Perioperative hepatic dysfunction

Question 1

The human liver consists of what lobes?

Answer 1

1) Left
2) Right
3) Caudate
4) Quadrate

Question 2

The human liver consists of how many lobes?

Answer 2

Eight

Question 3

How much CO goes to the liver?

Answer 3

20-25%

10-15% of total BV

Question 4

The portal vein supplies how much of blood flow?

Answer 4

75%

Question 5

Almost all plasma proteins are synthesized in the liver. These include albumin, a1-acid
glycoprotein, pseudocholinesterase, and all coagulation factors except factors?

Answer 5

II, IV, VIII

Question 6

The liver produces how much % of the body’s heme.

Answer 6

20%

Question 7

What is the most common cause of acute parenchymal liver disease?

Answer 7

Viral infection is responsible for the majority of cases of acute hepatitis (HBV)

Question 8

Portal pulmonary hypertension (PPH), defined as a mean pulmonary artery pressure greater than?

Answer 8

25 mmHg

Question 9

Define hepatorenal syndrome?

Answer 9

Creatine > 1.5

Urine sodium < 10 mmol/L

Question 10

Factor VIII is synthesized by?

Answer 10

Hepatic endothelial sinusoidal cells

Question 11

What are the components of the modified child-turcotte-puhg scoring?

Answer 11

1) Albumin
2) INR
3) Bilirubin
4) Ascites
5) Encephalopathy

Question 12

What are the classes of the modified child-turcotte-puhg scoring?

Answer 12

A (5-6 points)
B (7-9 points)
C (10-15 points)

Question 13

What serum bilirubin level can cause jaundice?

Answer 13

Levels of 2 to 2.5 mg/dl (normal 0.5 to 1 mg/dl) result in jaundice.
The oxidation of bilirubin to biliverdin gives the green hue often observed.

Question 14

This type of hyperbilirubinemia always signifies dysfunction of the liver or
biliary tract.

Answer 14

Conjugated

Question 15

This type of hyperbilirubinemia is usually related to changes in the turnover of red blood cells and their precursors

Answer 15

Unconjugated

Question 16

Is defined as an elevation of the total serum bilirubin of which the conjugated fraction does not exceed 15%.

Answer 16

Unconjugated hyperbilirubinemia

Question 17

Volatile anesthetic that causes least hepatic injury?

Answer 17

Desflurane

Question 18

Patients with end-stage liver disease have a hyperdynamic circulation with ____cardiac output and _____ systemic vascular resistance.

Answer 18

Patients with end-stage liver disease have a hyperdynamic circulation with increased cardiac output and decreased systemic vascular resistance.

Question 19

Because of potential perioperative complications of GI hemorrhage, sepsis, renal failure, and volume overload, elective surgery should not be performed in Child’s class _____ cirrhotics.

Answer 19

Class C (MELD >14)

Question 20

For major surgery, coagulopathy

should be corrected to an INR ___, and fibrinogen to > _____.

Answer 20

<1.5
>100
>100 mg/dl

Question 21

What are the intraoperative management goals in a patient with liver disease?

Answer 21

Preservation of hepatic blood flow and existing hepatic function are key.

Question 22

What induction agents promote a high hepatic extraction ratio?

Answer 22

1) Propofol
2) Etomidate (Esp in hypoalbuminemia)
3) Ketamine

Question 23

What muscle relaxants are prolonged in cirrhotics?

Answer 23

1) Vecuronium

2) Rocuronium

Question 24

All opioids, with the exception of ____, are metabolized in the liver.

Answer 24

Remifentanil (esterases)

Question 25

This opioid is metabolized in the liver but its effect is not prolonged in cirrhotics?

Answer 25

Fentanyl