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Sim Lab 3 > Hepatic and Renal > Flashcards

Hepatic and Renal Flashcards

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
Q

ESLD: Renal complications

A

Hepatorenal Syndrome
Edema
Ascities

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26
Q

ESLD: Hematological complications

A

Coagulopathy / Hypercoagulable
Thrombocytopenia

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27
Q

ESLD: Endocrine complications

A

Abnormal glucose use

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28
Q

ESLD: GI complications

A

Esophageal varcies

29
Q

Hepatic Scoring: Child-Pugh

A

5-6 = Class A
7-9 = Class B
10-15 = Class C

Lower score the better

30
Q

Hepatic Scoring: MELD

Model for End-Stage Liver Disease

A

Lower score = lower % of mortality
Anything over 40 is 71%

Predictive 3 month mortality from Liver Dx

31
Q

A few common hepatic issues

VICED-F

A

Variable drug metabolism
Inability to ventilate (Pulmonary Portal Syndrome)
Coagulopathy
Encephalopathy
Difficult glucose control
Full Stomach

32
Q

What is a TIPS

A

Transjugular Intrahepatic Portosystemic Shunt

Shut portal vein to hepatic vein to bypass damaged liver and reduce portal hypertension

33
Q

Which liver reseciton usually bleeds more, wedge or segment?

A

Wedge

34
Q

What is mugging?

A

When the liver is manipulated and the the IVC gets occluded

35
Q

What is hemodilution?

A

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

They do this to reduce hemoglobin losses from blood loss

36
Q

What is the Pringle Maneuver

A

Clamp and obliterate all blood flow to the liver

37
Q

What is a CPDA bag?

A

Blood bag predosed with an anti-coagulant for a specific volume of blood

Citrate Phosphate Dextrose Adenine

38
Q

What needs to be put on a CPDA blood bag?

A

Date
Time
Initials
Patient Sticker

39
Q

What time frame do we need to give the patients blood back?

A

8 hours

40
Q

Porto-Pulmonary Syndrome

AKA Portopulmonary hypertension

A

the coexistence of portal and pulmonary hypertension

41
Q

Porto-Renal Syndrome

A

(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
Q

Renal autoregulation?

A

80-180mmHg

43
Q

Urine Output values

A

Anuric = 0 mL/hr
Oliguric = <15 mL/hr
Nonoliguric = 15-80 mL/hr
Polyureic = >80 mL/hr

44
Q

Perioperative oliguria?

A

< 0.5 mL/kg/hr

45
Q

BUN

A

Blood Urea Nitrogen:

byproduct of ammnia metabolism

46
Q

BUN levels

A

5-10 mg/dL

47
Q

BUN:Cr ratio

A

> than 20:1 = prerenal dx

48
Q

Renal function indicator

A

GFR: 125 mL/min

49
Q

Renal function below 10%

A

ESRD

50
Q

Creatine value

A

0.5-1.0 mg/dL

51
Q

Doubling of Creatine means what

A

Reduction of GFR by 50%

52
Q

Renal vasoconstriction: Salt retention

A

Decrease in:
RBF
GFR
Urine Flow
Na Excretion

53
Q

Renal vasodialtion: Salt Excretion

A

Increase in:
RBF
GFR
Urine Flow
Na Excretion

54
Q

Name some renal vasoconstrictors

A
  • RAAS
  • Aldosterone
  • ADH
55
Q

Name some renal vasodilators

A

Prostaglandins
Kinins
ANP

56
Q

Clinical signs of renal failure (HAHA-HP)

A
  • Hypervolemia
  • Acidotic
  • Hyperkalemia
  • Anemia
  • HTN
  • Pulmonary edema
57
Q

Drug metabolism in renal dx

A
  • Morphine
  • Meperidine
  • Sevo / Compound A
58
Q

What is propofol infusion syndrome?

A

Green Urine due to 4mg/kg/hr for more than 48 hours

59
Q

Non depole muscle relaxers in renal dx patients?

A

Longer acting due to partial clearance in kidney.

60
Q

Succ’s in renal dx?

A

cleared independently of renal activity

61
Q

Two types of renal replacement therapy?

A

Hemodiaylsis
Peritoneal dialysis

62
Q

Complications of hemodialysis?

A

Hypovolemia induced hypotension
hypopnea

63
Q

What is a CRRT machine?

A

Continuous Renal Replacement Therapy
Used in the ICU for hemodialysis

processes blood much slower so no hypovelmia

64
Q

TURP

A

Transurethral Resection of Prostate

65
Q

TURP syndrome

A

The absorption of large amounts of fluid (2 L or more) results in a constellation of symptoms and signs

66
Q

TURP syndrome treatment

A

Fluid restrictions (fluid overloaded)
Lasix
Hypertonic Saline 3% (last resort)

67
Q

What is at a higher risk for blood loss, partial or radical nephrectomy?

A

Partial

68
Q

Open verse robotic prostate?

A

Open = bloody as hell
Robotic = the way to go

Sim Lab 3 (6 decks)

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