Liver 3 Flashcards
Normal alkaline phosphatase levels are
45-115 units/L
Alkaline phosphatase specificity?
not very specific (also in bone, placenta, and tumors
Normal Y glutamyl transpeptidase is
0-30 units/L
____________ is more sensitive than _____________
Y Glutamyul transpeptidase is more sensitive than alkaline phosphatase
The most specific indicator of biliary duct obstruction is
5’ -nucleotidase
Causes of prehepatic liver disease include
hemolysis
hematoma reabsorption
Lab value changes in prehepatic liver disease include
elevated unconjugated bilirubin
Causes of hepatocellular injury include
cirrhosis
alcohol abuse
drugs
viral infection
sepsis
hypoxemia
Lab values of hepatocellular injury include
elevated conjugated bilirubin
elevated aminotransferase (ALT & AST)
elevated prothrombin time
decrease albumin- chronic injury only
normal or increased alkaline phosphatase
Reasons of cholestatic disease includes
biliary tract obstruction
sepsis
Lab values of cholestatic disease includes
elevated conjugated bilirubin
normal or elevated aminotransferase (late disease)
normal or elevated prothrombin time (late disease)
normal or low albumin (late disease)
elevated alkaline phosphatase
elevated & glutamyl transpeptidase, 5’-nucleotidase
Select the statements that BEST describe hepatitis. (select 2)
a. halothane hepatitis is an immune-mediated response
b. alcohol abuse is the most common cause of chronic hepatitis
c. hepatitis is usually transmitted via blood transfusion
d. hepatitis A usually causes cirrhosis
a. halothane hepatitis is an immune-mediated response
b. alcohol abuse is the most common cause of chronic hepatitis
____________ is the most common form of viral hepatitis
Hepatitis A
________ & _______ can cause cirrhosis
Hepatitis B and C
The most common cause of chronic hepatitis is
alcohol abuse
Hepatitis A is transmitted via
the oral-fecal route
__________ is associated with hepatocellular injury with variable degrees of necrosis
Hepatitis
Hepatitis can be
acute or chronic
The most common cause of hepatitis is
liver cancer
The most common indication for liver transplantation is
hepatitis
Etiologies of hepatitis include
viruses, hepatotoxins, & autoimmune responses
Hepatitis B & C can lead to
cirrhosis and hepatocellular carcinoma
Etiologies of drug-induced hepatitis include
acetaminophen, halothane, and alcohol
The antidote for acetaminophen overdose is
oral N-acetlycysteine
The most common cause of drug-induced hepatitis and chronic hepatitis is
alcohol
Chronic hepatitis is characterized by
hepatic inflammation that exceeds 6 months
Chronic hepatitis leads to the progressive destruction of
the hepatic parenchyma, cirrhosis, and ultimately liver failure
What is the pathophys of acetaminophen overdose?
tylenol produces a toxic metabolite called N-acetyl-p-benzoquinoneimine which in normal dosing is conjugated with glutathione
tylenol overdose consumes the liver’s supply of glutathione letting NAPQI rise & leads to hepatocellular injury
The liver metabolizes desflurane, isoflurane, and halothane to
inorganic fluoride ions & trifluoracetic acid
Up to _________ of halothane is metabolized
20%
Risk factors for halothane hepatitis include
age >40, female gender, greater than two exposures, genetics, obesity, CYP2E1 induction (alcohol, isoniazid, phenobarbital)
Diagnosis of chronic hepatitis includes
increased liver enzymes and bilirubin + histologic evidence of liver inflammation
S/sx of chronic hepatitis include
jaundice, fatigue, thrombocytopenia, glomerulonephritis, neuropathy, arthritis, and myocarditis
What lab values are changed with chronic hepatitis?
PT is prolonged
albumin is decreased
All of the following drugs should be avoided in the patient with acute hepatitis EXCEPT:
a. amiodarone
b. tetracycline
c. acetaminophen
d. propranolol
d. propranolol
For acute hepatitis, non-emergent surgery should be
postponed until symptoms have resolved and liver function tests return to normal
For chronic hepatitis, the patient may
proceed to surgery so long as the condition is stable
MAC is reduced in the patient who is ____________, but is increased in the _________________
acutely intoxicated with alcohol; but increased in the chronic alcohol user who is not intoxicated
Alcohol impairs
pharyngeal reflexes
Always assumes that the acutely intoxicated patient has
a full stomach
Anesthetic considerations for acute hepatitis include
maintaining liver blood flow (use is or sevo)
avoid PEEP
avoid hepatotoxic drugs
avoid drugs that inhibit hepatic enzymes
carefully monitor the neuromuscular junction
liberal fluids
regional anesthesia OK if there are no coagulation defects
Signs and symptoms of alcohol withdrawal begin
6-8 hours after blood alcohol concentration returns to near normal
Alcohol withdrawal peaks at
24-36 hours
Hepatotoxic drugs or drugs that inhibit CYP450 enzymes include
acetaminophen
halothane
amiodarone
antibiotics: PCN, tetracycline, and sulfonamides
Alcohol potentiates
GABA
Alcohol inhibits
NMDA receptors
Treatment for alcohol withdrawal includes
alcohol
beta-blockers
alpha-2 agonists
Early s/sx of alcohol withdrawal include
tremors and disorder perception (hallucinations, nightmares)
Late s/sx of alcohol withdrawal include
increased SNS activity (tachycardia, HTN, dysrhythmias), N/V, insomnia, confusion, and agitation
________________ occurs after 2-4 days without alcohol
Delirium tremens
Treatment for delirium tremens include
diazepam and beta-blockers
S/sx of delirium tremens
grand mal seizures, tachycardia, hyper- or hypotension, & combativeness
Alcoholics are often deficient in
vitamin B1 (thiamine)
_________________ is characterized by a loss of neurons in the cerebellum, and this is brought on by thiamine deficiency
Wernicke-Korsakoff syndrome
__________ is a treatment used for alcoholics in recovery
disulfiram
Disulfiram is
hepatoxic and leads to hypotension
