Exam 3: Hepatic

Question 1

_____ is the largest solid organ in the body

Answer 1

Liver

Question 2

the liver is _______% of adult body weight and ____% of neonate body weight

Answer 2

2; 5

Question 3

the liver weighs about ________ g

Answer 3

1500

Question 4

the liver sits in the thoracic portion of the abdominal cavity from ribs ______ - _______

Answer 4

7; 11

Question 5

______________ is what divides the liver into the left and right lobes

Answer 5

falciform ligament

Question 6

What are the different anatomic lobes of the liver?

Answer 6

1. right lobe
2. left lobe
3. caudate lobe
4. quadrate lobe

Question 7

T/F: the liver is the only organ with a dual blood supply

Answer 7

True

Question 8

surgical liver anatomy has __________ segments

Answer 8

8 (1-8)

Question 9

Why is knowing the hepatic segments important as an anesthetist?

Answer 9

This becomes extremely important when we are doing segmental resections of the liver

Question 10

What is the portal triad?

Answer 10

1. Bile Duct
2. Hepatic Artery
3. Portal Vein

Question 11

The liver receives approximately _____% of cardiac output via a dual arterial and venous blood supply

Answer 11

25-30

Question 12

The _____and ______ enter the liver and progressively branch until terminating in the hepatic sinusoids.

Answer 12

hepatic artery ; portal vein

Question 13

Changes in hepatic artery or portal vein blood flow may not result in an overall change in total hepatic flow due to the _______

Answer 13

hepatic artery buffer response (HABR)

- This response is a semireciprocal autoregulatory mechanism whereby changes in portal flow inversely affect hepatic arterial flow

Question 14

the hepatic artery supplies _____% of blood to the liver, and the hepatic portal vein supplies ____% of blood to the liver; however, both supply ____% of O2

Answer 14

20-25 ; 70-75 ; 50

Question 15

if the portal vein supplies 70-75% of blood flow to the liver, why does it only supply 50% of Oxygen?

Answer 15

blood in hepatic portal vein is partially deoxygenated and nutrient rich 2/2 blood coming into it from splanchnic circulation

Question 16

the hepatic artery comes from the _____________ artery

Answer 16

celiac

Question 17

the portal vein comes from the ____________ & __________ veins

Answer 17

splenic vein; inferior mesenteric vein

Question 18

what should your hepatic artery pressure be?

Answer 18

should be the same as the SBP bc it comes right off the Ao

Question 19

What is the pressure in the hepatic portal vein?

Answer 19

7-10 mmHg

Question 20

O2 sat of the hepatic portal vein

Answer 20

85%

Question 21

the low pressure system of the hepatic portal vein allows for what ?

Answer 21

1. large venous reservoir in the liver
2. allows to compensate 25% of volume loss
3. can hold 1 L of volume

Question 22

SNS innervation to the liver

Answer 22

T3-T11

Question 23

parasympathetic innervation to the liver

Answer 23

R/L vagus nerves
R phrenic nerve

Question 24

what are the vasoconstricting receptors of the hepatic artery?

Answer 24

alpha 1 adrenergic

Question 25

what are the vasoconstricting receptors of the portal vein?

Answer 25

alpha 1 adrenergic D1 dopaminergic

Question 26

what are the vasodilating receptors of the hepatic artery

Answer 26

1. B2 adrenergic 2. D1 dopaminergic 3. cholinergic

Question 27

the D1 dopaminergic receptor causes _____________ in the hepatic artery, but causes ________________ in the portal vein

Answer 27

vasodilation; vasoconstriction

Question 28

_________________ is the functional unit of the liver

Answer 28

hepatic lobule

Question 29

there are approximately _________________ hepatic lobules in a normal liver

Answer 29

50,000 - 100,000

Question 30

what is in the center of each hepatic lobule

Answer 30

central vein

Question 31

all hepatic veins course through the hepatic lobule draining into the ____________, which then drains into the _______________

Answer 31

central vein; IVC

Question 32

describe the hepatic blood flow

Answer 32

1. in from hepatic artery and portal vein 2. through the sinusoids 3. into the central veins 4. Hepatic veins 5. then into the IVC

Question 33

how long does it take for blood to flow from the portal vein to the central vein?

Answer 33

8-9 seconds

Question 34

______________ is on each side of the hepatocyte which allows for large proteins to come through

Answer 34

fenestrated endothelium

Question 35

what is the fx of bile canaliculi

Answer 35

they collect the bile that the hepatocyte is producing --> bile duct

Question 36

What are the different functions of the liver? (Vasculature and metabolic)

Answer 36

vasculature: 1. blood reservoir 2. blood cleansing via kupffer cells metabolic liver fx: 1. bile formation and excretion 2. protein synthesis 3. glycogen storage 4. protein metabolism 5. insulin clearance 6. lactate conversion into glucose 7. drug metabolism 8. biotransformation

Question 37

The normal blood volume in the liver = __________, but can hold up to __________

Answer 37

450 mL; 1 L

Question 38

_____ cells line the sinusoids and function to cleanse the blood

Answer 38

kupffer cells

Question 39

_____ is stored glucose

Answer 39

Glycogen

Question 40

To maintain a steady blood glucose level, the liver moderates _______ and _______.

Answer 40

gluconeogenesis; glycogenolysis

Question 41

________ is the formation of glucose from the noncarbohydrate molecules lactate and pyruvate, as well as amino acids, all of which are products of anaerobic and catabolic metabolism. It is stimulated by ____________________.

Answer 41

Gluconeogenesis; a decrease in glycogen stores

Question 42

During periods of fasting, the liver maintains blood glucose at relatively normal levels through __________.

Answer 42

glycogenolysis

Question 43

Initiated by epinephrine and glucagon, _______ is the process of liberating glucose from glycogen stores found in the liver (and skeletal muscle).

Answer 43

glycogenolysis

Question 44

________ may be encountered in patients with severe liver disease due to dysfunctions in insulin clearance, a decrease in glycogen capacities, and impaired gluconeogenesis.

Answer 44

Hypoglycemia

Question 45

_____ is the formation of of glycogen from glucose

Answer 45

Glycogenesis

Question 46

Most proteins are synthesized by the liver *EXCEPT* ________

Answer 46

immunoglobulins

Question 47

What is the **MOST** important protein produced by the liver?

Answer 47

Albumin

Question 48

What happens to protein synthesis as a result of liver dysfunction?

Answer 48

Decreased albumin - Decreased plasma oncotic pressure - Ascites - Increased Vd --> Increased NMB Decreased drug binding - Exaggerated effect of some drugs (Barbiturates) Decreased plasma pseudocholinesterase - Prolonged succs action

Question 49

______ is a breakdown product of heme metabolism and is often classified as unconjugated or conjugated.

Answer 49

Bilirubin

Question 50

Explain the process of bilirubin metabolism

Answer 50

Heme is converted to unconjugated bilirubin in the reticuloendothelial cells of the spleen. This unconjugated bilirubin is not soluble in water and is neurotoxic at sufficiently high levels. It is then bound to albumin and transported to the liver. Once in the liver, the unconjugated bilirubin is conjugated with glucuronic acid. Bilirubin is then incorporated into the bile and secreted into the intestine, where it is metabolized by bacterial enzymes and predominantly excreted in the feces.

Question 51

Bile is created in the _____ Bile is stored and concentrated in the ______

Answer 51

Liver ; Gallbladder

Question 52

Bile is released from the gallbladder in response to ______

Answer 52

to the intestinal hormone cholecystokinin (CCK)

Question 53

_______ assists in the absorption of fat and fat-soluble vitamins (vitamins A, D, E, and K).

Answer 53

Bile secretion

Question 54

What are the fat-soluble vitamins?

Answer 54

*A, D, E, K* **All Dogs Eat Kats**

Question 55

Liver disease may result in impaired bile production or flow, leading to…

Answer 55

- steatorrhea - vitamin K deficiency - delayed removal of active drug metabolites

Question 56

All clotting factors are produced by the liver except

Answer 56

VIII and vWF

Question 57

What are the Vitamin-K-dependent clotting factors?

Answer 57

II, VII, IX, X