Hepatobillary PPT-Josh Flashcards Preview

BioScience II > Hepatobillary PPT-Josh > Flashcards

Flashcards in Hepatobillary PPT-Josh Deck (77):
1

this is my last ppt for this test I am going to go through it and only grab the highlights!!!


I cant look at this shit anymore

2


what is the largest solid organ in the body?


liver

3


Liver:

is made up of 50,000-100,000 discrete anatomic units called what?

 


lobules

4


Liver:

how many portal tracts are there?


4-5

5


what are the 2 types of cells that line the sinusoids?


endothelial

kupffer cells (macrophages)

6


Hepatic blood flow:

dual afferent blood supply equal to __% of CO


25%

7


Hepatic blood flow:

70% of blood is spplied via the ____

 


Portal vein

8


Hepatic blood flow:

30% suppied via the _______


hepatic artery

9


Hepatic blood flow:

is how many ml/min


1500 mL/min

10


Hepatic blood flow:

arterial flow is autoregulated based on what?


O2 consumption

11


Hepatic blood flow:

a decrease in either hepatic arterial or portal venous flow results in what?


compensatory increases in the other

12


what is teh normal hepatic blood volume?


450 mL

13


Fuctions of LIver?

Reservoir

Blood cleansing

metabolic

14


Blood cleansing fx:

blood from the gut contains large amounts of colonic bacilli, cleansing is performed by the ___ cells that line the hepatic sinus


Kupffer cells

15


____ cells lint the hepatic sinuc and permit diffusion of large plasma proteins and other substances into extravascular spaces in the liver, resulting in a large quanity of lymph that is nearly equal in protein concentration to plasma


endothelial

16


Metabolic Functions of liver

what re the 4 main metabolic fxns?

 

  1. Carbohydrate metabolism
  2. Fat metabolism
  3. Protein metabolism
  4. Drug metabolism

17


Metabolic Functions of liver

what are the 3 ways the liver does carbohydrate metabolism

 

 

  1. Gylcogenesis
    • process of glycogen synthesis
  2. Glycogenolysis
    • Release of glucose form glycogen
  3. Gluconeogenesis
    • Conversion of fats/proteins to glucose

18


Metabolic Functions of liver

what are the final products of Carbohydrate metabolism


glucose

frutose

galactose

19


Metabolic Functions of liver

what are the 2 ways of fat metabolism

 

  1. Lipogenesis
    • synthesis of cholesterol and proteins and carbs from fat
  2. Lipolysis
    • breakdown of lipids

20


Metabolic Functions of liver

how does it do protein metabolism

 

  • Deamination of proteins
  • Deamination of excess amino acids
  • Synthesis of lipoproteins

21


Metabolic Functions of liver

how does it do Drug metabolism


phase I and II biotransformation

22


Metabolic Functions of liver

what are the vitamins it stores?


A,D,E,K

23


Metabolic Functions of liver

the liver does synthesis of coagulation factors and inhibitors, in fact it does most all clotting factors except???


Factor VIII

24


Metabolic Functions of liver

how it is responsible for phagocytosis?


filtration and destruction of bacteria and debris in blood

25


Metabolic Functions of liver

what minerals is it responsible for?


iron hemostasis

copper regulation

26


LFTs:

normal Albumin


3.5-5.5 g/dL

27


LFTs:

normal AST

10-40 U.mL

28


LFTs:

normal ALT


5-35 U.mL

29


LFTs:

normal Alk phosphate


45-115 u/L

30

what is an inflammatory disease of the liver parenchyma

 


Hepatitis

31


Hepatitis:

what is teh most common form?


A (50%)

32


Hepatitis:

how are each form transmitted?

  1. A
  2. B
  3. C
  4. D

  1. fecal-oral (sewage)/ shellfish
  2. Percutaneous/ sex
  3. Percutaneous
  4. percutaneous

Reacap B by sex

A by shit

33


what is hepatic inflammation due to idiosyncratic reaction, dose related toxicity, or a combination of the 2


Drug induced hepatitis

34



Drug induced hepatitis

what is teh most common type?


Alcoholic hepatitis

35



Drug induced hepatitis

acetamiinophen ingestion of >_____ can cause this


25G

36



Drug induced hepatitis

the onset is ___ weeks post exposure but can be up to six months


2-6 weeks

37


what are the stages of alcohol induced liver damage?

 

  • fatty liver
  • Liver fibrosis
  • Cirrhosis

38


which VAA can cause hepatitis?


halothane

called halothane hepatisis

39


what is it called when normal liver parenchyma is replaced w/ fibrous and nodular tissie

Cirrhosis

40


Cirrhosis:

what are early S/S


fatique

Malaise

jaundice

41


Cirrhosis:w

hata re late S/S


spider angiomata

gynecomastia

testicular atrophy

ascites

42


Cirrhosis:

why is hypogycemia common?

due ti inadequate gluconeogenesis

43


Manisestations of Cirrhosis:

GI

 

  • PORTAL HTN
  • ascites
  • esophageal varies
  • Hemorrhoids
  • GI bleeding

44


Manisestations of Cirrhosis:

circulatory

 

  • High CO
  • Systemic ateriovenous shunts
  • Low SVR
  • cirrhotic cardiomyopathy

45


Manifestations of Cirrhosis:

Pulmonary

  • increased intrapulmonary shunting
  • Decreased FRC
  • Pleural effusion
  • Restrictive ventilatory defect
  • Resp alkolosis

46


Manifestations of Cirrhosis

Renal

 

  • Increased reabsorption of Na+
  • Impaired free water clearance

47


Manifestations of Cirrhosis:

Hematological

 

  • Anemia
  • Coagulopathy

48


Manifestations of Cirrhosis:

infections


spontaneous bacterial peritonitis

49


Manifestations of Cirrhosis:

Metabolic

 

  • HYPO Na+
  • HYPO K+
  • HYPO Mg++
  • HYPO albumin
  • HYPOglycemia

50


Manifestations of Cirrhosis:

neuro


encephalopathy

51


what disease is caused by obesity when there is an excess of intraheptic triglycerides, impaired insulin activity, and additional release of inflammatory cytokines

Non-alcoholic Fatty liver disease (NAFLD)

also called Nonalcoholic steatohepatitis

52


NAFLD

___% of severly obese adults have this?


85%

53


Anesthesia for pts w/ decreased liver function:

they are increased rick of what?


bleeding

infection

hepatic decompensation

death

54


Anesthesia for pts w/ decreased liver function:

intraop what should you monitoe


BGL

55


Anesthesia for pts w/ decreased liver function:

why to they get hypotensive?


low SVR and relative hypovolemia

56


Anesthesia for pts w/ decreased liver function:

what do u need to do with NDMBD?


increase dose

57


Anesthesia for pts w/ decreased liver function:

what do u need to do w/ propofol dose?


decrease

58


Anesthesia for pts w/ decreased liver function:

why may SCh be prolonged?


b/c plasma cholinesterase is produced in the liver and may also be deficient

59


Anesthesia for pts w/ decreased liver function:

VAAS and regional both decrease HBF by ____% in absence of stimulation


30%

60


Anesthesia for pts w/ decreased liver function:

what 3 VAAs undergo minimal hepatic metabolism and can be regarded as safe


Iso

sevo

des

61


Anesthesia for the drunk:

do they need more or less anesthesia


less (additive depressant effect)

62


Anesthesia for the drunk:

why do u need aspiration precautions?


slowed gastric emptying

decreased LES tone

63


Anesthesia for the drunk:

why may there be increased surgical bleeding


interferance w/ plt aggrigation

64


Anesthesia for the drunk:

is the brain more or less tolerant to hypoxia?


less

65


Anesthesia for the drunk:

what happens to circulating catecholamines


increased (labile VS and exaggerated responses to drugs and stimuli)

66

Gallbladder:

capable of holding how much fluid


30-50 ml

67


Gallbladder:

how is the common bile duct formed?

 

  • Bile ducts from hepatic Lobules join eventually forming the RIGHT and LEFT HEPATIC DUCTS
  • which combine to form the HEPATIC DUCT
  • which together with the CYSTIC DUCT from gallbladder become the COMMON BILE DUCT

68


Gallbladder:

At the termination of these ducts is an envolope of smooth muscle called what, which provides a barrier to intestinal bacteria


Sphinter of Oddi

69


Both the billary and pancreatic tracts empty into the duodenum via what?


ampulla of vater

70


Gallbladder:

what provides the blood supply?


Cystic artery

71


What is bile made of?

 

  • 97% water
  • <1% bile salts
  • inorganic salts
  • Lipids
  • Lecithin
  • Alkaline phosphate
  • Conjugated Bilirubin

72


what is the functions of bile?

 

  • emulsify and enhance absorption of ingested fats and fat-soluble vitamins
  • provide excretatory pathway for drugs and toxins
  • maintain duodenal alkalization

73


Bile:

hepatocytes in each lobule continuolsly secrete bile into bile canaliculi at a rate of ___ L/day

 


1

74


what causes constraction of the gallbladder, relaxation of the sphinter of oddi, and propulsion of bile into the duodenum


CHOLECYSTOKIN

75


what is the primary end product of Hgb metabolism and is formed from the degradation of the heme ring in the kupffer cells?


bilirubin

76


Anesthesia for Billary Disease:

what opiod is most associated w/ spasms of the sphincter of oddi


morphine

77


by far the award for the worst PPT goes to AMY WTF this shit was retarded and not to mention she filled up every single inch of the fucking ppt slides


really what the fuck????