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Coexisting+Basics > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Cholecystectomy Induction/Maintenance

A

Consider volume, e-lyte replacement
RSI with cricoid pressure, cuffed tube

Reverse tburg
Mechanical ventilation
Judicious use of opioids

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2
Q

Cholecystectomy and opioids

A

Sphincter of Oddi spasm occurs in 3% of the population

Antagonize spasm with: Naloxone (maybe not the best idea). glucagon, NTG

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3
Q

Volatile anesthetics and hepatic dysfunctions

A

VA produce a self-limiting post-op liver dysfunction- transient increase in alpha-GST

Halothane hepatitis:
Immune mediated
1 in 10,000-30,000
Only Sevo does not metabolize into trifluoroacetylaed compounds

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4
Q

In case of post-op hepatic dysfunction

A 
Review all drugs given
Check for sepsis
Check bilirubin
Rule out occult hematomas
Review peri-op record
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5
Q

What is hepatitis

A

Liver disorder of varying etiology that results in inflammation and necrosis for more than 6 months

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6
Q

Common hepatitis causes

A

HBV, HDV, HCV, autoimmune, drug induced

Graded on degree of inflammation, necrosis, progression, and degree of fibrosis

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7
Q

Anesthesia for hepatitis

A

How long has the hepatitis been present
What stage is it
What type/mode of transmission
Signs/symptoms the pt is experiencing

Is patient optimized for anesthesia (fluids, e-lytes)
Does everyone have proper vaccines in place?

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8
Q

Pre-op considerations in hepatitis

A

Coags?

Encephalopathy?

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9
Q

Induction for hepatitis

A

NPO?
Volume status (often hypovolemic)
Other organ system involvement

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10
Q

Viral hepatitis

A

5 types- HAV, HBV, HCV, HDV, HEV
C most common blood borne infection in US
D can only infect if the pt already has B
E for enteric transmission in Asia, Africa, Central America

S/S- anorexia, N/V, low grade fever, dark urine, clay colored stool, jaundice, acute liver failure

AST/ALT 400-4000

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11
Q

Hep B Tx

A

Interferon, Lamivudine, Adefovir

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12
Q

Hep C Tx

A

Interferon, Ribavirin

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13
Q

Autoimmune hepatitis Tx

A

AZT, corticosteroids

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14
Q

What is cirrhosis

A

Affects 3 million in US, 12th leading cause of death
Mostly due to ETOH and Hep C
Alters all organ systems in advanced stages

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15
Q

Liver synthesizes all coag factors except

A

vWF

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16
Q

Liver blood supply

A

Hep. artery gives 25% flow and 50% oxygen

Portal vein gives 75% flow and 50% oxygen

17
Q

Cirrhosis s/s

A 
Fatigue
Anorexia
N/V
Abd. pain
Jaundice
Hypoalbuminemia
Coag problems
Endocrine dysfunction
Hepatic encephalopathy
Esophageal varices
Hepatomegaly/ascites
18
Q

CV function in cirrhosis

A 
Hyperdynamic circulation
Increased CO
Normal ABP, filling pressures, HR
Possible cardiomyopathy
Decreased response to catecholamines
Increased flow to splanchnic, pulm, muscular, cutaneous beds
Decreased hepatic flow
Portal HTN
Arterial hypoxemia
19
Q

Pre-op cirrhosis

A 
Treat as full stomach
Low albumin, decrease doses
Ascites, fluid status
Cardiomyopathy
PaO2 60-70 (R->L pulm shunt)
Hypoglycemia
Pneumonia
Encephalopathy
Hepatorenal syndrome
20
Q

Coagulation in cirrhosis

A

Prolong PT/INR
Vit K deficiency, factors II, V, VII, IX, X deficiency
Thrombocytopenia common
Bleeding accounts for 60% of deaths in abd. surg
Platelets 3 contraindications to elective surg

Need FFP, Vitamin K, Platelets

21
Q

Monitors for cirrhosis

A

CVP, A-line, +/- PA
UOP- foley

Blood glucose

AVOID esophageal temp probe

22
Q

Pre-op/Induction cirrhosis

A 
volume status
RSI
Protein binding
ETOH on board?
Cardiomyopathy
Consider vitamin K, FFP, Platelets
Administer glucose solutions
23
Q

Maintenance cirrhosis

A

Avoid halothane, disrupts hepatic blood flow
Decrease in BP will decrease portal vein flow
Combine IA with N2O and opioids
Avoid pancuronium, succinylcholine/mivacurium/cis/atracurium OK
Increased Vd

24
Q

Post-op cirrhosis

A 
Increased post-op morbidity-
Pneumonia
Bleeding
Sepsis
Poor wound healing
Liver dysfunction
DTs
25
Q

DTs

A

6-8 hours of ETOH withdrawal, pt may become tremulous
WIthin 24 hours hallucinations, grand mal seizures may occur
DTs within 72 hours
Treat with benzos

26
Q

Porphyria

A

Defective enzyme leads to overproduction of porphyrin

Acute intermittent porphyria is most serious

27
Q

Porphyria Tx

A 
Remove trigger
Hydrate
Carbohydrates
Treat pain, N/V
BB for HTN, tachycardia
Benzos for seizures
Fluid and e-lyte balance

Hematin 3-4 mg/kg IV, somatostatin, plasmapheresis

28
Q

Triggers in porphyria

A

Allyl group barbs
Steroid structure drugs
Pentathol, thiamylal, methohexital, etomidate

Hormonal fluctuations, fasting, dehydration, stress, infection

29
Q

Anesthetic management in porphyria

A

Avoid known triggers, minimize use of multiple drugs
Minimize stress
Ensure proper hydration, use glucose solution

Give anxiolytics
Cimetidine decreases heme consumption and inhibits ALA synthetase (good)

Coexisting+Basics (10 decks)

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