Hepatic

Question 1

What is the portal triad?

Answer 1

Hepatic artery, portal vein & bile duct

Question 2

What is the portal triad?

Answer 2

Hepatic artery, portal vein & bile duct

Question 3

Albumin level indicative of liver failure?

Question 4

Pentothal dose with liver failure

Answer 4

Reduced

Question 5

Acute liver disease & PT

Answer 5

> 14

Question 6

Steps involved in coagulation?

Answer 6

Adhesion of platelets to vascular wall (requires Factor VIII:vWF), activation of platelets (requires thrombin - IIa), aggregation of platelets (requires ADP & TXA2), & production of fibrin (requires extrinsic, intrinsic & final common pathway)

Question 7

What produces VIII:vWF

Answer 7

Endothelial cells

Question 8

Cryoprecipitate contains what factors?

Answer 8

VIII, I & XIII - harvested from FFP

Question 9

What medications render COX nonfunctional?

Answer 9

NSAIDS/ASA

Question 10

What medications prevent ADP induced platelet aggregation?

Answer 10

Ticlid, PLAVIX, integrilin, reapro, aggrastat

Question 11

What coagulation factors are not made in the liver?

Answer 11

III (tissue factor), IV (calcium), & VIII:vWF

Question 12

What factors are vitamin k dependent?

Answer 12

2, 7, 9 & 10

Question 13

What is platelet dysfunction from with liver disease?

Answer 13

Elevated pressure from portal hypertension sequesters platelets in spleen rendering them inactive & elevated fibrin degradation products

Question 14

What is platelet dysfunction from with liver disease?

Answer 14

Elevated pressure from portal hypertension sequesters platelets in spleen rendering them inactive & elevated fibrin degredation products

Question 15

Hepatic blood flow

Answer 15

Liver receives 25% of cardiac output – hepatic artery supplies 25-30% of blood & 45-50% of oxygen, portal vein supplies 70-75% of blood & 50-55% of oxygen

Question 16

Pentothal dose with liver failure

Answer 16

Reduced

Question 17

Acute liver disease & PT

Answer 17

> 14

Question 18

Steps involved in coagulation?

Answer 18

Adhesion of platelets to vascular wall (requires Factor VIII:vWF), activation of platelets (requires thrombin - IIa), aggregation of platelets (requires ADP & TXA2), & production of fibrin (requires extrinsic, intrinsic & final common pathway)

Question 19

What produces VIII:vWF

Answer 19

Endothelial cells

Question 20

Cryoprecipitate contains what factors?

Answer 20

VIII, I & XIII - harvested from FFP

Question 21

Post-hepatic dysfunction tests

Answer 21

High bili & increased alk phos – bile duct obstruction

Question 22

What medications prevent ADP induced platelet aggregation?

Answer 22

Ticlid, PLAVIX, integrilin, reapro, aggrastat

Question 23

Cholestatic Disease

Answer 23

Gall bladder disease - gall stone pancreatitis, rarely progresses to MODS

Question 24

What factors are vitamin k dependent?

Answer 24

2, 7, 9 & 10

Question 25

Coagulation cascade

Answer 25

Extrinsic: 3&7 (PT/INR), Intrinsic: VIII, IX, XI, XII (PTT), Common: X, V, II, I, XIII

Question 26

What is platelet dysfunction from with liver disease?

Answer 26

Elevated pressure from portal hypertension sequesters platelets in spleen rendering them inactive & elevated fibrin degredation products

Question 27

Drug metabolism & hepatic disease

Answer 27

Inability to metabolize drugs from decreased blood flow and inactivation of P450 increases half life, decreased cholinesterase will prolong succ, mivacurium & ester locals,

Question 28

Hepatic blood flow

Answer 28

Liver receives 25% of cardiac output -- hepatic artery supplies 25-30% of blood & 45-50% of oxygen, portal vein supplies 70-75% of blood & 50-55% of oxygen

Question 29

Venous system of liver depends on what?

Answer 29

Cardiac output - flow is pressure dependent

Question 30

Reciprocal flow of hepatic system

Answer 30

If venous system decreases flow, arterial system can compensate, volatiles may decrease this & result in ischemia

Question 31

Things in anesthesia that may effect hepatic blood flow

Answer 31

Positive pressure ventilation decreases flow by increasing intrathoracic pressure, alpha stimulation causes constriction, regional >T10 decreases perfusion pressure

Question 32

Pre-Hepatic dysfunction tests

Answer 32

Bilirubin- elevated from hemolysis, reabsorption of hematoma, PRBC admin & surgery

Question 33

Intra-hepatic dysfunction tests

Answer 33

Reflects direct hepatocellular damage, results of toxic effects - aminotransferase spills into blood stream & AST/ALT will be elevated (though these can also be indicative of other organ function), use other tests with

Question 34

Post-hepatic dysfunction tests

Answer 34

High bili & increased alk phos -- bile duct obstruction

Question 35

Parenchymal liver disease

Answer 35

Results in MODS, varices, etc (high pressure)- cirrhosis, will have high CO, low SVR, decreased FRC & renal perfusion, e-lyte issues, ascites, coagulopathies

Question 36

Cholestatic Disease

Answer 36

Gall bladder disease - gall stone pancreatitis, rarely progresses to MODS

Question 37

Coagulation issues & liver failure - treatment

Answer 37

Vitamin K, if unresponsive use FFP

Question 38

MAC for ETOH acute vs chronic

Answer 38

Acute intoxication - require less anesthesia (additive depressant), RSI. Chronic intoxication requires more anesthesia - cross tolerance and P450 system enhanced