Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Apex Review > Liver 5 > Flashcards

Liver 5 Flashcards

1
Q

The anhepatic phase begins with

A

removal of the native liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The anhepatic phase ends with

A

implantation of the donor liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Surgical objectives of the anhepatic phase inlcude

A

removal of sick liver
implantation of donor liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Neohepatic phase begins with

A

reperfusion of donor liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The neohepatic phase ends with

A

biliary anastomosis (or transport to the ICU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Surgical objectives of the neohepatic phase include

A

reperfusion of donor liver
anastomosis of hepatic artery
anastomosis of biliary structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

During the pre-anehpatic phase, patients are at risk of

A

gastric regurgitation and pulmonary aspiration d/t liver disease and ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The pre-anhepatic phase dictates a

A

rapid sequence induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Items needed in the pre-anhepatic phase include

A

rapid infuser to administer warm fluids and replace blood products as needed b/c significant blood loss is a risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Goals of the pre-anhepatic phase include

A

hgb >7 g/dL
platelets >40,000
fibrinogen >100 mg/dL
and MA (TEG) >45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

With the pre-anhepatic phase, anticipate

A

CV instability (hypotension) as a result of drainage of ascites, compression of vascular structures, and ongoing blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A lower CVP will reduce

A

blood loss during surgical dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Just before clamping the IVC, increase the CVP to

A

10 cmH2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the approaches the surgeon can use for hepatic isolation?

A

bicaval clamp
piggyback technique
venovenous bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The bicaval clamp is when

A

clamps are applied to the IVC (above and below the liver) for full obstruction of IVC flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Special considerations of the bicaval clamps include

A

significant preload reduction (hypotension, tachyardia)
aggressive fluid administration to combat hypotension can lead to volume overload when the clamps are released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The piggyback technique is when there is

A

side clamping of the IVC (partial obstruction to IVC flow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Special considerations of the piggyback technique include

A

less preload reduction as compared to bicaval clamping
reduced operating and warm ischemic times
fewer blood products required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the venovenous bypass?

A

sites of cannulation include femoral vein & portal vein (outflow sites towards pump)
site of cannulation: axillary vein (return to body)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Special considerations of venovenous bypass include

A

piggyback technique has reduced the need for VVB
VVB is a reasonable choice if the patient does not tolerate piggyback
associated with less hemodynamic instability, less blood loss, and prevention of portal and splanchnic congestion but it has a higher complication rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

During the anhepatic phase, the patient will have no

A

liver function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Common problems during the anhepatic phase include

A

worsening coagulopathy, ongoing blood loss, lactic acidosis, and hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

__________________ is used to combat acidosis during the anhepatic phase

A

Sodium bicarbonate (or another buffer)

24
Q

How often should labs be monitored during the anhepatic phase?

A

q15-30

25
Q

In preparation for reperfusion, pay close attention to

A

serum potassium as it will get higher when the donor liver is reperfused

26
Q

Warm ischemic times begins when the donor liver is

A

removed from the ice and extends until the donor liver is reperfused

27
Q

Warm ischemic time should not exceed

A

30-60 minutes

28
Q

Key complications of the neohepatic phase include

A

hyperkalemia
hypocalcemia
cytokine release
lactic acidosis
embolic debris
hypovolemia
systemic hypotension
pulmonary hypertension
hypothermia
cardiac arrest

29
Q

The risk of hyperkalemia is highest during

A

the neohepatic phase

30
Q

First-line pharmacologic treatment for hyperkalemia includes

A

calcium chloride and sodium bicarbonate

31
Q

Avoid _________ as this will cause congestion in the graft

A

increased CVP

32
Q

Findings that suggest good graft function include

A

stabilization of serum glucose and acid-base status as well as prompt return to normothermia

33
Q

Post-reperfusion syndrome is defined as

A

systemic hypotension more than 30% below baseline for at least 1 minute during the first 5 minutes of reperfusion of the donor liver

34
Q

Signs of a poorly functioning graft include

A

continued hemodynamic instability and lack of bile output

35
Q

Pain control for liver transplants typically includes _____ and not __________

A

opioids (often PCA) and not epidural analgesia b/c of coagulation status

36
Q

Post-op considerations for liver transplant include

A

steroid-induced hyperglycemia
antirejection medications impact immune function

37
Q

All of the following drugs improve biliary hypertension EXCEPT:
a. naloxone
b. nitroglycerine
c. glucagon
d. octreotide

A

d. octreotide

38
Q

The most common gallbladder diseases are caused by

A

obstruction or inflammation

39
Q

_____________increases the risk of PONB

A

glucagon

40
Q

_________ can precipitate spasm of the sphincter of oddi

A

opioids- problem if it causes a false-positive during a cholangiogram

41
Q

You can relax the sphincter of oddi with

A

glucagon, naloxone, or nitroglycerin
glycopyrrolate and atropine may help as well

42
Q

___________ can cause an obstructive defect that impedes the flow of bile as well as pancreatic enzymes

A

Biliary stones

43
Q

If bile and pancreatic enzymes can’t move into the small intestine, then they

A

back up into the liver and the pancreas

44
Q

Obstruction of the cystic duct leads to

A

gallbladder distension
edema
risk of perforation
& jaundice

45
Q

Obstruction of the common bile duct leads to

A

cholecystitis
jaundice
pancreatitis
peritonitis

46
Q

The incidence of gallstones increases with

A

obesity, aging, rapid weight loss, pregnancy, and women>men

47
Q

S/sx of biliary stones include

A

leukocytosis, fever, and RUQ pain
pain is worse with inspiration (Murphy’s sign)

48
Q

Prolonged NPO status increases the

A

likelihood of gallstone formation

49
Q

Biliary pathology includes

A

increased alkaline phosphatase, increased conjugated bilirubin, increased amylase, increased Y glutamyl transpeptidase, and increased 5’-nucleotidase

50
Q

Treatment of cholecystitis and cholelithiasis is

A

cholecystectomy

51
Q

treatment of choledocholithiasis is

A

ERCP

52
Q

Choledocholithiasis is

A

stones in the common bile duct

53
Q

___________ should be avoided due to bowel distension

A

Avoid N2O

54
Q

If there is liver dysfunction, ____________ should be selected

A

a benzylisoquinolinium NMB (cisatracurium or atracurium)

55
Q

Using naloxone in a surgical patient is

A

a poor choice

Apex Review (224 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions