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Anesthesia Principles 2 (Broadbent) > Liver and Gallbladder (Apex) > Flashcards

Liver and Gallbladder (Apex) Flashcards

1
Q

The ______ is the functional unit of the liver.

A

lobule

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2
Q

Hepatocytes in zone ____ are most susceptible to ischemic injury

A

3

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3
Q

_____ cells remove bacteria from portal blood before the blood enters the systemic circulation

A

Kupffer

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4
Q

Bile is produced by _____ and stored in the _______.

A

hepatocytes
gallbladder

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5
Q

Bile pathway to duodenum:

A

canaliculi—> bile duct —> common hepatic duct —-> common bile duct —> ampulla of Vater—> duodenum

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6
Q

_____ and ______ drain into the space of Disse before they enter into the ______ duct.

A

lymph and proteins
lymphatic

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7
Q

The liver receives SNS innervation from ____-______

A

T3-T11

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8
Q

There are _______ to _____ lobules in the liver

A

50,000-100,000

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9
Q

Zone __ has the highest concentration of CYP450 enzymes

A

3

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10
Q

How much CO does the liver receive?

A

30% or 1500ml/min from dual blood supply

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11
Q

The portal vein provides ____% of the total liver blood flow and provides ___% of the liver’s oxygen supply.

A

75%
50%

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12
Q

The hepatic artery provides __% of the total liver blood flow and provides __% of the liver’s oxygen supply.

A

25%
50%

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13
Q

A decrease is portal vein flow will cause…. How does liver disease affect this?

A

an increase in hepatic artery flow
severe liver disease impairs this response which makes the diseased liver more susceptible for hypoperfusion

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14
Q

Portal Perfusion = ________ - ________.
Normal portal vein pressure =

A

Portal Vein pressure - Hepatic Vein pressure
7-10 mmHg
Portal HTN = >20-30 mmHg

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15
Q

Portal HTN reduces blood flow to the liver which produces back pressure on the ______ organs. Vascular engorgment accounts for _______ and ______ in the esophagus, stomach, and intestines.

A

Splanchic
splenomegaly and varices

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16
Q

Physiologic consequences of Portal HTN include:

A

ascites, spider angiomas, hemorrhoids, and encephalopathy

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17
Q

Both ______ and ______ reduce MAP and CO which can reduce liver blood flow in a dose-dependent fashion.

A

GA and neuraxial

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18
Q

Hepatocytes produce: (3)

A

-Thrombopoietin
-Alpha -1- acid glycoprotein
-Factor 7

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19
Q

Vitamin K is required to synthesize factors…….and proteins……(anticoagulant)

A

2,7,9,10 (procoagulants)

S,C,Z (anticoagulants)

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20
Q

Factor 8 is produced by the liver ______ cells and ______ cells (not by hepatocytes)

A

sinusoidal cells
endothelial cells

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21
Q

______ is a reservoir for acidic drugs.

A

Albumin

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22
Q

________ glycoprotein is a reservoir for basic drugs.

A

Alpha-1-acid glycoprotein

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23
Q

The liver produces all plasma proteins except for ______.

A

immunoglobulins (gamma globulins)

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24
Q

The liver clears ______ from the circulation which makes patients with liver failure at risk for ______.

A

insulin
hypoglycemia

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25
Q

The liver converts ammonia to ____ which is eliminated by the ____.

A

urea
kidney

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26
Q

Failure to clear ______ leads to hepatic encephalopathy.

A

ammonia

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27
Q

Old RBCs are broken down by the _______ cells in the ______.

A

reticuloendothelial cells
spleen

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28
Q

Spleen: Hemoglobin——> _______—->_______

A

heme —-> unconjugated bilirubin (neurotoxic)

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29
Q

What coagulation Factors are NOT produced in the Liver?

A

von Willenbrand factor (vascular endothelial cells)

Factor 3 (vast. endothelial cells)

Factor 4 (calcium comes from diet)

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30
Q

Glucose is stored as glycogen =

A

Glucogenisis

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31
Q

Glycogen is cleaved into glucose:

A

Glycogenolysis

32
Q

Glucose is created from non-carbohydrate sources (magically)

A

Gluconeogensis

33
Q

Test for Hepatocellular injury:

A

AST (10-40 units/L)
ASL (10-50 units/L)

34
Q

Test for Synthetic Function:

A

PT (12-14 secs)
Albumin (3.5-5.0 g/dL)

35
Q

Test for Hepatic Clearance:

A

Bilirubin (0-11 units/L)

36
Q

Test for Biliary duct obstruction:

A

Alkaline phoshatase

37
Q

__________ _____ is very sensitive for acute hepatic injury because Factor __ has a half-life of only __-__ hours.

A

Prothrombin time
7
4-6 hours

38
Q

The _____ ___ ____ controls the flow of bile released from the common hepatic duct.

A

Sphincter of Oddi

39
Q

______ of the sphincter of Oddi increase biliary pressure. Caused by ____.

A

Contraction
Opioids
(more potent = greater increase in biliary pressure)

40
Q

Hypercapnea and acidosis causes ………

A

increased liver flow

41
Q

Pre-hepatic jaundice is caused by _____ ______.

A

increased hemolysis

42
Q

Hepatic jaundice is caused by ____ ____.

A

liver impairment

43
Q

Post-hepatic jaundice is caused by:

A

a blockage of bile ducts

44
Q

AST/ALT ratio > __ suggests cirrhosis or alcoholic liver disease

A

2

45
Q

Hepatitis ___ is the most common form of viral hepatitis. oral-fecal route.

A

A

46
Q

Chronic hepatitis is characterized by hepatic inflammation that exceeds ____ months.

A

6

47
Q

Antidote for acetaminophen overdose

A

Oral N-acetylcysteine

48
Q

Most common cause of chronic hepatitis. Second most common?

A

alcoholism
2nd = hepatitis C

49
Q

S/S of chronic hepatitis

A

jaundice, fatigue, thrombocytopenia, glomerulonephritis, neuropathy, arthritis, myocarditis

50
Q

Chronic Hepatitis: ___ is prolonged and ____ is decreased

A

PT
albumin

51
Q

Hepatotoxic drugs that inhibit CYP450

A

-tylenol
-halothane
-amio
-antibiotics (pcn, tetracyclines, sulfonamides)

52
Q

Max dose of Acetaminophen
Tx?

A

4g in 24hrs
Tx= N-acetylcysteine

53
Q

Acutely intoxicated patient anesthetic considerations:

A

-decrease MAC (increase in chronic)
-aspiration precautions
-alcohol inhibits NMDA receptors
-alcohol impairs pharyngeal reflexes

54
Q

Cirrhosis has a reduction in the # of functional ______ and ______.

A

hepatocytes and sinusoids

55
Q

MELD score predicts _____ mortality with patients with ESLD

A

90 day

56
Q

MELD- three factors that measure hepatic function:
Score (low, intermediate, high risk)

A

bilirubin, INR, serum creatinine (BIC)

Low risk= <10
Intermediate = 10-15
High = >15

57
Q

Volatile agents preferred for Liver Disease:

A

Iso and Sevo (less decrease in hepatic blood flow)

Halothane bad for liver! (halothane hepatitis)

58
Q

Muscle relaxant drug of choice for liver disease

A

Cistatricurium

59
Q

TIPS procedure bypasses a portion of the hepatic circulation by shunting blood from the ______ vein (inflow) to the ____ vein (outflow).

A

portal vein
hepatic vein

60
Q

TIPS procedure reduces:

Main risk?

A

portal pressure
back pressure on splanchin organs
reduces likelihood of bleeding from esophageal varicose
ascites

Main risk= hemorrhage

61
Q

Severe liver disease impairs the liver’s ability to clear ________ substances from systemic circulation. This leads to a _______ circulation (_______ + ______)

A

-vasodilating
-high cardiac output
-low SVR

62
Q

The common bile duct and pancreatic duct form the_______ which leads to the ________

A

Ampulla of Vater
Sphincter of Oddi

63
Q

You can relax the sphicter of Oddi with……..

A

-glucagon, naloxone or nitroglycerin
-glycopyrolate and atropine

64
Q

Biliary stones cause obstruction of bile. If these substances can’t move into the ______ ______ they back up into the _____ and ______.

A

small intestine
liver and pancrease

65
Q

How much bile does the gallbladder hold?

A

30-50cc

66
Q

3 main functions of Bile

A

Emulsify and enhance absorption of ingested fats and fat-soluble vitamins.

Provide an excretory pathway for bilirubin, drugs, toxins, and immunoglobulin A (IgA)

Maintain duodenal alkalization

67
Q

Cholecystitis characteristics and s/s:

A

Acute obstruction of the cystic duct

-Patients present with acute, severe, midepigastric pain that often radiates to right abdomen.

68
Q

Labs for Cholecystitis

A

increase in plasma bilirubin, alkaline phosphatase, amylase, and WBCs.

69
Q

Cholecystitis: Free abdominal air suggests?

A

ruptured viscus with perforation of gallbladder. (Free air = emergency ex-lap)

70
Q

Cholelithiasis /Choledocholithiasis=

A

Acute obstruction of the common bile duct.

71
Q

Cholelithiasis /Choledocholithiasis: Charcot triangle

A

fever, chills, upper quadrant pain

72
Q

Surgical treatment for Choledocholithiasis (stones in the common bile duct)

A

ERCP (endoscopic retrograde cholangiopancreatography)

73
Q

Cholecystectomy Anesthesia Considerations:

A

Post-op pain
Nausea and vomiting
Peritoneal irritation from CO2
Intravascular volume restoration

74
Q

Cholecystectomy: Open approach involves a _____ upper quadrant abdominal incision which will _____ lung volume and _____ pain.

A

right
decrease
increase

75
Q

______ duct and the ______ duct join the common hepatic duct before it empties into the ______

A

cystic duct
pancreatic duct
duodenum

Anesthesia Principles 2 (Broadbent) (4 decks)

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