Liver

Question 1

________ is a connective tissue covering that encapsulates the liver

Answer 1

Glisson’s capsule

Question 2

What is the functional unit of the liver?

Answer 2

the lobule

Question 3

In the liver, arterioles are called:

Answer 3

Terminal branches of either the hepatic artery or portal vein

Question 4

In the liver, capillaries are called:

Answer 4

sinusoids

Question 5

In the liver, venules are called:

Answer 5

the central vein

Question 6

What is the acinus?

Answer 6

Another way of defining the functional units of the liver

Question 7

What are the three zones of the acinus

Answer 7

Question 8

Which cells remove bacteria from the liver?

Answer 8

Kupffer cells

Question 9

Answer 9

Question 10

Answer 10

Question 11

Bile has three functions:

Answer 11

Absorbs fat soluble vitamins (DAKE)

Excretes bilirubin and other byproducts

alkalizes the duodenum

Question 12

What is CCK?

Answer 12

Cholecystokinin

produced in the duodenum and released when large amounts of fat are present, stimulating gallbladder contraction and bile flow

Question 13

How much lymph is produced in the liver?

Answer 13

About 50% of the lymph in the body

Question 14

The liver receives ____% of the cardiac output

Answer 14

30%

Question 15

The portal vein supplies _____% of total liver blood flow

Answer 15

75%

Question 16

The portal vein supplies _____% of the liver’s oxygen delivery

Answer 16

50%

Question 17

The hepatic artery supplies _____% of total liver blood flow

Answer 17

25%

Question 18

The hepatic artery supplies ____% of the liver’s oxygen delivery

Answer 18

50%

Question 19

How is portal blood flow autoregulated?

Answer 19

It isn’t. It’s completely dependent on splanchnic vascular resistance. Any increase in splanchnic resistance decreases liver flow

Question 20

How is the hepatic artery autoregulated?

Answer 20

Whenever liver perfusion decreases from portal flow, the hepatic artery increases flow to compensate

Question 21

The celiac artery supplies which three organs?

Answer 21

Liver
Stomach
Spleen

Question 22

The liver produces all clotting factors except:

Answer 22

3
4
vWF

Question 23

What are the vitamin K dependent clotting factors?

Answer 23

2
7
9
10
Proteins C & S

Question 24

The liver produces all of the plasma proteins EXCEPT

Answer 24

immunoglobulins

Question 25

Which factor is produced by sinusoids, NOT hepatocytes?

Answer 25

Factor 8

Question 26

What does the liver do with unconjugated bilirubin?

Answer 26

Conjugates it with glucuronic acid for excretion in bile

Question 27

Which form of bilirubin is neurotoxic?

Answer 27

Unconjugated

Question 28

Which test is the most sensitive for acute hepatic injury?

Answer 28

PT, because the half life of factor 7 is only 4-6 hours

Question 29

What is the half life of albumin?

Answer 29

21 days

Question 30

An AST/ALT ratio greater than 2 suggests:

Answer 30

cirrhosis or alcoholic liver disease

Question 31

Which forms of hepatitis can lead to cirrhosis?

Answer 31

B or C, but NOT a

Question 32

Why does a tylenol overdose lead to liver failure?

Answer 32

Glutathione is the substrate for Tylenol's toxic metabolite (NAPQ). Once glutathione stores are consumed, the liver is damaged by the overwhelming amount of NAPQ

Question 33

Which beta blocker is helpful with portal hypertension?

Answer 33

Propanolol. It has the added benefit of constricting splanchnic vessels, which reduces blood delivery to the liver

Question 34

What paralytic considerations are there for a patient with liver dysfunction?

Answer 34

May be reduced pseudocholinesterase production Roc excretion will be delayed (biliary) Large Vd because of low plasma proteins

Question 35

Alcohol withdrawal begins at _____ hours and peaks at _____ hours

Answer 35

begins at 6-8 peaks at 24-36

Question 36

Why does cirrhosis create portal hypertension?

Answer 36

Fibrotic cells do not have the same vascular supply, so blood entering the liver has fewer vessels to empty into, hence the back up

Question 37

What is the treatment for alcohol withdrawal?

Answer 37

Alcohol Precedex Beta blockers

Question 38

Does severe liver disease increase or decrease CO?

Answer 38

Increases The liver is unable to clear vasodilating substances from the blood stream, leading to a drop in SVR and a hyperdynamic CO

Question 39

What are the pulmonary effects of cirrhosis?

Answer 39

Ascites and pleural effusions create restriction Hypoxemia from pulmonary vasodilation and pHTN leads to compensatory hyperventilation, causing resp alkalosis

Question 40

What does a TIPS procedure do?

Answer 40

Shunts blood from the portal vein to the hepatic vein

Question 41

What are some induction considerations for a patient receiving a liver transplant?

Answer 41

RSI. They're all considered full stomach.

Question 42

How is serum potassium effected during liver transplant?

Answer 42

When the new liver is perfused, K will spike and Ca will fall!

Question 43

What is postreperfusion syndrome?

Answer 43

Systemic hypotension 30% or more below baseline for 1 of 5 minutes following reperfusion

Question 44

glucagon increases the risk of:

Answer 44

PONV

Question 45

What are the risk factors for halothane hepatitis?

Answer 45

Female Age > 40 Genetic predisposition Obesity CYP2E1 inhibition