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A1 > Liver APEX > Flashcards

Liver APEX Flashcards

1
Q

What is the functional unit of the liver?

A

Acinus
Also
Lobules

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2
Q

What structure is responsible for eliminating bacteria from the liver?

A

Kupffer cells remove bacteria and viruses that enter the liver from the intestine before it flows back to the vena cava

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3
Q

The kupffer cells are located in the ____

A

sinusoids

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4
Q

Bile is produced by ___ and is stored in the ___

A

Hepatocytes
Gallbladder

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5
Q

Describe to anatomy of the gallbladder and bile’s outflow

A

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

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6
Q

What are 3 functions of bile?

A

Absorption of fat and fat soluble vitamins
Excretory pathway for bilirubin
Alkalization of the duodenum

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7
Q

How much blood and oxygen is delivered to the liver?

A

30% CO
Portal vein- 75% blood flow, 50% O2
Hepatic artery- 25%, 50% O2

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8
Q

The liver produces which clotting factors?

A

All except 3, 4, and VWF

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9
Q

Vitamin K dependent clotting factors

A

2,7,9,10
Protein C, S, Z

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10
Q

Albumin serves as a reservoir for ___ drugs

A

Acidic, but will also bind basic drugs

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11
Q

_____ is a reservoir for basic drugs

A

Aplha 1 glycoprotein

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12
Q

Ammonia is a byproduct of ___

A

protein metabolism

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13
Q

Bilirubin is a product of ____

A

RBC metabolism

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14
Q

What produces albumin and alpha 1 glycoproteins?

A

The liver!

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15
Q

LFTs

A

Hepatocellular injury: AST/ ALT
Hepatic clearance: Bilirubin
Biliary duct obstruction: 5 nucelotidase
Synthetic function: Pt, albumin

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16
Q

Is checking albumin good for assessing for acute hepatic injury?

A

No, the half life is too long (21 days)
PT is better, T1/2 is 5 hours

17
Q

AST/ALT ratio of ____ suggests cirrhosis

A

> 2

18
Q

Which hepatitis are blood vs orally transmitted

A

B & C= Blood Contamination
A & E= Always Eating
D- coinfection with B

19
Q

Main culprits for drug induced hepatitis

A

Tylenol >4mg/ day, tx N acetylcysteine within 8 hours
Halothane- immune mediated
Alcohol- most common drug

20
Q

Anesthetic considerations for acute hepatitis

A

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

21
Q

ETOH withdrawal begins ___

A

6-8 hours after BAC returns to normal
Peaks at 24-36 hours

22
Q

MELD vs child PUGH score

A

ESRD 90 day mortality
MELD- ESRD requiring transplant
Child PUGH- subjective (encephalopathy, ascites)

23
Q

TIPS

A

Transjugular Intrahepatic Portosystemic Shunt
Reduces portal pressure
Reduces volume of ascites
Reduces bleeding from varices
Temp treatment for hepatoreenal system
Significant risk: hemorrhage

24
Q

Cirrhosis body changes

A

INCREASE CO from low SVR
RL shunt/ hypoxemia
Decreased GFR
Pulmonary vasodilation
Respiratory alkalosis d/t hyperventilation

25
Q

The most common indications for liver transplants

A

Most common: Hep C
But also- alcohol liver disease, malignancy

26
Q

Phases of liver transplant surgery

A

pre anhepatic- begins with incision
anhepatic- begins with removal of native liver
neohepatic- begins with reperfusion of donor liver

27
Q

What is post reperfusion syndrome (PRS)? Treatment?

A

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

28
Q

The incidence of gall stones increase with ____

A

Obesity
Middle age
Rapid weight loss
Pregnancy
Women

29
Q

S/S gallstones

A

Leukocytosis
Fever
RUQ pain
Pain worse on inspiration (Murphys sign)

30
Q

Cholelithiasis vs cholecystitis vs choledocholithiasis

A

LITHIASIS- Stone
CYSTITIS- Inflammation of gallbladder
CHOLEDO- stone in the common bile duct (ERCP)

31
Q

Anesthetic considerations for cholecystectomy

A

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

32
Q

Normal Albumin

A

> 3.5 g/dL

32
Q
A

A1 (125 decks)

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