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Sim Lab 3 > Hepatic and Renal > Flashcards

Hepatic and Renal Flashcards

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1
Q

Hepatic Blood Flow

A

20% of CO

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2
Q

Hepatic Blood Flow: Intrinsic Controls

A
  • HABR (hepatic arterial buffer response)
  • Metabolic
  • Autoregulation
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3
Q

Hepatic Blood Flow: Extrinsic Controls

A
  • Neural
  • Humoral
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4
Q

What is HABR?

A

Hepatic Arterial Buffer Response:

The hepatic arterial buffer response (HABR) is a self-regulating mechanism that helps maintain hepatic perfusion during times of reduced portal venous blood flow, such as during acute occlusion or in cirrhosis

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5
Q

What 4 things does the liver metabolize?

A

Proteins
Carbohydrates
Lipids
Bile

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6
Q

What does the liver make?

A

Coagulation factors
Proteins for coagulation

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7
Q

List some protein regulators in coagulation

A

Protein S
Protein C
Protein Z
Plasminogen Activator Inhibitor
Antithrombin III

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8
Q

How much of heme produciton is done by the liver?

A

20%

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9
Q

Where is Bilirubin, Angiotensinogen, and Thrombopoietin made?

A

Liver

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10
Q

How does the liver and thyroid interact?

A

The liver activates T4 to T3

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11
Q

How do the liver and kidneys interact?

A

Inactivates aldosterone and ADH

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12
Q

How does the liver and pancreas interact?

A

Inactivates insulin

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13
Q

What are kupffer cells?

A

Liver cells that filter toxins and contaminates from splanchnic blood

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14
Q

Hepatic Drug Metabolism: Phases

A
  • Phase 1: CYP increases drug polarity
  • Phase 2: conjugating drugs with H2O soluable substrate
  • Phase 3: excrete into bile
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15
Q

Liver Function Tests

SLAAPS

A

Serum Albumin
LDH
ALT
AST
PT
Serum Bilirubin

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16
Q

Normal Albumin

A

3.5-5.5 g/dL

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17
Q

Normal Prothrombin Time

A

12-14secs

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18
Q

Normal Bilirubin

A

0.2-1.1 mg/dL

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19
Q

Which inhaled agent is the worse for hepatic blood flow?

A

Halothane

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20
Q

Which inhaled agent is associated with Hepatitis?

A

Halothane

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21
Q

What is ESLD?

A

End Stage Liver Disease

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22
Q

ESLD: CNS complications

A

Hepatic Encepalopathy

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23
Q

ESLD: Cardiovascular complications

A

Hyperdynamic State
Cardiomyopathy
Altered Blood Flow
Portal Hypertension

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24
Q

ESLD: Pulmonary complications

A

Hypoxemia
Portopulmoary Syndrome
Hepatorpulmonary Syndrome

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25
ESLD: Renal complications
Hepatorenal Syndrome Edema Ascities
26
ESLD: Hematological complications
Coagulopathy / Hypercoagulable Thrombocytopenia
27
ESLD: Endocrine complications
Abnormal glucose use
28
ESLD: GI complications
Esophageal varcies
29
Hepatic Scoring: Child-Pugh
5-6 = Class A 7-9 = Class B 10-15 = Class C ## Footnote Lower score the better
30
Hepatic Scoring: MELD ## Footnote Model for End-Stage Liver Disease
Lower score = lower % of mortality Anything over 40 is 71% ## Footnote Predictive 3 month mortality from Liver Dx
31
A few common hepatic issues ## Footnote VICED-F
Variable drug metabolism Inability to ventilate (Pulmonary Portal Syndrome) Coagulopathy Encephalopathy Difficult glucose control Full Stomach
32
What is a TIPS
Transjugular Intrahepatic Portosystemic Shunt Shut portal vein to hepatic vein to bypass damaged liver and reduce portal hypertension
33
Which liver reseciton usually bleeds more, wedge or segment?
Wedge
34
What is mugging?
When the liver is manipulated and the the IVC gets occluded
35
What is hemodilution?
Pull off some blood Give same volume back as crystalloid This keeps the body volume the same while diluting the blood Give the pulled off blood back after surgery ## Footnote They do this to reduce hemoglobin losses from blood loss
36
What is the Pringle Maneuver
Clamp and obliterate all blood flow to the liver
37
What is a CPDA bag?
Blood bag predosed with an anti-coagulant for a specific volume of blood ## Footnote Citrate Phosphate Dextrose Adenine
38
What needs to be put on a CPDA blood bag?
Date Time Initials Patient Sticker
39
What time frame do we need to give the patients blood back?
8 hours
40
Porto-Pulmonary Syndrome ## Footnote AKA Portopulmonary hypertension
the coexistence of portal and pulmonary hypertension
41
Porto-Renal Syndrome
(Not an issue with renal function) Dx liver = portal HTN Cascades to splanchnic vasodilation RAAS system compensates Increased renal artery constriction causes ischemia and decreased renal function
42
Renal autoregulation?
80-180mmHg
43
Urine Output values
Anuric = 0 mL/hr Oliguric = <15 mL/hr Nonoliguric = 15-80 mL/hr Polyureic = >80 mL/hr
44
Perioperative oliguria?
< 0.5 mL/kg/hr
45
BUN
Blood Urea Nitrogen: byproduct of ammnia metabolism
46
BUN levels
5-10 mg/dL
47
BUN:Cr ratio
> than 20:1 = prerenal dx
48
Renal function indicator
GFR: 125 mL/min
49
Renal function below 10%
ESRD
50
Creatine value
0.5-1.0 mg/dL
51
Doubling of Creatine means what
Reduction of GFR by 50%
52
Renal vasoconstriction: Salt retention
Decrease in: RBF GFR Urine Flow Na Excretion
53
Renal vasodialtion: Salt Excretion
Increase in: RBF GFR Urine Flow Na Excretion
54
Name some renal vasoconstrictors
* RAAS * Aldosterone * ADH
55
Name some renal vasodilators
Prostaglandins Kinins ANP
56
Clinical signs of renal failure (HAHA-HP)
* Hypervolemia * Acidotic * Hyperkalemia * Anemia * HTN * Pulmonary edema
57
Drug metabolism in renal dx
* Morphine * Meperidine * Sevo / Compound A
58
What is propofol infusion syndrome?
Green Urine due to 4mg/kg/hr for more than 48 hours
59
Non depole muscle relaxers in renal dx patients?
Longer acting due to partial clearance in kidney.
60
Succ's in renal dx?
cleared independently of renal activity
61
Two types of renal replacement therapy?
Hemodiaylsis Peritoneal dialysis
62
Complications of hemodialysis?
Hypovolemia induced hypotension hypopnea
63
What is a CRRT machine?
Continuous Renal Replacement Therapy Used in the ICU for hemodialysis ## Footnote processes blood much slower so no hypovelmia
64
TURP
Transurethral Resection of Prostate
65
TURP syndrome
The absorption of large amounts of fluid (2 L or more) results in a constellation of symptoms and signs
66
TURP syndrome treatment
Fluid restrictions (fluid overloaded) Lasix Hypertonic Saline 3% (last resort)
67
What is at a higher risk for blood loss, partial or radical nephrectomy?
Partial
68
Open verse robotic prostate?
Open = bloody as hell Robotic = the way to go

Sim Lab 3 (6 decks)

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