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Health Assessment SEM 2 > Exam 3: Hepatic & Biliary > Flashcards

Exam 3: Hepatic & Biliary Flashcards

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1
Q

What is gluconeogenesis?

A

The process by which the liver synthesizes glucose.

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2
Q

How does the liver store excess glucose?

A

As glycogen.

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3
Q

What substances does the liver synthesize?

A

Cholesterol, proteins, hormones, and vitamins.

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4
Q

What does the liver metabolize to generate energy?

A

Fats, proteins, and carbohydrates.

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5
Q

Which enzyme pathways are involved in drug metabolism in the liver?

A

CYP-450 and other enzyme pathways.

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6
Q

What is one major role of the liver in detoxification?

A

Detoxifies blood.

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7
Q

How does the liver contribute to immune support?

A

Involved in the acute phase of immune support.

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8
Q

The liver processes _____ and stores _____.

A

hemoglobin
iron

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9
Q

What are the coagulation factors synthesized by the liver?

A

All except factors III, IV, VIII, and vWF.

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10
Q

How many segments is the liver divided into?

A

8 segments

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11
Q

What separates the right and left lobes of the liver?

Which is larger?

A

Falciform ligament

R lobe > left lobe

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12
Q

What is the primary function of the portal vein and hepatic artery?

A

perfuse each segment of liver

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13
Q

What percentage of cardiac output does the liver receive?

A

25%
via portal vein and hepatic artery

1.25-1.5 L/min

highest proportionate CO of all organs

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14
Q

What is the hepatic artery and portal vein contribution to hepatic blood flow?

O2 delivery?

A

Hepatic artery: 25% HBF

Portal vein: 75% HBF
*partially deoxygenated

O2 delivery: 50/50

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15
Q

What does increased portal venous pressure lead to?

A

Blood backs up into the systemic circulation, potentially causing esophageal and gastric varices.

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16
Q

How is hepatic blood flow autoregulated?

A

The hepatic artery dilates in response to low portal venous flow.

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17
Q

What are the vague symptoms of late-stage liver disease?

A

Disrupted sleep and decreased appetite

*often asymptomatic

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18
Q

What are common risk factors for cholelithiasis?

Percentage asympatomatic?

A
  • Obesity
  • Increased cholesterol
  • Diabetes mellitus
  • Pregnancy
  • Female gender
  • Family history

80%

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19
Q

Choledocholithiasis:

Cause:
S/S:
TX:

A

S/S: N/V, cramping, RUQ pain
Cholangitis s/s: fever, rigors, jaundice

Endoscopic removal of the stone via ERCP

  • guidewire through Sphincter of Oddi into Ampulaa of Vator to retrieve the stone from the pancreatic duct or CBD
  • Glucagon 1 mg treats Oddi spasm
  • GA, prone w/ ET tube left side
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20
Q

What is the most common cause of viral hepatitis requiring liver transplant in the US?

A

Hepatitis C virus

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21
Q

Non-Alcoholic Fatty Liver Disease (NAFLD)

diagnosis:
TX:

A

Liver biopsy: gold standard
Imaging, histology
Hepatocytes contain >5% fat

TX: diet, exercise, transplant

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22
Q

Two scoring systems to determine the severity of liver disease?

A

CTP (child Turcotte Pugh): bili, albumin, PT, encephalopathy, ascites

MELD (model for end-stage liver disease): bilirubin, INR, creatinine, and sodium

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23
Q

Hepatorenal Syndrome

what is it?
TX?

A

excess production of endogenous vasodilators (NO, PG) -> decreased RBF

Midodrine, Octreotide, Albumin

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24
Q

What does the term ‘TIPS’ stand for in liver management?

A

Transjugular Intrahepatic Portosystemic Shunt

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25
What are the contraindications for TIPS procedure?
HF, tricuspid regurg, severe pulmonary HTN
26
What is the purpose of partial hepatectomy?
Resection to remove neoplasms and provide adequate tissue for regeneration
27
What percentage of liver can be removed in patients with normal liver function?
Up to 75%
28
What may the surgeon clamp to control blood loss during liver resection?
IVC or hepatic artery
29
What post-operative care do patients often require after liver resection?
Post op PCA
30
What is the most common indication for liver transplant?
Alcoholic liver disease
31
How does the liver aid in volume control?
blood reservior
32
What empties into the IVC?
right, middle, left hepatic veins
33
The hepatic artery branches off the ________.
aorta
34
What is hepatic arterial blood flow inversely realted to?
portal venous flow
35
Normal hepatic pressure
1-5 mmHg
36
Hepatic pressure for portal HTN? variceal rupture?
>10 mmHg >12 mmHg
37
Risk factors for liver impairment:
family history ETOH, drug use DM obesity mult. partners tattoos (DYI, dirty needles) transfusions (rare)
38
Physical exam liver impairment S/S
pruritis jaundice ascites asterixis (flapping tremor) hepatomegaly splenomegaly spider nevi
39
Most specific enzymes for hepato-biliary function
AST, ALT
40
What are the 3 groups of hepato-biliary disease?
hepatocellular injury - acute liver injury - alcoholic liver disease - NAFLD reduced synthetic function cholestasis
41
hepatocellular injury: types and labs
low albumin high PT high conjugated bili high AST/ALT: *acute liver disease: 25X elevated *alcoholic liver disease: 2:1 *NAFLD: 1:1
42
Reduced synthetic function: labs
low albumin high PT/INR
43
Cholestasis: labs
high phosphatase high GGT high conjugated bili **low bile flow
44
Hemolysis bili overload: what lab is increased?
only unconguated bili
45
Cholelithiasis: S/S TX:
aka gallstones: 80% asymptomatic RUQ pain N/V, indigestion fever (acute obstruction) TX: IVF, abx, pain mangement, LAP CHOLE (remove gallbladder)
46
What is the product of heme breakdown?
bilirubin
47
what does non-alcoholic fatty liver disease progress to?
NASH, cirrohsis, hepatocellular carcinoma
48
Unconjugated Bilirubin causes of high levels?
aka indirect protein bound to albumin, transported to liver, conjugated to H2O soluble "direct" state, excreted in bile *high levels: imbalances between bili synthesis and conjugation
49
Conjugated Bilirubin causes of high levels?
aka direct *obstruction resulting in reflux into circulation
50
What types of hepatitis are more chronic?
B, C
51
How many types of hepatitis?
5 A-E
52
Why is hepatitis incidence decreasing?
vaccines new treatments: - 12 wks Sofosbuvir/Velpatasvir - 98-99% clearance of genotype 1A/1B of hep C - HCV genotype 75% type 1
53
mode of transmission for Hepatitis B and C? Percentages?
transfusions percutaneous sexual perinatal Hep B: 1-5% adults, 80-90% kids Hep C: 76% chronic liver disease
54
Platelet level of alcoholic liver disease, needing transfusion?
<50,000
55
Labs for alcoholic liver disease
high: mean corpuscular volume liver enzymes GGT Bili ETOH level
56
How many people have NAFLD regardless of weight?
1 out of 4
57
More than ____ diabetics and ______ obese people have NAFLD
6 9/10
58
Autoimmune Hepatitis primarily affects ____. May be ____, ____, or _____. Positive _____ and hypergammaglobulinemia. AST/ALT _____x normal value. Percentage remission? Treatment?
women asymptomatic, acute, or chronic +autoantibodies 10-20X remission: 60-80% relaspe common TX: steroids, azathioprine (immunosuppressant), transplant if needed
59
Most common cause of drug induced liver injury?
acetaminophen normally reversible when drug is removed
60
What are the 3 types of Inborn Errors of Metabolism? Occur in what ratio of births? What are they?
wilsons disease alpha-1 antitrypsin deficiency hemochromatosis 1:25000 births genetic inherited disorders w/defects in enzymes breaking down & storing protein, carbs, fatty acids Neonatal period -> high mortality
61
Wilsons Disease aka _____. Leads to oxidative stress in the liver, basal ganglia, and cornea from _____ build-up. S/S: Diagnosis: TX:
hepatolenticular degeneration copper S/S: asymptomatic, severe liver dysfunction, neurological and psychologic manifestations Dx: serum ceruloplasmin, aminotransferase, urine copper level, liver biopsy TX: copper chelation therapy, oral zinc (binds copper in GI)
62
What's the #1 cause for liver transplant in children?
Alpha-1 antitrypsin deficiency
63
Alpha-1 anti-trypsin deficiency results from defective ______ protein, which normally protects liverand lungs from ______ ______. diagnosis: TX:
alpha-1 antitrypsin neutrophil elastase diagnosis: phenotyping TX: pooled alpha-1 antitrypsin for pulmonary symptoms **** Transplant only cure
64
Hemochromatosis is excessive intestinal absorption of _____, which causes _____. May be genetic, repetitive blood transfusions, or _____ infusions. Present in? labs: DX: TX:
Iron -> tissue damage iron transfusions present in cirrhosis, HF, DM, adrenal insufficiency, poly arthropathy high AST/ALT, transferring, ferritin Dx: genetic mutation, ECHO, MRI, liver biopsy TX: weekly phlebotomy, iron chelating drugs, transplant
65
Hepatic Encephalopathy caused by buildup of _____ _____. S/S: TX:
nitrogenous waste neuropsychotic, cognitive impairment lactulose Rifaximin: decreases ammonia production bacteria in the gut
66
Hepatopulmonary Syndrome triad includes:
liver disease hypoxemia intrapulmonary vascular dilation **platypnea (hypoxia when upright) right to left shunt
67
Portopulmonary HTN causes: TX:
pulm. HTN and portal HTN systemic vasodilation triggering pulmonary vasoconstrictor production TX: PD-I, NO, prostacyclin analogs, endothelin receptors antagonists *** Transplant only cure
68
What 2 NMB not metabolized by the liver
Sux and Cis ** but plasma cholinesterase may be decreased
69
Alcohol can ______ MAC of volatiles.
increase
70
Colloids or crystalloids?
colloids *liver no longer producing albumin
71
TIPS: stent/graft placed in the _____ and _____ vein.
portal vein hepatic vein ** shunts blood to systemic circulation
72
Purpose of TIPS?
portal HTN refractory variceal hemorrhage, ascites
73
During partial hepatectomy, you want to maintain CVP _____, to reduce blood loss.
low
74
What can post-op liver resection cause?
coagulation disturbances
75
Primary Sclerosing Cholangitis: Autoimmune, chronic inflammation of ___ ___ ___. Intrahepatic and ______. Biliary tree fibrosis looks like? males vs females S/S: DX: TX:
larger bile ducts intrahepatic and extrahepatic beads on a string Males > females, onset 40s S/S: fatigue, itching, deficient fat-soluble vitamins (A,D,E,K), cirrhosis *high alkalinity phos, GGT * positive antibodies liver biopsy no drug TX Transplant only long-term tx (but reoccurrence can happen since autoimmune)
76
Primary Biliary Cholangitis previously called ___ _____. Autoimmune destruction of ____ _____. males vs female? Causes? S/S: labs: imaging: TX:
biliary cirrhosis bile ducts Male > female Middle age causes: environmental toxins S/S: jaundice, fatigue, itching labs: high alkalinity phos, GGT, + antimicrobial antibodies MRI, CT, MRCP, biopsy TX: no cure; exogenous bile acids
77
Causes of acute liver failure? What percentage is drug induced?
viral hepatitis, autoimmune, hypoxia, ALF of pregnancy, HELLP drug induced 50%
78
Occurrence of acute liver failure after insult?
days to 6 months after the insult
79
Acute liver failure leads to rapid increase in _____ and _____, altered mental status, and ______, and hepatocyte necrosis. S/S:
AST/ALT coagulpathy S/S: jaundice, N/V, RUQ pain, cerebral edema, encephalopathy, MOF
80
Most common causes of cirrhosis?
ALD NAFL Hep C Hep B
81
What's the cure for cirrhosis?
transplant
82
What labs are elevated in cirrhosis?
AST/ALT bili Alk phos PT/INR thrombocytopenia
83
What is the final stage of liver disease, often asymtomaptic in early stages. Normal liver parenchya is replaced with scar tissue.
Cirrosis
84
What does cirrohsis lead to?
jaundice, ascites, varices, coagulopathy, encephalopathy, bacterial peritonitis (abx)
85
What is present in 50% of cirrosis patients?
varices
86
What's the most lethal complication of cirrhosis? What reduces the risk? TX?
hemorrhage *varices BB to reduce risk banding, ligation, balloon tamponade
87
Most common complication of cirrhosis
ascites
88
Portal HTN level is?
>5

Health Assessment SEM 2 (26 decks)

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