LIVER

Question 1

The child-pugh score was developed to predict _____________ with liver disease.

Answer 1

surgical mortality

Question 2

The 5 variables in the Child-pugh score are:

Answer 2

• INR
• encephalopathy
• ascites
• albumin
• bilirubin

Question 3

With pneumoperitoneum, you will immediately see a ____________________________

Answer 3

decrease in venous return and CO

Question 4

Which opioid should you NEVER use d/t the sphincter of Oddi spasm?

Answer 4

Morphine

Question 5

You can antagonize the sphincter of Oddi spasm with what 3 meds?

Answer 5

glucagon, IV naloxone, NTG

Question 6

Volatile agent produce transient increases in _____________

Answer 6

alpha-GST

Question 7

Halothane hepatitis occurs with what kind of IHAs?

Answer 7

fluorinated

Question 8

Fluorinated volatile anesthetics may form _____________ metabolites which cause halothane hepatitis. ___________ does not undergo this metabolism and is therefore safe to use with liver patients

Answer 8

trifluroacetyl

Sevoflurane

Question 9

If your patient is having post operative hepatic dysfunction, first rule out _________________

Answer 9

occult hematoma

Question 10

_______ is the most common blood borne infection in the US

Answer 10

Hep C

Question 11

You cannot transmit hepatitis ____ without first having hepatitis ____

Answer 11

D

B

Question 12

Hepatitis ___ is enteric transmission is asia/africa/central america

Answer 12

E

Question 13

Expected AST/ ALT findings with someone with hepatitis would be:

Answer 13

400-4000

Question 14

Treatment of auto-immune hep. is with __________ & __________

Answer 14

corticosteriods and AZT

Question 15

The hepatic artery delivers ____% of hepatic blood flow and ___% of O2 delivery. The Portal Vein delivers ___% of hepatic blood flow and ___% of O2 delivery

Answer 15

25
50
75
50

Question 16

The liver is the site of synthesis for all clotting factors except?

Answer 16

VWF

Question 17

With cirrhosis, will you see hypodyanmic or hyperdyanmic circulation?

Answer 17

Hyper

Question 18

With cirrhosis, will you see an increase or decrease in CO?

Answer 18

increase

Question 19

With cirrhosis, will you see an increase or decrease in response to catecholamines?

Answer 19

decreased/ diminished response

Question 20

With Cirrhosis, will you see an increase or decrease in total hepatic blood flow?

Answer 20

decrease

Question 21

Which factors will be reduced in cirrhosis?

Answer 21

II, V, VII, XI, X

Question 22

A platelet counts of ___________ are contraindications to elective surgery

Answer 22

50,000

3

Question 23

Will you need to increase or decrease you dosing with highly protein bound drugs on liver failure patients?

Answer 23

decrease

Question 24

Within how many hours of ETOH withdrawal may the patient become tremulous?

Answer 24

6-8

Question 25

______ 3-4mg/kg IV is used to treat porphyria. Along with ____________ and ______________.

Answer 25

Hematin somatostatin plasmapheresis

Question 26

What drugs are the biggest triggers for porphyria?

Answer 26

BARBITURATES

Question 27

Which induction agent would you want to avoid with porphyria?

Answer 27

etomidate - enzyme inducer

Question 28

Which preop med n/v med would be beneficial to use in a patient with porphyria?

Answer 28

Cimetidine - decrease heme consumption and inhibits ALA synthetase activity

Question 29

What are 7 unsafe medications to use in a patient with porphyria?

Answer 29

ketorolac, sulfonamide antibiotics, etomidate, diazepam, alcholol, barbiturates, nifedipine