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Adv Pr III > Liver > Flashcards

Liver Flashcards

1
Q

What is the acinus

A

Microvascular unit of the liver. Hepatic arteriole, portal venule, bile ductile, and lymph vessels and nerves

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2
Q

Zone 1: ___ zone. Cells are closest to what, receive what, and major site of what

A

Periportal. Portal axis. Rich in oxygen. Oxidative metabolism and conversion of ammonia to urea

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3
Q

Zone 2: ____ ____. What it is

A

Midzonal region. Transition zone, anatomic reserve

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4
Q

Zone 3: ___ cells, at ___, receive blood that has what. Least what. Major site of

A

Pericentral. Margin of acinus. Has exchanged gases and metabolites w cells in zones 1 and 2. Least resistant to metabolic and anoxic damage. Cyp450 and anaerobic metab

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5
Q

SNS stim of liver __-__ does what

A

T3-11, inc hepatic vascular resistance (less blood vol), inc glycogenolysis and gluconeogenesis

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6
Q

PNS stim of liver does what

A

Increases glucose uptake and glycogen synthesis

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7
Q

Hepatic arterioles have a myogenic response that does what

A

Keeps local bf constant despite bp changes

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8
Q

What is the hepatic arterial buffer response

A

Portal venous flow dec- adenosine builds up- arteriolar res dec and arterial flow inc. portal venous flow inc- adenosine washed out- arteriolar res inc and hepatic arterial flow dec

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9
Q

Changes in __ or ___ of portal blood associated with inc in hepatic arterial flow

A

Ph or pa02

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10
Q

___ ___ increases hepatic arterial and portal venous flow

A

Postprandial hyperosmolarity

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11
Q

What does the IVC do that can lead to ascites

A

Pressures of 10-15 inc hepatic lymph flow, leads to sweating free fluid from liver to abd cavity

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12
Q

Anesthetics and liver disease impair what response

A

Ability of liver to decrease bf/vol in response to sns stim

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13
Q

Coag factors formed by liver

A

All except vwfIII, III, and IV

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14
Q

Vitamin k dependent factors made in liver

A

PT/factor II, VII, IX, X, proteins c and s

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15
Q

Opioid effects on sphincter of oddi antagonized by 5.

A

VAs, narcan, nitro, atropine, glucagon

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16
Q

Which zone of liver most vulnerable to toxic metabolites of tyelenol

A

Zone 3

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17
Q

What is intrinsic clearance

A

Fraction of delivered drug load that’s metabolized during a single pass thru liver

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18
Q

High clearance means what, which drugs 3

A

Hepatic clearance approaches the rates at which they transverse the liver. Lido, benadryl, metoprolol

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19
Q

Low clearance (IC) means what, ex of drugs 3

A

Hepatic clearance rel independent of hepatic bf. Diazepam, tyelenol, warfarin

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20
Q

4 tests of hepatocellular damage

A

AST, alt, ldh, gst

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21
Q

Assessments of bile flow (4)

A

Alk phos, 5 nucleotides, ggt, bilirubin

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22
Q

Assessment of hepatic synthetic function 2

A

Albumin, pt/inr

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23
Q

Idiosyncratic rxns leading to hepatitis 4

A

Nsaids, va, anti htn, anticonvulsants

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24
Q

Risk factors to halothane depatitis

A

Prior exposure, >40 y/o, obesity, female, Mexican, mult brief exposures with short duration, enzyme induction

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25
Q

% metabolism of volatile agents

A

Halothane 46%, enflurane 6%, sevo 3%, iso 1%, des .02%

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26
Q

Most to least: hepatic bf and oxygenation decrease w GA and VA

A

Hal, enf, des, iso, sevo

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27
Q

How nitrous effects liver

A

Inc sns- vasoconstrict sphlanchnic/portal flow. B12 deficiency (methionine synthase)

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28
Q

Alcoholic liver disease: 3 forms

A

Steatosis, alcoholic hepatitis, cirrhosis

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29
Q

Hallmark of end stage cirrhosis

A

Portal htn

30
Q

Hyperdynamic circ in cirrhosis: ___ CO, ___ SVR, ___ BP, ___ filling pressures, ____ hr

A

Hi CO, low SVR, low/nml BP, nml/inc SV, nml filling pressures, hi/nml hr

31
Q

Hepatopulm syndrome: intrapulm _____, type I v II

A

Shunting. I precapillary II arteriovenous

32
Q

Hepatopulm syndrome: 0xyhgb curve shifts where. VQ mismatch leads to what

A

Right (inc 2,3 dpg). Imp HPV, pleural effusions, ascites, diaphragm dysfunction

33
Q

Treatment of cirrhosis w portal htn and suites 5

A

Na and fluid restriction, diuretics (spironolactone or amigo ride), paracentesis

34
Q

Cirrhosis renal abn: reduction in __ and __ excretion

A

Sodium and water

35
Q

Hepatorenal synd: ____renal failure, ___ gfr, ___ renal tubular func and ___ renal histology

A

Pre, low, preserved, nml

36
Q

Type 1 hepatorenal syndrome

A

Progressive oliguria, rapid creat rise, poor prognosis

37
Q

Type 2 hepatorenal syndrome

A

Moderate, more stable impairment, in pts w refractory ascites

38
Q

Hepatorenal treatment: aimed at what, 4 options

A

Reversing patho cause= sphlanchnic arterial vasodilation. AVP, octreotide, albumin, transplant

39
Q

4 cirrhosis heme/coag abn

A

Anemia, dec vit k dep factors (long PT), thrombocytopenia and thrombopathy, dysfibrinogenemia

40
Q

Endocrine disorders in cirrhosis

A

Dec ability of muscle to uptake insulin, inc GH and glucagon, hypoglycemia, feminization males/amenorrhea females

41
Q

Factors assoc w hepatic encephalopathy 4

A

Inc ammonia produc, fluid/lyte/acid base imbalance generates ammonia, alt liver/brain func, reduced hepatic metabolism

42
Q

3 overall fx of cirrhosis cholestatic disease

A

Cv dysfunction, coag disorders (vit k def), renal vulnerability

43
Q

Cv effects of cholestatic disease

A

Imp contractility, less resp to NE/Isuprel/ang II, dec SVR, inc CO

44
Q

MELD: what it is, how to calc

A

Non subjective factor risk score. Creatinine (adults w dialysis biweekly value=4) bilirubin, INR

45
Q

Child Pugh score: what makes it up. What c means

A

Albumin, pt, inr, bilirubin, ascites, encephalopathy. Elective sx contraindicated

46
Q

Ways to optimize liver pt preop

A

Correct etoh dependency, coagulopathy, ph, lyte abn (esp K), malnutrition, anemia, varicies, hepatic encephalopathy

47
Q

How to correct PT/INR in liver pt, when. What for emergency

A

Few days prior. Vit k IV, factor VII, FFP in emergency

48
Q

How benzos metab differently

A

Inc cerebral uptake, dec clearance, longer e 1/2

49
Q

How precedex diff

A

Dec clearance, longer e 1/2

50
Q

How propofol response dif, DOC w what

A

Single dose response similar, recovery may be longer post gtt. Encephalopathy

51
Q

Morphine: e 1/2, PB, sedative and resp fx

A

Prolonged, decreased, exaggerated

52
Q

Demerol: clearance, half life, SE

A

50% dec clearance, double e 1/2, neuro toxic

53
Q

Fentanyl: clearance, effect of gtt

A

Decreased. Exaggerated fx

54
Q

Sufentanil: kinetics, e 1/2

A

Similar. Infusions and repeat doses may prolong effect

55
Q

Alfentanil: e 1/2, DOA, effects

A

Doubled, prolonged, enhanced

56
Q

NMB: ____ Vd, ____ initial dose. Advanced disease reduces elim of: 4= inc DOA

A

Inc, higher. Vec, roc, panc, miva

57
Q

2 NMB not dep on hepatic elim

A

Atra and cis

58
Q

NMB fx prolonged in liver/why. ___ vd, ___ initial dose.

A

Sux. Dec cholinesterase levels. Inc, higher

59
Q

Intra op: ____ response to catecholamines, why

A

Decreased. Circulating vasodilators (bile acid, glucagon)

60
Q

Intra op: consider ___ dose of catecholamines or add ____ to support bp

A

Increased, vaso

61
Q

Patients with biliary obstruction are intolerant of ___ ____

A

Blood loss

62
Q

Assess what 4 things when deciding if CVP or PA placement for liver pt

A

Hypovolemia, abd compartment syndrome, distributive shock, CHF

63
Q

Local/mac case: what is necessary to avoid which SE

A

Adequate sedation. Minimize SNS stim which could lead to dec hepatic bf/02

64
Q

GA in liver pt: airway and gas options

A

RSI or awake ett. Sevo, iso doc. N20 ok

65
Q

Which symptoms defined as fulminant hepatic failure

A

Encephalopathy within 2-8 weeks of symptoms w surgery

66
Q

Hepatocellular causes of post op jaundice

A

Drugs (anesthetics), ischemia (shock, hypotension, sx retraction), viral hepatitis

67
Q

What TIPS does on a basic level

A

Used for end stage liver pts to dec portal pressure and dec portal htn SE. connects PBF into hepatic vein

68
Q

TIPS: anesthesia types, what if variceal bleed, pts typically have what

A

MAC unless long sx/sick then general. Resusc w fluid and blood. Severe coagulopathy

69
Q

Concerns of what could happen in TIPS procedure

A

Ptx, neck vessel injury, cardiac dysrhythmias from catheter, hemorrhage, pulm edema and CHF w low cardiac reserve

70
Q

Techniques other than fluid and blood to dec blood loss in hepatic resection

A

Pressers, intermittent portal triad clamp, ischemic pre conditioning

71
Q

Hepatic resection: which position in OR and why

A

Modest t-berg, reduce intrahepatic venous p, inc preload and CO, reduce VAE risk

72
Q

Hepatic resection postop: fluid type and why

A

IVF w phosphates to help liver regeneration and avoid hypophosphatemia

Adv Pr III (4 decks)

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