Hepatic Flashcards
function of the liver
synthesizes glucose via gluconeogenesis
sotres excess glucose as glycogen
synthesizes cholesterol and proteins into hormones and vitamins
metabolizes fats, protiens, and carbs to generate energy
metabolizes drugs via CYP450 and other enzyme pathways
detoxifies blood
involved in the acute phase of immune support
processes HGB and stores iron
synthesizes coagulation factors
aids in volume control as a blood reservoir
what coagulation factors are not synthesized by the liver
Factor III, IV, VIII, vWF
T/F liver dysfunction can lead to multi-organ failure
true, nearly every organ is impacted by liver function
what seperates the right and left lobe of the liver
falciform ligament
how many segments are in the liver
8 based on blood supply and bile drainage
which vessels branch into each segment of the liver
portal vein and hepatic artery
how many hepatic veins empty into IVC
3- right, middle, left hepatic veins
where does the bile duct travel
along portal veins
bile drains through the _____ ________ into ______ & _______
bile drains through the hepatic duct into gall bladder and common bile duct
bile enters duodenum via
ampulla of vater
how much of the cardiac output goes to the liver
25%
1.25-1.5L/min
highes proprotionate CO of all organs
where does the portal vein arise from
splenic vein and superior mesenteric vein
portal vein contains deoxygenated blood from which organs
GI organs (stomach, intestine), pancreas, spleen
portal vein provides how much of hepatic blood flow (%)
75%
hepatic artery, which branches off the aorta, provides how much hepatic blood flow (%)
25%
oxygen delivery sources to the liver
50% portal vein (deoxygenated)
50% hepatic artery
hepatic arterial blood flow is inversely related to
portal venous blood flow
T/F hepatic blood is not autoregulated
false, hepatic artery dilates in response to low portal venous flow; keeping consistent HBF
portal venous pressure reflects what?
splanchnic arterial tone and intrahepatic pressure
normal hepatic venous pressure gradient
HVPG 1-5 mmHg
what hepatic venous pressure gradient is clincally significant for portal HTN, i.e chirroshis, esophageal varices
HVPG > 10 mmHg
increasing portal venous pressure causes
blood to back up in systemic circulation
*esophagel and gastric varices
what hepatic venous pressure gradient is associated with variceal rupture
HPVG > 12 mmHg
risk factors for liver disease
family history
heavy ETOH
lifestyle
DM
obesity
illicit drug use
multiple partners
tattoss (basement tattoos)
blood transfusions (in the 80s)
rely heavily on “risk factors” for degree of suscpicion
when do liver symptoms begin to appear
late-stage liver disease
often asymptomatic until late-stage liver disease
physical exam findings of liver disease
pruritis
jaundice
ascites
asterixis (flapping tremor)
hepatomegaly
splenomegaly
spider nevi
hepato-biliary function tests
BMP, CBC
PT/INR
Aspartate aminotransferase (AST)
Alanine Aminotransferase (ALT)
bilirubin
alkaline phosphatase
ɣ-glutamyl-transferase (GGT)
*imaging includes: ultrasound, doppler US (portal blood flow), CT, MRI
most liver-specific enzyme
alanine aminotransferase (ALT)
which labs are elevated in late-stage liver disease
ɣ-glutamyl-transferase (GGT)
Alkaline phosphatase
labs suggesting hepatocellular injury
elevated AST/ALT (hepatocyte enzymes)
labs suggesting reduced synthetic function
decreased albumin
increased PT/INR
labs suggesting cholestasis
increased alkaline phosphatase
increrased GGT
increased bilirubin
3 groups of hepatobiliary disease
hepatocellular injury
reduced synthetic function
cholestasis
3 subclasses of hepatocellar injury and lab findings
Acute Liver Failure (ALF): hepatic enzymes may be elevated 25x
Alcoholic Liver Disease (ALD): AST:ALT ratio is usually 2:1
Non-Alcoholic Fatty Liver Disease (NALFD): AST:ALT ratio usually 1:1
bile pathway
hepatocytes secrete bile through bile ducts into common hepatic duct and go through gall bladder and common bile duct
GallBladder stores bile to deliver during ________ , Common Bile Ducts secretes bile directly into _____
GB stores bile to deliver during meals, CBD secretes bile directly into duodenum
risk factors for cholelithiasis “gallstones”
obesity, increased cholesterol, DM, pregnancy, female, family Hx
80% asymptomatic
symptoms and treatment of cholelithiasis “gallstones”
S/S: RUQ referred to shoulders, N/V, indigestion, fever (acute, obstruction)
Tx: IVF, ABX, pain management
Lab Choleysectomy
what is choledocolithiasis?
inital symptoms?
cholangitis?
treatment?
stone obstructing common bile duct > biliary colic
initial symptoms: N/V, cramping, RUQ pain
Cholangitis symptoms: fever, rigors, jaundice
Treatment: endoscopic removal of stone via ERCP
how is Endoscopic Retrograde Cholangiopancreatography (ERCP) done
guidewire through Sphincter of Oddi into Ampulla of Vater to retrieve stone from pancreatic duct or common bile duct
treatment for Spincter of Oddi Spasm
glucagon
1.
what anesthetic is done with ERCP and what postion is the patient in
GA
patient prone with left tilt, head of patient to the right
Tape ETT to the left
what is bilirubin
end product of heme- breakdown