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Apex Review > Liver 3 > Flashcards

Liver 3 Flashcards

(56 cards)

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1
Q

Normal alkaline phosphatase levels are

A

45-115 units/L

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2
Q

Alkaline phosphatase specificity?

A

not very specific (also in bone, placenta, and tumors

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3
Q

Normal Y glutamyl transpeptidase is

A

0-30 units/L

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4
Q

____________ is more sensitive than _____________

A

Y Glutamyul transpeptidase is more sensitive than alkaline phosphatase

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5
Q

The most specific indicator of biliary duct obstruction is

A

5’ -nucleotidase

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6
Q

Causes of prehepatic liver disease include

A

hemolysis
hematoma reabsorption

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7
Q

Lab value changes in prehepatic liver disease include

A

elevated unconjugated bilirubin

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8
Q

Causes of hepatocellular injury include

A

cirrhosis
alcohol abuse
drugs
viral infection
sepsis
hypoxemia

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9
Q

Lab values of hepatocellular injury include

A

elevated conjugated bilirubin
elevated aminotransferase (ALT & AST)
elevated prothrombin time
decrease albumin- chronic injury only
normal or increased alkaline phosphatase

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10
Q

Reasons of cholestatic disease includes

A

biliary tract obstruction
sepsis

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11
Q

Lab values of cholestatic disease includes

A

elevated conjugated bilirubin
normal or elevated aminotransferase (late disease)
normal or elevated prothrombin time (late disease)
normal or low albumin (late disease)
elevated alkaline phosphatase
elevated & glutamyl transpeptidase, 5’-nucleotidase

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12
Q

Select the statements that BEST describe hepatitis. (select 2)
a. halothane hepatitis is an immune-mediated response
b. alcohol abuse is the most common cause of chronic hepatitis
c. hepatitis is usually transmitted via blood transfusion
d. hepatitis A usually causes cirrhosis

A

a. halothane hepatitis is an immune-mediated response
b. alcohol abuse is the most common cause of chronic hepatitis

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13
Q

____________ is the most common form of viral hepatitis

A

Hepatitis A

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14
Q

________ & _______ can cause cirrhosis

A

Hepatitis B and C

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15
Q

The most common cause of chronic hepatitis is

A

alcohol abuse

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16
Q

Hepatitis A is transmitted via

A

the oral-fecal route

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17
Q

__________ is associated with hepatocellular injury with variable degrees of necrosis

A

Hepatitis

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18
Q

Hepatitis can be

A

acute or chronic

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19
Q

The most common cause of hepatitis is

A

liver cancer

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20
Q

The most common indication for liver transplantation is

A

hepatitis

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21
Q

Etiologies of hepatitis include

A

viruses, hepatotoxins, & autoimmune responses

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22
Q

Hepatitis B & C can lead to

A

cirrhosis and hepatocellular carcinoma

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23
Q

Etiologies of drug-induced hepatitis include

Study These Flashcards
A

acetaminophen, halothane, and alcohol

24
Q

The antidote for acetaminophen overdose is

Study These Flashcards
A

oral N-acetlycysteine

25
The most common cause of drug-induced hepatitis and chronic hepatitis is
alcohol
26
Chronic hepatitis is characterized by
hepatic inflammation that exceeds 6 months
27
Chronic hepatitis leads to the progressive destruction of
the hepatic parenchyma, cirrhosis, and ultimately liver failure
28
What is the pathophys of acetaminophen overdose?
tylenol produces a toxic metabolite called N-acetyl-p-benzoquinoneimine which in normal dosing is conjugated with glutathione tylenol overdose consumes the liver's supply of glutathione letting NAPQI rise & leads to hepatocellular injury
29
The liver metabolizes desflurane, isoflurane, and halothane to
inorganic fluoride ions & trifluoracetic acid
30
Up to _________ of halothane is metabolized
20%
31
Risk factors for halothane hepatitis include
age >40, female gender, greater than two exposures, genetics, obesity, CYP2E1 induction (alcohol, isoniazid, phenobarbital)
32
Diagnosis of chronic hepatitis includes
increased liver enzymes and bilirubin + histologic evidence of liver inflammation
33
S/sx of chronic hepatitis include
jaundice, fatigue, thrombocytopenia, glomerulonephritis, neuropathy, arthritis, and myocarditis
34
What lab values are changed with chronic hepatitis?
PT is prolonged albumin is decreased
35
All of the following drugs should be avoided in the patient with acute hepatitis EXCEPT: a. amiodarone b. tetracycline c. acetaminophen d. propranolol
d. propranolol
36
For acute hepatitis, non-emergent surgery should be
postponed until symptoms have resolved and liver function tests return to normal
37
For chronic hepatitis, the patient may
proceed to surgery so long as the condition is stable
38
MAC is reduced in the patient who is ____________, but is increased in the _________________
acutely intoxicated with alcohol; but increased in the chronic alcohol user who is not intoxicated
39
Alcohol impairs
pharyngeal reflexes
40
Always assumes that the acutely intoxicated patient has
a full stomach
41
Anesthetic considerations for acute hepatitis include
maintaining liver blood flow (use is or sevo) avoid PEEP avoid hepatotoxic drugs avoid drugs that inhibit hepatic enzymes carefully monitor the neuromuscular junction liberal fluids regional anesthesia OK if there are no coagulation defects
42
Signs and symptoms of alcohol withdrawal begin
6-8 hours after blood alcohol concentration returns to near normal
43
Alcohol withdrawal peaks at
24-36 hours
44
Hepatotoxic drugs or drugs that inhibit CYP450 enzymes include
acetaminophen halothane amiodarone antibiotics: PCN, tetracycline, and sulfonamides
45
Alcohol potentiates
GABA
46
Alcohol inhibits
NMDA receptors
47
Treatment for alcohol withdrawal includes
alcohol beta-blockers alpha-2 agonists
48
Early s/sx of alcohol withdrawal include
tremors and disorder perception (hallucinations, nightmares)
49
Late s/sx of alcohol withdrawal include
increased SNS activity (tachycardia, HTN, dysrhythmias), N/V, insomnia, confusion, and agitation
50
________________ occurs after 2-4 days without alcohol
Delirium tremens
51
Treatment for delirium tremens include
diazepam and beta-blockers
52
S/sx of delirium tremens
grand mal seizures, tachycardia, hyper- or hypotension, & combativeness
53
Alcoholics are often deficient in
vitamin B1 (thiamine)
54
_________________ is characterized by a loss of neurons in the cerebellum, and this is brought on by thiamine deficiency
Wernicke-Korsakoff syndrome
55
__________ is a treatment used for alcoholics in recovery
disulfiram
56
Disulfiram is
hepatoxic and leads to hypotension

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