Liver

Question 1

what is the acinus

Answer 1

liver tissue served by a single terminal branch of the heaptic artery

Question 2

which liver zone is most suceptibel to ischemic injury?

Answer 2

Zone 3

Question 3

where is bile produced and stored

Answer 3

produced in the liver
stored in teh gallbladder

Question 4

bile drainage pathway from the liver

Answer 4

canaliculi > bile duct > common hepatic duct > common bile duct > ampulla of vater

Question 5

lymph and protein drainage pathway

Answer 5

space of disse > lymphatic duct

Question 6

liver gets how much CO

Answer 6

30%

Question 7

portal vein blood flow and oxygen content and portal artery

Answer 7

Vein: 75% of blood flow and 50% oxygen

Artery: 25% blood flow and 50% oxygen

Question 8

is portan blood flow autoregulated?

Answer 8

no

Question 9

how might spanchnic vascualr resistance affect portal bood flow because portal blood flow is not autoregulated?

Answer 9

increased spanchnic vascular resistance will decrease portal blood flow

Question 10

explain the hepatic arterial buffer response

Answer 10

decreased portal vein flow > increased flow through the hepatic artery

severe liver disease impairs this response making diseased liver even more susceptible to hypo-perfusion.

Question 11

how do GA and neuraxial affect liver blood flow

Answer 11

both decrease MAP and CO so liver blood flow is decreased

Question 12

what clotting factors does the liver not produce

Answer 12

3 4 and vonwillebrand factor

Question 13

vit k dependent clotting factors

Answer 13

2,7,9,10
protein c
protein s
protein Z

Question 14

where are plasma proteins produced?

Answer 14

liver, except for immunoglobulins

Question 15

albumin is a resorvoir for

Answer 15

acidic drugs

Question 16

alpha 1 acid glycoprotein is blood resorvoir for

Answer 16

basic drugs

Question 17

when might decreased psuedocholinesterase be an issue

Answer 17

only in severe liver disease

Question 18

proteins are broken down into

Answer 18

ammonia

Question 19

Hgb is metabolized into

Answer 19

billirubin

Question 20

billirubin is conjugated with?

Answer 20

glucuronic acid in the body

Question 21

billirubin is an indicator or what?

Answer 21

hepatic clearance

Question 22

AST/ALT are indicators of?

Answer 22

hepatocellular injury

Question 23

albumin and PT and indicators of?

Answer 23

livers synthetic function

Question 24

5’ nucleotidase, akaline phosphatase, and glutamyl transpeptidase are indicators of?

Answer 24

billiary obstruction

Question 25

what is an exuisitely sensitive indicator of actue liver disease? why?

Answer 25

prothrombin time becasue factor 7 has a short half life of only 4-6 hours

Question 26

is albumin a good indicator of acute liver disease? why?

Answer 26

No, 21 day half life

Question 27

halothanse hepatitis is an?

Answer 27

immune response

Question 28

most common cause of chronic hepatitis?

Answer 28

alcohol abuse

Question 29

most common cause of viral hepatitis

Answer 29

hep A

Question 30

what kinds of hepatitis can cause cirrohis? what can this lead to?

Answer 30

B & C Can lead to hepatocellular carcionoma

Question 31

Does Hep A cause cirrhosis?

Answer 31

no

Question 32

how are Hep B and C transmitted?

Answer 32

blood transmission

Question 33

how are hep A and E transmitted?

Answer 33

Fecal Oral route

Question 34

when does Hep D occur?

Answer 34

it is a co-infection that occurs with Hep B

Question 35

chronic hepatitis is hepatiis that has lasted for over how long?

Answer 35

longer than 6 months

Question 36

should patinet with acute hepatits go to surgery? what about chronic?

Answer 36

acute postpone non-emergency surgery until symptoms resolve and labs return to normal chronic hepatits okay to go to surgery is condition is stable

Question 37

anesthetic considerations in liver failure

Answer 37

maintain liver blood flow: iso or sevo avoid PEEP avoid hepatotoxic drugs avoid drugs that inhibit hepatic enzymes careful moniotoring of the NMJ

Question 38

what should you assume about patient acutely intoxicated with alcohol needing surgery?

Answer 38

full stomach RSI

Question 39

how does alcohol affect MAC?

Answer 39

acute: decrease MAC chronic: increase MAC

Question 40

when do s/s of alochol withdrawl start and peak?

Answer 40

begin: 6-8 hrs after BAC normal pel: 24-36hrs

Question 41

hemodynaimc effects from cirrhosis

Answer 41

inability to clear vasodilating substances > pulm vasodilation > R-L shunting > hypoxemia > hyperventilation > resp alkolosis

Question 42

what scores show increased risk of periop morbidity in liver cirrhosis

Answer 42

MELD > 6 child pugh C

Question 43

major risk of TIPS procedure

Answer 43

hemorrhage

Question 44

most common indication for liver transplant?

Answer 44

apex said both Hep C and NAFLD... I think NAFLD is more recent though...

Question 45

important anesthetic consideration of pre-hepatic stage?

Answer 45

risk gastric regurg RSI

Question 46

what should you do do CVP just before IVC clamping in liver transplant

Answer 46

increase it to about 10

Question 47

what is post-reperfusion syndrome in liver transplant?

Answer 47

system HoTN >30% less of baseline for at least 1min during first 5min of donor liver reperfusion tx is supportive

Question 48

can you use TEE in setting of esophageal varicies?

Answer 48

yes but must avoid transgastric view

Question 49

how is sodium level affected in lliver tranplant?

Answer 49

can be low or high

Question 50

some things you should expect to see in anhepatic phase

Answer 50

worseing coagulopathy ongoing blood loss lactic acidosis hypoglycemia

Question 51

warm ischemic time for new liver should be how long?

Answer 51

less than 30-60min

Question 52

what medication can increase billiary pressure?

Answer 52

octreotide

Question 53

what meds can decrease billiarly pressure that I didn't alreay know?

Answer 53

atropine glycopyrrrolate

Question 54

hypoalbunemia is defined as?

Answer 54

albumin <3.5

Question 55

risk factors for cholelithasis

Answer 55

obesity female gender midle age

Question 56

draw the bile duct pathway with pancreatic duct, spincter of oddi, and amupulla of vater.

Answer 56