable to clear vasodilating substances from the blood stream, leading to a drop in SVR and a hyperdynamic CO

39
Q

What are the pulmonary effects of cirrhosis?

A

Ascites and pleural effusions create restriction

Hypoxemia from pulmonary vasodilation and pHTN leads to compensatory hyperventilation, causing resp alkalosis

40
Q

What does a TIPS procedure do?

A

Shunts blood from the portal vein to the hepatic vein

41
Q

What are some induction considerations for a patient receiving a liver transplant?

A

RSI. They’re all considered full stomach.

42
Q

How is serum potassium effected during liver transplant?

A

When the new liver is perfused, K will spike and Ca will fall!

43
Q

What is postreperfusion syndrome?

A

Systemic hypotension 30% or more below baseline for 1 of 5 minutes following reperfusion

44
Q

glucagon increases the risk of:

A

PONV

45
Q

What are the risk factors for halothane hepatitis?

A

Female
Age > 40
Genetic predisposition
Obesity
CYP2E1 inhibition

46
Q
A

Apex (46 decks)

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