Liver Exam 3 Flashcards
How much blood is contained in the liver at any given time?
1L
What positioning is often necessary to gain access to liver? (imaging, biopsy, etc.)
Trendelenburg
How much bile is produced by the gallbladder daily?
500mls
What is the consequence of not having a gallbladder?
Digestion problems
What patient populations most often have their gallbladder removed?
Pregnant, Obese
What divides the left and right lobes of the liver?
Falciform Ligament
What is the most serious source of local bleeding encountered in cholecystectomies?
Cystic Artery
What are common s/s of gallbladder disease?
Murphy’s sign, RUQ pain, ↑WBCs
T/F. Most of the liver’s blood flow comes from the hepatic artery.
False.
Portal vein.
What is Bud-Chiari syndrome? What are the s/s?
Obstruction of the venous outflow of the liver.
ABD pain, Ascites, Hepatomegaly
What is a normal portal vein pressure?
7-10 mmHg
What pressure is seen with portal vein hypertension?
> 20-30 mmHg
What is a normal pressure in the venous sinusoids?
0 mmHg
What pressure is seen in the venous sinusoids of a portal hypertension patient?
5 mmHg
How is hepatic artery perfusion pressure calculated?
HAPP = MAP - HVP
HAPP = hepatic artery perfusion pressure, HVP = Hepatic vein pressure
What blood coagulation factors are dependent on vitamin K for synthesis?
2, 7, 9, 10
What is the name of factor two?
Prothrombin
What clotting factors are produced by the liver?
needs work
What is the name of factor 3?
Tissue thromboplastin
What is the name of factor 8?
vWf (von Willebrand factor)
What is the name of factor 4?
Calcium
What drug is given intra-operatively that ‘opens up’ the gallbladder?
Glucagon
What conditions/drugs/positions/etc increase hepatic blood flow?
Eating, Glucagon, β-agonists, Recumbent position, Acute hepatitis, Hypercapnia
What conditions/drugs/etc decrease hepatic blood flow?
Anesthetics, Surgical trauma, α-agonists, β-blockers, PEEP, Vasopressin boluses, Cirrhosis, Hypocapnia
This molecule is a degradation product of Hgb.
Bilirubin
What are normal bilirubin levels?
< 1mg/dL
At what bilirubin level would one see scleral icterus?
3 mg/dL
At what bilirubin level would one see jaundice?
> 4 mg/dL
The liver aminotransferases are primarily involved in what?
Gluconeogenesis
If AST/ALT are both elevated and there is a ratio of < 1 then what is indicated?
Non-alcoholic liver disease
If AST/ALT are both elevated and there is a ratio of 2-4 then what is indicated?
Alcoholic liver disease
If AST/ALT are both elevated and there is a ratio of >4 then what is indicated?
Wilson’s disease
What is Wilson’s disease?
Inherited disorder where your body accumulates copper (especially in the liver).
When is alkaline phosphatase elevated?
When bile-salt induced liver damage has occurred.
Which liver transaminase is more specific to the liver?
ALT (alanine transaminase)
Which liver transaminase is found in mitochondria and the cytosol?
AST (aspartate transaminase)
Which of the liver transaminases has a longer half-life?
AST (36hrs), ALT (18hrs)
What would be considered a minor increase in AST & ALT? What would be indicated by this?
< 100 IU
Hep B & C, Non-alcoholic disease, Fatty liver
What would be considered a moderate increase in AST & ALT? What would be indicated by this?
100 - 300 IU
Alcoholic hepatitis, Autoimmune hepatitis, Acute viral hepatitis
What would be considered a marked/severe increase in AST & ALT? What would be indicated by this?
> 300 IU
Drugs, Acute viral hepatitis, Ischemia, Extrahepatic cholestasis
AST/ALT ratio of greater than ___ is suggestive of cirrhosis or alcoholic liver disease.
2
What are normal AST values? ALT?
AST = 10 - 40 IU/L, ALT = 10 - 50 IU/L
What is a normal prothrombin time?
12 - 14 seconds
What liver lab is sensitive for acute injury?
PT (prothrombin time)
What liver lab is not sensitive for acute injury?
Albumin
How long could it take to go from jaundice to 80-90% loss of liver function?
4 weeks
What are the four grades of encephalopathy?
Behavioral changes, minimal LOC changes. Disorientation, drowsiness, inappropriate behavior. Marked confusion, incoherence, somnolent. Comatose.
What are the s/s of hepatorenal syndrome?
H₂O retention, Azotemia, ↓ Na⁺, Oliguria
What pharmacokinetic changes in liver patients necessitate decreases in drug dosing?
↑ VD, ↓ plasma-protein binding, ↓ drug clearance
How is Hepatitis A spread?
Fecal matter contact w/ food and water.
What are the s/s of Hep A?
Asymptomatic to full liver failure.
How is Hep A treated?
Pooled gamma globulin.
What is the leading cause of liver cancer?
Hepatitis B.
How is Hepatitis B spread?
Sex, Blood.
Who most often develops chronic infection from hepatitis B?
Children.
What is the treatment for Hep B?
Hepatitis B immunoglobulin.
What is the leading cause for liver transplantation?
Hepatitis C.
How is Hepatitis C spread?
Sex, Blood, Parenteral drug use.
How is Hepatitis C treated?
Sofosbuvir, Interferon w/ ribavirin, other antivirals.
Hepatitis D occurs in conjunction with what?
Hepatitis B.
How is Hepatitis E spread?
Oral/Fecal.
What treatments exist for Hepatitis E?
NO treatments, usually self-limiting.
What is the most common cause of acute liver failure in the US?
Acetaminophen.
How is acetaminophen-induced acute liver failure treated?
N-acetylcysteine within 8 hours.
What compound(s) of halothane metabolism contributes to hepatocellular injury?
TFA (trifluroacetic acid), Fluoride.
What is the MELD score?
Model for End-Stage Liver Disease Score (predicts mortality based on symptomology).
A MELD score of > 40 means what?
100% mortality in the hospitalized patient.
A MELD score < 10 is indicative of what for a preoperative patient?
Safe to undergo elective surgery.
A MELD score 10-15 is indicative of what for a preoperative patient?
Needs optimization to undergo elective surgery.
A MELD score >15 is indicative of what for a preoperative patient?
Elective surgery is contraindicated.
What are the coagulative effects of cirrhosis?
Hemostasis → clotting.
What are the cardiac effects of cirrhosis?
Portal HTN, ↓ circulating volume.
What are the renal effects of cirrhosis?
Hepatorenal Syndrome, ↑ H₂O and Na⁺ retention.
What are the pulmonary effects of cirrhosis?
Chronic Lung Disease and SOB from fluid retention and ascites.
Why does hepatic encephalopathy occur?
Accumulation of ammonia.
What is the goal Hgb for acute variceal bleeding?
Hgb = 8 mg/dL.
What volatile is best for liver surgeries?
Sevoflurane.
What result does hypocapnia have on hepatic blood flow? Hypercapnia?
↓ PaCO₂ = ↓ HBF, ↑ PaCO₂ = ↑ HBF.
What portion of the clotting cascade does warfarin affect? What test measures warfarin effect?
Warfarin, Extrinsic pathway, Prothrombin Time.
