Prodigy- Liver Flashcards
What is the largest internal organ in the human body?
The liver
Liver is located between T__ & T___
T7 - T11
7-11 - Indians, drink their liver to death
How much blood can the liver store up to?
1L
What supplies blood flow to the GB?
the cystic artery
What stimulates the GB to contract after eating?
CCK (cholecystokinin)
What is formed as a byproduct of deamination?
Ammonia
In pts with liver failure, the low albumin leads to increased free fraction of the drug, which can prolong your DOA of vec/roc/panc….. however, it is often necessary to give an INCREASED induction dose in order to reach the intended clinical effect… why?
Bc low protein = decreased oncotic pressure = more fluid moves to intersistial space, increasing the volume of distribution
What is gluconeogenesis stimulated by and what does it form?
stimulated by reduced glycogen stores.
-forms glucose from noncarb substances: pyruvate, lactate, and amino acids
Vitamin K is a (water/fat) soluble vitamin required for the absorption of what clotting factors?
2, 7, 9, 10
What lab value changes would reflect vitamin K deficiency
prolonged PT with a normal PTT
IV Vitamin K improves PT in what time frame?
6-8 hours
If your patient is on orlistat, what should you consider?
Checking PT/PTT
-if PT is prolonged and PTT is normal, may have a coagulopathy due to vitamin K deficiency and it needs to be corrected prior to surgery.
Which metabolism pathways are the P450 isoenzymes a part of?
Oxidation, Reduction, and Conjugation
Just not hydrolysis bc that happens outside of the liver
Which is more specific to liver damage, AST or ALT
ALT (L = Liver)
AST/ALT don’t indicate liver function; they are an assessment of what?
cellular damage
How do you differentiate alcoholic hepatitis vs viral hepatitis
etoh will have a AST/ALT ratio > 2
viral hepatitis will have a AST/ALT ratio < 1
if the alk phos is significantly more elevated than the AST/ALT, what is most likely the cause?
Bile obstruction
in patients with an AST/ALT ratio > 2, which level is usually higher?
AST
Increased resistance to blood flow to the liver is known as what
Portal hypertension
pt’s with a MELD score > ____ carry a 100% 3-month mortality rate
> 40
T/F- an elevation in liver enzymes less than twice the normal value is relatively common after abdominal surgery
True
-usually resolves within 48hours
T/F - volatile agents increase liver blood flow
True
Which opioid should be avoided in liver disease
Meperidine
Which is the only opioid unaffected by hepatic disease?
Remi
Will acute liver failure result in the prolongation of sux?
No - bc pseudocholinesterase has a half life of about 2 weeks
All of the following could precipitate hepatic encephalopathy in patients with cirrhosis except: A. Gastrointestinal hemorrhage B. Diuretic administration C. Hyperkalemia D. Azotemia
C.
Venous blood from the gallbladder drains into the A. portal vein B. hepatic artery C. cystic vein D. hepatic vein
A
The gallbladder normally stores about \_\_\_\_\_ mL of bile. A. 50 B. 500 C. 100 D. 25
A
A patient is in steep Trendelenburg position during a laparoscopic cholecystectomy. The patient suddenly exhibits a decrease in oxygen saturation, subcutaneous crepitation over the chest, and an increase in end-tidal CO2. The first step you should take is
A. Begin chest compressions
B. Hyperventilate the patient
C. Tell the surgeon to turn off the insufflator
D. Administer epinephrine 100 mcg IV
C
The preferred treatment of cholecystitis due to cholelithiasis is A. opioids and antibiotics B. laparoscopic cholecystectomy C. cholecystostomy tube D. open cholecystectomy
B
Which anesthetic agent is metabolized by the liver to the greatest degree? A. Sevoflurane B. Isoflurane C. Nitrous oxide D. Desflurane
A
Hepatic blood flow can decrease substantially during abdominal surgery. This is most likely due to A. propofol-induced hepatitis B. the effects of volatile anesthetics C. histamine release D. prostaglandin release
D.
thought to be from the retractors
Alcoholic hepatitis is characterized by alcohol abuse, liver dysfunction, and A. an AST/ALT ratio less than 1 B. encephalopathy C. a prolonged PT D. jaundice
D
Bile performs several functions, one of which is to
A. keep the duodenum alkaline
B. excrete IgM
C. produce pseudocholinesterase
D. enhance the absorption of water-soluble vitamins
A
