Liver Disease, Renal Disease, Endocrine Disease, and Thermoregulation

Question 1

What are alterations in the hemostatic system in patients with liver disease that impair hemostasis?

Answer 1

1- Thrombocytopenia
2- platelet function defects
3- enhanced production of nitric oxide and prostacyclin
4- low levels of factors II, V, VII, IX, X, and XI
5- Vitamin K deficiency
6- dysfibrinogenemia
7- elevated t-PA levels
8- low levels of factor XIII

Question 2

What alterations in the hemostatic system in patients with liver disease promote hemostasis?

Answer 2

1- Elevated levels of vWF
2- decreased levels of ADAMTS-13
3- elevated levels of factor VIII
4- decreased levels of protein C, protein S, antithrombin
5- low levels of plasminogen

Question 3

T or F: In a liver transplant case, plasma must be given that is compatible with the recipient’s red blood cells but also has no antibodies against the donor liver.

Answer 3

True

Question 4

T or F: like the brain and myocardium, the kidney has the capacity to autoregulate blood flow.

Answer 4

True

Question 5

T or F: between the range of MAP 60-160, renal blood flow, and consequently the GFR, remains constant.

Answer 5

True

Question 6

T or F: developmentally, humans reach the adult stage of RBF as a percent of cardiac output by 3 years of age.

Answer 6

True

Question 7

T or F: After reaching adulthood, RBF progressively decreases with age and is only about half that of a younger adult at an age of 90 years.

Answer 7

True

Question 8

T or F: the thermoregulatory threshold, below which humans activey regulate body temperature, is decreased during general anesthesia and is less effective under general anesthesia.

Answer 8

True

Question 9

T or F: sweating is the best preserved mechanism under general anesthesia.

Answer 9

True

Question 10

T or F: under general anestheia, the thresholds for shivering and vasoconstriction are markedly reuced and less effective than normal when activated.

Answer 10

True

Question 11

Define convection.

Answer 11

Hat loss by currents, such as from drafts and the infusino of cold blood and fluids.

Question 12

Define radiation.

Answer 12

The heat exchange from one surface to another. This is the most important mechanism for heat loss.

Question 13

Define conduction.

Answer 13

Heat exchanged by direct molecular contact, such as from the skin to the cold OR table

Question 14

Define evaporation.

Answer 14

Heat lost by the movement of molecules from the liquid to the gas phase.

Question 15

T or F: postoperative hypothermia increases sympathetic nervous system activity.

Answer 15

True

Question 16

Describe the mechanism of action of furosemide.

Answer 16

A loop diuretic that acts at the medullary thick ascending loop of Henle and inhibits the Na/K/Cl pump.

Question 17

Name the pharmacokinetic profiles of insulin and insulin analogues in order from shortest to longest acting.

Answer 17

Aspart, lispro –> regular insulin –> NPH –> glargine (aka Lantus)

Question 18

Describe diabetic ketoacidosis.

Answer 18

A metabolic abnormality in diabetic patients that is identified by hyperglycemia, ketoacidosis, dehydration, and electrolyte abnormalities. Due to a deficiency in insulin and an excess of counterregulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone.

Question 19

What can trigger DKA?

Answer 19

infection (UTI, pneumonia), insufficient insulin administration, MI, CVA, acute pancreatitis, trauma, burns, certain drugs

Question 20

Treatment for DKA

Answer 20

crystalloid resuscitation with isotonic fluids and administration of insulin to reverse the production of ketoacidosis

Question 21

T or F: despire measured hyperkalemia in DKA, patients are usually suffering from total body potassium depletion. Potassium supplementation is frequently required during tretment as fluids and insulin lower the serum potassium level.

Answer 21

True- monitor K levesl every 2-4 hours to prevent symptomatic hypokalemia.

Question 22

T orF: in patients with ESRD, there can be prolongation of the clinical effect of rocuronium due to decreased renal clearance of the drug in patients with renal failure.

Answer 22

True

Question 23

T or F: hepatic blood flow is derived from the portal venous system and the hepatic artery. The portal vein provides 75% of the total hepatic blood flow, and the hepatic artery only about 25%.

Answer 23

True

Question 24

Describe the hepatic arterial buffer response.

Answer 24

A novel intrinsic mechanism in which a decrease or increase in portal venous flow will be compensated by an increase or decrease in hepatic arterial flow. The synthesis and removal of adenosine from periportal regions is involved in the HABR mechonism.

Question 25

What is the HBV surface antigen (HBsAg)?

Answer 25

an early serologic marker of infection and if present for greater than 6 months identifies chronic infection

Question 26

What is the HBV e antigen (HBeAg)?

Answer 26

a marker for active viral replication and infectivity and can persist in a chronic infection for years.

Question 27

Describe propofol infusion syndrome.

Answer 27

Metabolic acidosis, heart failure, hypotension, and hepatomegaly, progressive lactic acidosis, hyperipidemia, rhabdomyolysis, cardiac instability.

• associated with propofol infusion at doses greater than 4 mg/kg/hr for a duration of more than 48 hours
• proposed mechanism is propofol-mediated inhibition of the mitochondrial respiratory chain and an impairment of mitochonidrial fatty acid metabolism.