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Brandon’s AFN Health Assessment > Test 4 GI > Flashcards

Test 4 GI Flashcards

1
Q

what is defined as the portal triad?

A

hepatic arteriole
portal venule
bile ductal

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2
Q

microcirculation of the liver lobule is divided into ________ zones that receive varying oxygen content`

A

3

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3
Q

zone 1 of liver lobule receives __________ blood from the __________ & ________

A

oxygen rich; adjacent portal vein and hepatic artery

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4
Q

blood entering zone 3 of the liver lobule is _______________

A

oxygen poor

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5
Q

what zone of the liver lobule is most affected by hypoxia and reactive metabolic intermediates?

A

zone 3

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6
Q

liver synthesizes all clotting factors except ?

A

III, IV, and VIII

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7
Q

Vitamin K dependent clotting factors are dependent on what function of the liver?

A

bile excretion

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8
Q

blood coagulation fx of the liver

A
  • synthesis of clotting factors (except III, IV, VIII)
  • synthesis of pro and anti-clotting factors
  • produces thrombopoietin
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9
Q

liver receives __________% of CO via dual supply

A

25%

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10
Q

how much bile is produced daily?

A

500ml

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11
Q

the hepatic portal vein supplies 75% of the liver inflow, this is due to the ____________________ in the portal vein

A

low vascular resistance

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12
Q

metabolism functions of the liver

A
  • stores/releases glycogen/site of gluconeogenesis
  • urea production (aa and protein metabolism)
  • fatty acid, cholesterol, and plasma protein synthesis (lipid metabolism)
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13
Q

T/F: endocrine abnormalities may be more common with liver disease

A

true

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14
Q

endocrine management fx of liver

A
  1. synthesizes and secretes: angiotensinogen, thrombopoietin, thyroid binding globulin
  2. converts T4 to T3
  3. inactivates corticosteroids, mineralcorticosteroids, and androgens
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15
Q

in liver dysfunction there may be alterations that affect pharmacokinetics/dynamics of many anesthetic agents. This is because of what function of the kidney

A

protein synthesis

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16
Q

what protein synthesized in the liver binds amide type local anesthetics, opoids, and propranolol

A

alpha-1 acid glycoprotein

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17
Q

what protein synthesized in the liver metabolizes succinylcholine and ester local

A

pseudocholinesterase

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18
Q

drug metabolism is primarily performed by what organ?

A

liver (hepatic)

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19
Q

what is the goal of hepatic biotransformation within the liver

A

to make drugs inactive, water soluble, and ready to excrete

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20
Q

phase 1 of hepatic biotransformation

A

oxidation, reduction, dealkylation, hydrolysis

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21
Q

which phase of hepatic biotransformation is more susceptible to inhibition by advanced age and/or hepatic dysfunction?

A

phase 1

22
Q

phase 2 reaction of hepatic biotransformation

A

conjugation

23
Q

what is the first pass effect?

A

pre-systemic elimination of drugs delivered via the oral route

24
Q

what is the effect on high extraction rate drugs taken orally (lidocaine, propranolol, morphine) due to the first pass effect?

A

they will have reduced bioavailability due to the presystemic metabolism

25
Q

what is the effect on drugs with a low extraction rate (tegretol, valium, dilantin, procanamide, warfarin) if taken orally, due to the first pass effect?

A

will have minor first pass effects, but will have a slow metabolism and are more dependent on hepatic clearance

26
Q

if liver dysfucnction is known or suspected, what does this mean for your anesthetic agent plans perioperatively?

A
  • unknown effects with kinetics and dynamics
  • need to weigh risk/benefit of comorbid conditions
  • CAREFUL TITRATION
27
Q

T/F: in the absence of a positive H&P or known liver disease preoperative lab testing is unnecessary

A

true

28
Q

what should you evaluate if a pt has a known hx or positive hx of liver dz prior to surgery?

A
  1. eval hepatocyte injury/necrosis through ALT, AST, GST (liver fx tests)
  2. eval hepatic conjugation and excretion (bilirubin)
  3. eval hepatic excretion (alkaline phosphatase, GGT)
  4. evaluate protein synthesis (Albumin, PT, INR)
29
Q

normal AST

A

10-40 IU/L

30
Q

normal ALT

A

10-60 IU/L

31
Q

what could a ALT of 180/AST of 120 indicate? (i.e. mildly elevated transaminases)

A

fatty liver
non-etoh steatohepatitis
drug toxicity
chronic viral hepatitis

32
Q

mildly elevated ALT/AST (3x) normal would be ALT ____; AST ____

A

180; 120

33
Q

what is defined as a large increase in ALT & AST

A

4 - 22x normal (AST: 40-160 - 220-880)(ALT: 40-220 - 240-1320)

34
Q

an AST/ALT ratio of > 2 indicates

A

alcoholic liver disease

35
Q

an AST/ALT ratio of <1 indicates

A

viral hepatisis

36
Q

what do liver fx tests (AST/ALT) assess

A

hepatocyte cellular injury

37
Q

having ALT of 500 and AST of 700 would indicate?

A
  1. acute hepatitis
  2. chronic hepatitis exacerbation (etoh induced)
  3. drug/toxin induced hepatocellular necrosis
  4. severe hepatitis
  5. ischemia hepatitis complicating circulatory shock
38
Q

bilirubin orginiates from _______________

A

breakdown of hemoglobin

39
Q

unconjugated bilirubin is the _________ soluble form; while conjugated is the ___________ soluble form

A

lipid; water

40
Q

normal value for unconjugated bilirubin

A

1-4 mg/dL

41
Q

elevated unconjugated bilirubin indicates?

A

disorder of bilirubin metabolism d/t either excess production of bilirubin through hemolysis or decrease in the uptake and conjugation of bilirubin by hepatocytes

42
Q

what does elevated conjugated bilirubin indicate?

A
  1. impaired intrahepatic excretion or extrahepatic obstruction
  2. could be d/t gall stones
43
Q

Bilirubin > 35 indicates

A

severe liver dz in association with hemolysis or renal failure

44
Q

T/F: serum albumin is a great indicator of acute liver disease

A

false; due to 3-week half life it is not a reliable indicator of acute liver dz

45
Q

other than in liver dz when may albumin levels be low?

A

enteropathy
burns
nephrotic syndrome

46
Q

albumin levels can be a significant indicator of what in regards to liver dz?

A

worsening fx of liver in chronic liver dz

47
Q

what labs are sensitive indicators of hepatic dz because of short half life?

A

PT and INR

48
Q

when might PT be prolonged in the absence of liver dz?

A

biliary obstruction
congenital coagulation factor deficiencies
DIC
warfarin therapy

49
Q

what are the 3 types of alcoholic liver dz?

A

steatosis
hepatitis
cirrhosis

50
Q

which type of etoh liver dz is usually benign and will resolve with abstinence

A

steatosis

Brandon’s AFN Health Assessment (17 decks)

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