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N935 Pathophysiology > Liver Function Tests and Anesthesia Effect on Hepatic Fx > Flashcards

Liver Function Tests and Anesthesia Effect on Hepatic Fx Flashcards

1
Q

tests that measure liver synthetic function include (4)

A

serum albumin
prothrombin time (PT/INR)
cholesterol
pseudocholinesterase

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2
Q

can lab tests be normal in the presence of cirrhosis

A

yes because the liver has a large functional reserve

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3
Q

liver abnormalities are typically divided into

A

parenchymal DO’s (hepatocellular dysfunction)

obstructive DO’s (biliary excretion)

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4
Q

normal total bilirubin

A

<1.5mg/dL (includes unconjugated and conjugated)

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5
Q

total bilirubin in the presence of jaundice

A

usually evident when total bilirubin >3mg/dL

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6
Q

a predominantly conjugated hyperbiliruminemia (>50%) is associated with increased urobilinogen and may reflect __________, __________ and lead to _________

A

intrahepatic cholestasis or extra hepatic biliary obstruction
hepatocellular dysfunction

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7
Q

a primarily unconjugated hyperbilirubinemia may be seen with

A

hemolysis orr congenital or acquired defects in bilirubin conjugation

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8
Q

which type of bilirubin is toxic to cells

A

conjugated bilirubin

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9
Q

transaminases

A

enzymes released into the circulation as a result of hepatocelluar injury

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10
Q

two commonly measured serum aminotransferases

A 
aspartate aminotansferase (AST, AKA SGOT)
alanine aminotrransferase (ALT, AKA SGPT)
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11
Q

aspartate aminotransferase

A

present in many tissues in addition to liver including heart, skeletal muscle, kidneys and is therefore considered nonspecific

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12
Q

alanine aminotransferase

A

present primarily in liver rand is therefore considered specific

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13
Q

normal AST and ALT levels

A

<35-45IU/L

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14
Q

mild elevations (<300IU/L) seen with

A

cholestasis or metastatic dx

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15
Q

serum alkaline phosphatase produced by (5) and excreted into

A

liver, bone, small bowel, kidneys, and placenta and is excreted into the bile

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16
Q

normal serum alk phos

A

25-85IU/L

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17
Q

most of the circulating alk phos comes from

A

bone

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18
Q

more alk phos is synthesized and released into the circulation in the presence of this pathology

A

biliary obstruction

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19
Q

elections up to 2x normal alk phos is associated with

A

hepatocellular injury or hepatic metastatic disease

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20
Q

normal serum albumin and half life

A

3.5-5.5g/dL

long half life, can be initially normal with acute liver disease

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21
Q

serum albumin <2.5g/dL generally indicative of

A

chronic liver disease
acute stress
malnutrition

22
Q

two reasons hypoalbuminemia can occur that are not of liver etiology

A 
nephrotic syndrome (albumin loss in urine)
enteropathy with protein loss (GI loss of albumin)
23
Q

normal whole blood NH3 (ammonia)

A

47-65mmol/L or 80-110mg/dL

24
Q

increased NH3 usually indicative of

A

hepatic urea synthesis disrruption

25
Q

marked elevations of NH3 usually reflective of

A

severe hepatocelluar damage

26
Q

normal PT and significant finding

A

11-14 seconds

>3-4 seconds from control is significant and corresponds to an INR of 1.5

27
Q

PT measures the activity of

A

fibrinogen, factor 2, V, VII, X

28
Q

factor VII

A

has short half life therefore the PT is useful in evaluating hepatic synthetic function of patients with a cute or chronic liver idsease

29
Q

what do you suspect with the PT does not correct within 24 hours of vitamin K administration

A

severe liver disease

30
Q

hepatic blood flow and anesthesia

A

usually decreased during general and regional anesthesia due to indirect and direct effects of anesthetic agents themselves, type of ventilation, surgical procedure

31
Q 
diagnostic feature: pre hepatic (bilirubin overload)
bilirubin:
aminotransferase enzymes
alkaline phosphatase
prothrombin time
albumin 
causes
A

diagnostic feature: pre hepatic (bilirubin overload)
bilirubin: increased (unconjugated fraction)
aminotransferase enzymes: no change
alkaline phosphatase: no change
prothrombin time: no change
albumin: no change
causes: hemolysis, hematoma reabsorption, bilirubin overload from whole blood

32
Q 
diagnostic feature: intra hepatic (parenchymal/hepatocellular dysfunction)
bilirubin:
aminotransferase enzymes
alkaline phosphatase
prothrombin time
albumin 
causes
A

bilirubin: increased (conjugated fraction)
aminotransferase enzymes: markedly increased
alkaline phosphatase: no change to slightly increased
prothrombin time: prolonged
albumin: decreased
causes: viruses, drugs, sepsis, arterial hypoxemia, congestive heart failure, cirrhosis

33
Q 
diagnostic feature: post hepatic (cholestasis)
bilirubin:
aminotransferase enzymes
alkaline phosphatase
prothrombin time
albumin 
causes
A

bilirubin: increased (conjugated fraction)
aminotransferase enzymes: normal to slightly increased
alkaline phosphatase: markedly increased
prothrombin time: no change to prolonged
albumin: no change to decreased
causes: stones, cancer, sepsis

34
Q

volatile agents and portal hepatic blood flow

A

all volatile agents decrease portal blood flow. greatest with halothane, least with isoflurane

35
Q

anesthetic agent and hepatic blood flow

A

all anesthetic agents indirectly decrease hepatic blood flow in proportion to any decrease in CO or MAP. decrease in CO also reduces hepatic BF by reflex SNS stimulation and vasoconstriction of arterial and venous splanchnic vasculature

36
Q

spinal and epidural anesthesia decrease hepatic BF primarily by

A

decreasing BP

37
Q

GA usually decreases hepatic BF by

A

decreasing BP, CO, and resulting SNS stimulation

38
Q

ways mechanical ventilation decrease hepatic BF

A

controlled PPV with high mean airway pressures decrease venous return and CO
PEEP accentuates these effects

39
Q

spontaneous ventilation and hepatic BF

A

may be most advantageous for maintaining hepatic BF

40
Q

hypoxemia and hepatic BF

A

produces increased SNS stimulation and decreases hepatic BF

41
Q

surgical procedures on or near liver and hepatic BF

A

can reduce hepatic BF up to 60% most likely by DNS activation, local vascular reflexes, direct compression of vessels of hepatic circulation

42
Q

drugs that decrease hepatic BF

A

Beta blockers
alpha agonists
vasopressin

43
Q

drug that can increase hepatic BF

A

low dose dopamine

44
Q

endocrine stress response secondary to fasting and surgical stress increases levels of

A

catecholamines, glucagon, cortisol

45
Q

endocrine stress rrersponse can at least partially blunted by

A

regional anesthesia
deep general
pharmacological block of SNS

46
Q

CHO and protein stores are mobilized resulting in

A

hyperglycemia and negative nitrogen balance

47
Q

opioids that can cause spasm of sphincter of odd and increase biliary pressure in order of effect

A 
fentanyl/alfentanil (short lived)
morphine
meperidine
butorphanol
nalbuphine
48
Q

two drugs to relieve opioid induced sphincter spasm

A

naloxone and glucagon

49
Q

most common cause of postoperative jaundice

A

over production of bilirubin due to reabsorption of large hematoma or RBC breakdown following transfusion

50
Q

hepatitis has been associated with these halogenated anesthetics

A

methoxyflurane
enflurane
isoflurane

51
Q

hepatitis has NOT been associated with these halogenated anesthetics

A

sevoflurane, desflurane

52
Q

risk factors associated with halothane hepatitis

A

middle aged
obese
female
repeat exposure, particularly within 28d

N935 Pathophysiology (12 decks)

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