Liver APEX Flashcards
What is the functional unit of the liver?
Acinus
Also
Lobules
What structure is responsible for eliminating bacteria from the liver?
Kupffer cells remove bacteria and viruses that enter the liver from the intestine before it flows back to the vena cava
The kupffer cells are located in the ____
sinusoids
Bile is produced by ___ and is stored in the ___
Hepatocytes
Gallbladder
Describe to anatomy of the gallbladder and bile’s outflow
Bile is formed from hepatocytes
The bile is sent out via the bile ducts to form the common hepatic duct
The gallbladder has the cystic duct outflowing
The cystic and common hepatic duct meet to form the common bile duct
The common bile duct meets the pancreatic duct to for the Hepatopancreatic duct (AKA ampulla of vader)
The Ampulla of vader is ended with the sphincter of Oddi which controls the flow of bile release into the duodenum
What are 3 functions of bile?
Absorption of fat and fat soluble vitamins
Excretory pathway for bilirubin
Alkalization of the duodenum
How much blood and oxygen is delivered to the liver?
30% CO
Portal vein- 75% blood flow, 50% O2
Hepatic artery- 25%, 50% O2
The liver produces which clotting factors?
All except 3, 4, and VWF
Vitamin K dependent clotting factors
2,7,9,10
Protein C, S, Z
Albumin serves as a reservoir for ___ drugs
Acidic, but will also bind basic drugs
_____ is a reservoir for basic drugs
Aplha 1 glycoprotein
Ammonia is a byproduct of ___
protein metabolism
Bilirubin is a product of ____
RBC metabolism
What produces albumin and alpha 1 glycoproteins?
The liver!
LFTs
Hepatocellular injury: AST/ ALT
Hepatic clearance: Bilirubin
Biliary duct obstruction: 5 nucelotidase
Synthetic function: Pt, albumin
Is checking albumin good for assessing for acute hepatic injury?
No, the half life is too long (21 days)
PT is better, T1/2 is 5 hours
AST/ALT ratio of ____ suggests cirrhosis
> 2
Which hepatitis are blood vs orally transmitted
B & C= Blood Contamination
A & E= Always Eating
D- coinfection with B
Main culprits for drug induced hepatitis
Tylenol >4mg/ day, tx N acetylcysteine within 8 hours
Halothane- immune mediated
Alcohol- most common drug
Anesthetic considerations for acute hepatitis
Avoid PEEP
Iso or Sevo
Avoid hepatotoxic drugs (tylenol, amio, halothane, ABX)
MAC changes with alcohol (acute or chronic)
Always assume acute alcohol has full stomach
ETOH withdrawal begins ___
6-8 hours after BAC returns to normal
Peaks at 24-36 hours
MELD vs child PUGH score
ESRD 90 day mortality
MELD- ESRD requiring transplant
Child PUGH- subjective (encephalopathy, ascites)
TIPS
Transjugular Intrahepatic Portosystemic Shunt
Reduces portal pressure
Reduces volume of ascites
Reduces bleeding from varices
Temp treatment for hepatoreenal system
Significant risk: hemorrhage
Cirrhosis body changes
INCREASE CO from low SVR
RL shunt/ hypoxemia
Decreased GFR
Pulmonary vasodilation
Respiratory alkalosis d/t hyperventilation
The most common indications for liver transplants
Most common: Hep C
But also- alcohol liver disease, malignancy
Phases of liver transplant surgery
pre anhepatic- begins with incision
anhepatic- begins with removal of native liver
neohepatic- begins with reperfusion of donor liver
What is post reperfusion syndrome (PRS)? Treatment?
Systemic HOTN >30% for at least 1 minute during the first 5 minutes of reperfusion of donor liver
Tx: (supportive) Pressors, correcting electrolytes, correcting acid base status
The incidence of gall stones increase with ____
Obesity
Middle age
Rapid weight loss
Pregnancy
Women
S/S gallstones
Leukocytosis
Fever
RUQ pain
Pain worse on inspiration (Murphys sign)
Cholelithiasis vs cholecystitis vs choledocholithiasis
LITHIASIS- Stone
CYSTITIS- Inflammation of gallbladder
CHOLEDO- stone in the common bile duct (ERCP)
Anesthetic considerations for cholecystectomy
Avoid N2O d/t bowel distention, combustion
If liver dysfunction, use Benzyl NBM (nimbex, atracurium)
Opioids can cause a spasm of the sphincter of Oddi, but is still used in real life
Glucagon risk of PONV
Normal Albumin
> 3.5 g/dL
