Advanced | Liver Pathology and Anesthesia Flashcards
(29 cards)
Which of the following volatile anesthetics can induce liver pathology?
A. Halothane
B. Enflurane
C. Sevoflurane
D. Isoflurane
E. Both A&B
E. Both Halothane and Enflurane produce TFA intermediates which is hepatotoxic.
True or False
Nitrous oxide increases hepatic blood flow and therefore can be safely used in Liver Cirrhosis?
FALSE
Due to its sympathomimetic effects, Nitrous Oxide can lead to decreased in hepatic blood flow and INHIBITION of Methionine synthase even in brief exposures.
Barash | 8th edition
MELD Score is utilized to predict the outcome of Liver transplant?
TRUE or FALSE
FALSE
MELD Score appears to predict the perioperative mortality of cirrhotic patients.
Barash | 8th edit
Modified Child-Pugh Score consists of which of the following parameters:
A. Albumin, PT, Ascites, Encephalopathy, Nutritional status
B. Albumin, PT, Creatinine, Ascites, Encephalopathy, Nutritional status
C. Albumin, PT, Ascites, Encephalopathy, Bilirubin
D. INR, Creatinine, Bilirubin, Albumin
C. Albumin, PT, Ascites, Encephalopathy, Bilirubin
TRUE or FALSE
Cardiopulmonary bypass surgery can be safely performed in a patient with Child class B
Child class A and selected Child class B can safely undergo cardiac bypass surgery.
TRUE
TRUE or FALSE
Elective cardiac and abdominal surgery should be cancelled until after liver transplant in a patient with Child’s C.
TRUE
Elective high-risk procedures (Abdominal and Cardiac surgery) in patients with Child C cirrhosis should be deferred until after lover transplant.
TRUE or FALSE
Age more than 70 years old has an equivalent MELD Score of 3 points.
TRUE
other than MELD score, the other important predictors of perioperative mortality in cirrhotics are
age (>70 years old)
ASA IV or V
TRUE or FALSE
ASA physical status > IV is equivalent to 5 MELD points.
TRUE
MELD score of less than 11 have a low post-operative mortality and represents an acceptable surgical risk.
Which of the following is the NMB-agent of choice for ESLD (End-Stage Liver Disease) patients?
A. Atracurium
B. Rocuronium
C. Succinylcholine
D. Vecuronium
E. Cisatracurium
CISATRACURIUM
This is due to its organ-independent elimination and lack of histamine release.
Which of the following coagulation factors are not affected in ADVANCED LIVER DISEASE:
A. II
B. V
C. VII
D. VIII
D. VIII
Factor VIII is produced both by the liver and endothelial cells. It may be normal even if the liver disease is advanced.
TRUE or FALSE
Total hepatic blood flow is directly proportional to the perfusion pressure across the liver and is inversely proportional to splanchnic vascular resistance.
TRUE
TRUE OR FALSE
Dopamine infusions at 0.5mcg to 2.5mcg/kg/min increases liver blood flow
TRUE
A 50-year-old man with jaundice is scheduled for inguinal hernia repair. An increase in which of the following is the best indicator of impaired hepatic function?
A. PT
B. ALT
C. A:G ratio
D. Alkaline phosphatase
E. Bilirubin
Prothrombin Time
▪ Sensitive because short half-life. Thus progressively rise is poor prognostic sign in likely acute hepatic failure.
A 20-year-old athlete weighing 70 kg receives nitrous oxide, oxygen, and 1.25 mg (25 mL) of fentanyl during a 3-hour reconstructive surgery. He does not awaken or resume spontaneous breathing. What is the most likely explanation for the prolonged effect of fentanyl?
A. Dose dependent elimination half-life
B. Genetically slow biotransformation
C. Large volume of distribution
D. Presence of active metabolite in high concentration
E. Time required for hepatic elimination
E. Time required for hepatic elimination
Plasma half-time of which of following is prolonged in patients with end stage cirrhotic liver disease?
A. Diazepam
B. Pancuronium
C. Fentanyl
D. All of the above
D. All of the above
A healthy ASA I women is undergoing arthroscopy with spinal anesthesia to T4. Which finding is least likely to occur:
A. ↓ HR
B. ↓ hepatic blood flow
C. ↓ MAP
D. ↓ TV
E. Hyperperistalsis
D. ↓ TV
Decrease hepatic blood flow is apparent after spinal anesthesia.
- The least affected is pulmonary physiology. Lung volumes are not affected.
A 65-year-old man with a history of alcohol abuse is scheduled for surgery. Which preoperative serum test would provide the most reliable assessment of his hepatic synthetic function?
A. Albumin
B. Alkaline phosphatase
C. Bilirubin
D. Globulin
E. Transaminase
A. Albumin
A 50-year-old man with jaundice is scheduled for inguinal hernia repair. An increase in which of the following is the best indicator of impaired hepatic function?
A. PT
B. ALT
C. A:G ratio
D. Alkaline phosphatase
E. Bilirubin
Prothrombin Time
▪ Sensitive because short half-life. Thus progressively rise is poor prognostic sign in likely acute hepatic failure.
A 20-year-old athlete weighing 70 kg receives nitrous oxide, oxygen, and 1.25 mg (25 mL) of fentanyl during a 3-hour reconstructive surgery. He does not awaken or resume spontaneous breathing. What is the most likely explanation for the prolonged effect of fentanyl?
A. Dose dependent elimination half-life
B. Genetically slow biotransformation
C. Large volume of distribution
D. Presence of active metabolite in high concentration
E. Time required for hepatic elimination
E. Time required for hepatic elimination
Plasma half-time of which of following is prolonged in patients with end stage cirrhotic liver disease?
A. Diazepam
B. Pancuronium
C. Fentanyl
D. All of the above
D. All of the above
Which of the following test can be conducted to investigate the cause of acute liver failure in patients under 40 years old, when no other obvious explanation is present?
A. Ceruloplasmin level
B. Ammonia (arterial if possible)
C. Autoimmune markers
D. ANA and ASMA levels
A. Ceruloplasmin level
A patient with chronic liver failure scheduled for a liver transplant. Which of the following preoperative findings is MOST likely?
A. Hypoxemia
B. ↑ Platelet count
C. ↑ Systemic vascular resistance
D. ↑ Factor VIII
E. Metabolic alkalosis
D. ↑ Factor VIII
A patient presenting with the following symptoms: Gross disorientation, drowsiness, possibly asterixis, and inappropriate behavior would corresponds to which of the following grading of hepatic encephalopathy?
A. Grade I
B. Grade II
C. Grade III
D. Grade IV
B. Grade II
A patient with no prior history of liver disease presents for an emergency upper GI endoscopy. His signs, symptoms, and laboratory results suggest hepatitis. Along with encephalopathy, what INR value would strongly support the diagnosis of acute liver failure (ALF)?
A. INR more than or equal 1.2
B. INR more than or equal 1.5
C. INR more than or equal 2.5
D. INR more than or equal 3.0
B. INR more than or equal 1.5
