Liver 4 Flashcards

1
Q

Common physiologic changes in the patient with cirrhosis include all of the following EXCEPT:
a. respiratory acidosis
b. increased cardiac output
c. right-to left shunt
d. decreased GFR

A

a. respiratory acidosis

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2
Q

Cirrhosis is characterized by

A

cell death where nodules and fibrotic tissue replace healthy hepatic tissue

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3
Q

Cirrhosis reduces the number of

A

functional hepatocytes as well as the number of sinusoids

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4
Q

Why does portal hypertension occur with cirrhosis?

A

the number of blood vessels passing through the liver is also reduced which creates portal hypertension

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5
Q

The following can be used to predict the risk of perioperative mortality with cirrhosis:

A

the MELD score & child-pugh class

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6
Q

Severe liver disease impairs the liver’s ability to

A

clear vasodilating substances from the systemic circulation

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7
Q

The liver’s impedance to clearing vasodilating substances from the systemic circulation leads to

A

a hyperdynamic circulation (high cardiac output & low SVR)

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8
Q

______________ introduces a stent between the portal vein and hepatic vein to bypass an increased hepatic vascular resistance

A

A transjugular intrahepatic portosystemic shunt (TIPS procedure)

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9
Q

____________ is a significant risk of a TIPS procedure

A

Hemorrhage

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10
Q

Etiologies of cirrhosis include

A

non-alcoholic fatty liver disease
alcohol abuse
alpha-1-antitrypsin deficiency
biliary obstruction
chronic hepatitis
right-sided heart failure
hemochromatosis
Wilson’s disease

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11
Q

The most common cause of liver disease is

A

non-alcoholic fatty liver disease

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12
Q

Hemochromatosis causes

A

iron overload

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13
Q

Wilson disease is

A

genetic (copper accumulates in the tissues)

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14
Q

Right-sided heart failure leads to

A

increased hepatic vascular resistance

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15
Q

Biliary obstruction and chronic hepatitis lead to

A

inflammation and tissue destruction

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16
Q

Alcohol abuse and non-alcoholic fatty liver disease lead to

A

fatty infiltration

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17
Q

To partially offset the increased resistance, the body creates collateral vessels that bypass the liver, these are called

A

portosystemic shunts

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18
Q

A patient is at increased risk of perioperative morbidity and mortality if their Child-Pugh score is

A

C

19
Q

a patient is at increased risk of perioperative morbidity and mortality if their MELD score is

A

> 15

20
Q

A MELD score of ______- is an intermediate risk

A

10-15

21
Q

The MELD score predicts

A

90 day mortality in patients with ESLD

22
Q

The MELD score uses

A

logarithmic calculation of hepatic function: bilirubin, INR, and serum creatinien

23
Q

The Child-Pugh score examines the following five factors:

A

albumin
PT
bilirubin
ascites
encephalopathy

24
Q

A Class C Child-Pugh score has a

A

80% risk of perioperative mortality

25
Q

A class B Child-Pugh score has a

A

30% risk of perioperative mortality

26
Q

Cardiovascular changes that accompany ESLD include

A

hyperdynamic circulation
portal hypertension (esophageal varices, splenomegaly)
ascites

27
Q

Pulmonary changes that accompany ESLD inclue

A

restrictive defect
respiratory alkalosis
hepatopulmonary syndrome (Right to left shunt)
portopulmonary hypertension

28
Q

CNS changes that accompany ESLD include

A

hepatic encephalopathy

29
Q

Autonomic changes that accompany ESLD include

A

increased SNS and RAAS

30
Q

Renal changes that accompany ESLD include

A

renal hypoperfusion
hepatorenal syndrome (renal failure)

31
Q

Hematologic changes that accompany ESLD include

A

anemia
reduce factor production
thrombocytopenia

32
Q

What is a TIPS procedure?

A

it reduces portal pressure by shunting blood from the portal vein to the hepatic vein

33
Q

Match each phase of liver transplantation with its MOST likely complication:
pre-anhepatic phase
anhepatic phase
neohepatic phase
hyperkalemia
pulmonary aspiration of gastric contents
profound reduction of cardiac output

A

pre-anhepatic phase- pulmonary aspiration of gastric contents
anhepatic phase- profound reduction of cardiac output
neohepatic phase- hyperkalemia

34
Q

The most common indication for liver transplant is

A

hepatitis C

35
Q

Other common indications for liver transplant include

A

alcoholic liver disease
malignancy

36
Q

The surgical procedure of liver transplant can be divided into the following phases

A

pre-anhepatic phase
anhepatic phase
neohepatic phase

37
Q

Post-reperfusion syndrome is defined as

A

systemic hypotension more than 30% below baseline for at least 1 minute during the first 5 minutes of reperfusion of the donor liver

38
Q

Treatment of post-reperfusion syndrome is

A

supportive
vasopressors
correcting electrolyte abnormalities
correcting acid-base

39
Q

Preoperative considerations for liver transplant include

A

ensure adequate supply of blood products
patients are coagulopathic so careful during invasive procedures (NGT, a-line, etc.)
hepatic encephalopathy–> avoid anxiolytic
Hyper or hyponatremic d/t volume overload & sodium retention

40
Q

If the patient has esophageal varices, can you still do TEE?

A

yes as long as transgastric views are avoided

41
Q

If the patient suffers from hepatic encephalopathy,

A

then avoid anxiolytic premedication

42
Q

The pre-anhepatic phase begins with

A

surgical incision

43
Q

The pre-anhepatic phase ends with

A

cross-clamping of the portal vein, hepatic artery, and IVC

44
Q

Surgical objectives of the pre-anhepatic phase include

A

surgical incision
mobilization of liver structures
mobilization of vascular structures
isolation of bile duct