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apex review > Liver 3 > Flashcards

Liver 3 Flashcards

1
Q

Normal alkaline phosphatase levels are

A

45-115 units/L

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2
Q

Alkaline phosphatase specificity?

A

not very specific (also in bone, placenta, and tumors

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3
Q

Normal Y glutamyl transpeptidase is

A

0-30 units/L

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4
Q

____________ is more sensitive than _____________

A

Y Glutamyul transpeptidase is more sensitive than alkaline phosphatase

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5
Q

The most specific indicator of biliary duct obstruction is

A

5’ -nucleotidase

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6
Q

Causes of prehepatic liver disease include

A

hemolysis
hematoma reabsorption

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7
Q

Lab value changes in prehepatic liver disease include

A

elevated unconjugated bilirubin

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8
Q

Causes of hepatocellular injury include

A

cirrhosis
alcohol abuse
drugs
viral infection
sepsis
hypoxemia

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9
Q

Lab values of hepatocellular injury include

A

elevated conjugated bilirubin
elevated aminotransferase (ALT & AST)
elevated prothrombin time
decrease albumin- chronic injury only
normal or increased alkaline phosphatase

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10
Q

Reasons of cholestatic disease includes

A

biliary tract obstruction
sepsis

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11
Q

Lab values of cholestatic disease includes

A

elevated conjugated bilirubin
normal or elevated aminotransferase (late disease)
normal or elevated prothrombin time (late disease)
normal or low albumin (late disease)
elevated alkaline phosphatase
elevated & glutamyl transpeptidase, 5’-nucleotidase

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12
Q

Select the statements that BEST describe hepatitis. (select 2)
a. halothane hepatitis is an immune-mediated response
b. alcohol abuse is the most common cause of chronic hepatitis
c. hepatitis is usually transmitted via blood transfusion
d. hepatitis A usually causes cirrhosis

A

a. halothane hepatitis is an immune-mediated response
b. alcohol abuse is the most common cause of chronic hepatitis

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13
Q

____________ is the most common form of viral hepatitis

A

Hepatitis A

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14
Q

________ & _______ can cause cirrhosis

A

Hepatitis B and C

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15
Q

The most common cause of chronic hepatitis is

A

alcohol abuse

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16
Q

Hepatitis A is transmitted via

A

the oral-fecal route

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17
Q

__________ is associated with hepatocellular injury with variable degrees of necrosis

A

Hepatitis

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18
Q

Hepatitis can be

A

acute or chronic

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19
Q

The most common cause of hepatitis is

A

liver cancer

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20
Q

The most common indication for liver transplantation is

A

hepatitis

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21
Q

Etiologies of hepatitis include

A

viruses, hepatotoxins, & autoimmune responses

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22
Q

Hepatitis B & C can lead to

A

cirrhosis and hepatocellular carcinoma

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23
Q

Etiologies of drug-induced hepatitis include

A

acetaminophen, halothane, and alcohol

24
Q

The antidote for acetaminophen overdose is

A

oral N-acetlycysteine

25
Q

The most common cause of drug-induced hepatitis and chronic hepatitis is

A

alcohol

26
Q

Chronic hepatitis is characterized by

A

hepatic inflammation that exceeds 6 months

27
Q

Chronic hepatitis leads to the progressive destruction of

A

the hepatic parenchyma, cirrhosis, and ultimately liver failure

28
Q

What is the pathophys of acetaminophen overdose?

A

tylenol produces a toxic metabolite called N-acetyl-p-benzoquinoneimine which in normal dosing is conjugated with glutathione
tylenol overdose consumes the liver’s supply of glutathione letting NAPQI rise & leads to hepatocellular injury

29
Q

The liver metabolizes desflurane, isoflurane, and halothane to

A

inorganic fluoride ions & trifluoracetic acid

30
Q

Up to _________ of halothane is metabolized

A

20%

31
Q

Risk factors for halothane hepatitis include

A

age >40, female gender, greater than two exposures, genetics, obesity, CYP2E1 induction (alcohol, isoniazid, phenobarbital)

32
Q

Diagnosis of chronic hepatitis includes

A

increased liver enzymes and bilirubin + histologic evidence of liver inflammation

33
Q

S/sx of chronic hepatitis include

A

jaundice, fatigue, thrombocytopenia, glomerulonephritis, neuropathy, arthritis, and myocarditis

34
Q

What lab values are changed with chronic hepatitis?

A

PT is prolonged
albumin is decreased

35
Q

All of the following drugs should be avoided in the patient with acute hepatitis EXCEPT:
a. amiodarone
b. tetracycline
c. acetaminophen
d. propranolol

A

d. propranolol

36
Q

For acute hepatitis, non-emergent surgery should be

A

postponed until symptoms have resolved and liver function tests return to normal

37
Q

For chronic hepatitis, the patient may

A

proceed to surgery so long as the condition is stable

38
Q

MAC is reduced in the patient who is ____________, but is increased in the _________________

A

acutely intoxicated with alcohol; but increased in the chronic alcohol user who is not intoxicated

39
Q

Alcohol impairs

A

pharyngeal reflexes

40
Q

Always assumes that the acutely intoxicated patient has

A

a full stomach

41
Q

Anesthetic considerations for acute hepatitis include

A

maintaining liver blood flow (use is or sevo)
avoid PEEP
avoid hepatotoxic drugs
avoid drugs that inhibit hepatic enzymes
carefully monitor the neuromuscular junction
liberal fluids
regional anesthesia OK if there are no coagulation defects

42
Q

Signs and symptoms of alcohol withdrawal begin

A

6-8 hours after blood alcohol concentration returns to near normal

43
Q

Alcohol withdrawal peaks at

A

24-36 hours

44
Q

Hepatotoxic drugs or drugs that inhibit CYP450 enzymes include

A

acetaminophen
halothane
amiodarone
antibiotics: PCN, tetracycline, and sulfonamides

45
Q

Alcohol potentiates

A

GABA

46
Q

Alcohol inhibits

A

NMDA receptors

47
Q

Treatment for alcohol withdrawal includes

A

alcohol
beta-blockers
alpha-2 agonists

48
Q

Early s/sx of alcohol withdrawal include

A

tremors and disorder perception (hallucinations, nightmares)

49
Q

Late s/sx of alcohol withdrawal include

A

increased SNS activity (tachycardia, HTN, dysrhythmias), N/V, insomnia, confusion, and agitation

50
Q

________________ occurs after 2-4 days without alcohol

A

Delirium tremens

51
Q

Treatment for delirium tremens include

A

diazepam and beta-blockers

52
Q

S/sx of delirium tremens

A

grand mal seizures, tachycardia, hyper- or hypotension, & combativeness

53
Q

Alcoholics are often deficient in

A

vitamin B1 (thiamine)

54
Q

_________________ is characterized by a loss of neurons in the cerebellum, and this is brought on by thiamine deficiency

A

Wernicke-Korsakoff syndrome

55
Q

__________ is a treatment used for alcoholics in recovery

A

disulfiram

56
Q

Disulfiram is

A

hepatoxic and leads to hypotension

apex review (224 decks)

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