Liver Flashcards
What increased unconjugated bilirubin means
Inc bilirubin production, decreased hepatic uptake, or decreased conjugation
What increased conjugated bilirubin means
Decreased canalicular transport of bilirubin, acute/chronic hepatocellular dysfunction, obstruction of bile ducts
What ALT and AST are representative to
ALT- liver. AST- liver and extrahepatic tissues
Alkaline phosphatase represents what. Lacks what. Which most specific to biliary damage
Inc levels may mean inc bile salts and induced damage of hepatocytes membranes. Lack specificity. 5’NT
INR indicates what
Strong correlation w declining hepatic func. Predictive value for survival, used in child Pugh score. Hepatic synthesis of clotting (vitamin K) factors
Pre hepatic dysfunction: what happens to LFTs and causes
Bilirubin (inc unconjugated). AST/ALT and alk phos normal. Hemolysis, hematoma absorption, bilirubin overload
Intrahepatic dysfunction: what happens to LFTs and causes
Inc conjugated, inc AST/ALT, normal/inc alk phos. Viral infec, drugs, etoh, sepsis, cirrhosis
What posthepatic dysfunction labs look like and causes
Inc conjugated bilirubin, normal/inc AST/ALT, inc alk phos. Biliary stones or sepsis
Acute cholecystitis. Occurs most often in who. Symp
Women, fair, inc age, obese, rapid wt loss, pregnancy. NV, fever, RUQ pain (radiating to back), dark urine, sclera icterus
What insufflation of abd does to vent and cv systems
Inadequate vent. Dec venous return/CO, inc MAP and SVR. Bradycardia.
Risks w laparoscopic procedure
Vascular injury, blood loss, co2 embolism
Consid for lap Chloe procedure
Vol/lyte replacement pre op. RSI. Watch PIP/MV. Support BP and HR. NGT. No Nitrous oxide. Opioids may cause oddi spasm, tx w glucagon/narcan/ntg
What causes drug induced hepatitis. What happens.
Analgesics, anticonvulsants, abx, antihypertensives. APAP exhausts glutathione stores, unable to conjugate. Build up of n acetylcysteine
Halothane hepatitis- cause, mediation, sensitized ppl show what
Trifluroacetyl halide metabolites bind w proteins on hepatocytes, change them to not self. IgG mediated. Cross reactivity w other VA except for sevo
What cirrhosis labs look like
Inc bilirubin, aminotransferase, alk phos, INR. Dec albumin, plt BG
Child Pugh score. Used for what. Components. Mortality
Predicts surgical mortality w cirrhosis. Total bili, albumin, INR, ascites, hepatic encephalopathy. A- 10% mort w intraabdominal sx. B- 30% mortality. C- 80% mortality (delay sx)
Anesthesia consid encephalopathy
RSI, careful use of sedatives/induction agents
Anesthesia consid ascites
RSI, mech vent, PFTs, PA pressures, fluid status
Esophageal varicies anesthesia consid
No esophageal temp probe. If bleeding, RSI. Ocreotide 50 mcg/hr or vaso 20 u over 5 min
Anesthesia consid for hyperdynamic circ
Dec SVR and inc CO. Avoid direct myo depressants, place invasive monitors, replace fluids, give neo/NE/vaso. Impaired response to catecholamines
Anesthesia consid for coagulopathy
T/C. Vit K non emergently. Only factors not made by liver are 3, 4, 12. Unable to handle citrate in PRBCs, monitor calcium/replace. Give FFP/Cryo/Plt
Pharmacokinetics
Dec protein binding and inc VD from low albumin. DEecreased clearance- inc initial NMB dose then less subsequent dose.
NMB not cleared by liver
Cis atra, atra, miva
Causes of post op morbidity w cirrhosis
Liver dysfunc/failure, pna, bleed, sepsis, poor wound healing, DTs, lyte disturbance, renal failure
Anes consid w alcoholism
Chronic- inc anesthesia reqs. Acute- dec anesthesia Recs. If acutely intoxicated- RSI.
Etoh withdrawal s/s
Inc SNS/catecholamines, inc HR, agitated, DTs 48 h after, halluc, dysrhythmias, seizures, low BG
Tx etoh withdrawal
Benzos, BB (propranolol or esmolol), a/w protection, correct fluid/lutes
Acute intermittent porphyria implic
Most serious. Affects CNS and PNS. Htn and renal dysfunc. Can be life threatening
Porphyria triggers
Allyl group on barbs, steroid structure. Avoid thiamylal, methohexital, and etomidate. Menstruation/menopause/preg, fasting, dehyd, stress, infec
Porphyria s/s
Abd pain, NV, ANS instability, Na/K/Mg imbalance, muscle weakness, resp failure, htn, tachycardia, seizures
Tx porphyria
Remove trigger. Hydrate, carbs, tx pain and nv, bb for htn/tachy, benzos for seizures, fluid and lyte balance, hematin 3-4 mg/kg, somatostatin, plasmapheresis
Anes manage porphyria
Avoid trigger drugs. Assess skeletal and CN func. Tx htn and tachy. Fluid and lute. Anticipate post op vent. Give glucose and saline. Pre op anxiolytics and cimetitidine (asp prophylaxis)
Regional consid w porphyria
Neuro eval. May lead to cv instability if hypovolemic. Avoid in acute exac
General consid porphyria
Short acting agents. Propofol or ketamine. Maintain w N20/VA/opioids/NMBs.
Safe drugs prophyria
Opioids, propofol, ketamine, ASA, pcn, glucocorticoids, insulin, atropine/glyco, neostigmine, LAs, cv drugs, IAs, NMBs
Unsafe drugs w porphyria
Barbs, etomidate, sulfonamide abx, etoh, diazepam, nifedipine, ketorolac, phenacetin
