Liver 4

Question 1

Common physiologic changes in the patient with cirrhosis include all of the following EXCEPT:
a. respiratory acidosis
b. increased cardiac output
c. right-to left shunt
d. decreased GFR

Answer 1

a. respiratory acidosis

Question 2

Cirrhosis is characterized by

Answer 2

cell death where nodules and fibrotic tissue replace healthy hepatic tissue

Question 3

Cirrhosis reduces the number of

Answer 3

functional hepatocytes as well as the number of sinusoids

Question 4

Why does portal hypertension occur with cirrhosis?

Answer 4

the number of blood vessels passing through the liver is also reduced which creates portal hypertension

Question 5

The following can be used to predict the risk of perioperative mortality with cirrhosis:

Answer 5

the MELD score & child-pugh class

Question 6

Severe liver disease impairs the liver’s ability to

Answer 6

clear vasodilating substances from the systemic circulation

Question 7

The liver’s impedance to clearing vasodilating substances from the systemic circulation leads to

Answer 7

a hyperdynamic circulation (high cardiac output & low SVR)

Question 8

______________ introduces a stent between the portal vein and hepatic vein to bypass an increased hepatic vascular resistance

Answer 8

A transjugular intrahepatic portosystemic shunt (TIPS procedure)

Question 9

____________ is a significant risk of a TIPS procedure

Answer 9

Hemorrhage

Question 10

Etiologies of cirrhosis include

Answer 10

non-alcoholic fatty liver disease
alcohol abuse
alpha-1-antitrypsin deficiency
biliary obstruction
chronic hepatitis
right-sided heart failure
hemochromatosis
Wilson’s disease

Question 11

The most common cause of liver disease is

Answer 11

non-alcoholic fatty liver disease

Question 12

Hemochromatosis causes

Answer 12

iron overload

Question 13

Wilson disease is

Answer 13

genetic (copper accumulates in the tissues)

Question 14

Right-sided heart failure leads to

Answer 14

increased hepatic vascular resistance

Question 15

Biliary obstruction and chronic hepatitis lead to

Answer 15

inflammation and tissue destruction

Question 16

Alcohol abuse and non-alcoholic fatty liver disease lead to

Answer 16

fatty infiltration

Question 17

To partially offset the increased resistance, the body creates collateral vessels that bypass the liver, these are called

Answer 17

portosystemic shunts

Question 18

A patient is at increased risk of perioperative morbidity and mortality if their Child-Pugh score is

Answer 18

C

Question 19

a patient is at increased risk of perioperative morbidity and mortality if their MELD score is

Answer 19

> 15

Question 20

A MELD score of ______- is an intermediate risk

Answer 20

10-15

Question 21

The MELD score predicts

Answer 21

90 day mortality in patients with ESLD

Question 22

The MELD score uses

Answer 22

logarithmic calculation of hepatic function: bilirubin, INR, and serum creatinien

Question 23

The Child-Pugh score examines the following five factors:

Answer 23

albumin
PT
bilirubin
ascites
encephalopathy

Question 24

A Class C Child-Pugh score has a

Answer 24

80% risk of perioperative mortality

Question 25

A class B Child-Pugh score has a

Answer 25

30% risk of perioperative mortality

Question 26

Cardiovascular changes that accompany ESLD include

Answer 26

hyperdynamic circulation portal hypertension (esophageal varices, splenomegaly) ascites

Question 27

Pulmonary changes that accompany ESLD inclue

Answer 27

restrictive defect respiratory alkalosis hepatopulmonary syndrome (Right to left shunt) portopulmonary hypertension

Question 28

CNS changes that accompany ESLD include

Answer 28

hepatic encephalopathy

Question 29

Autonomic changes that accompany ESLD include

Answer 29

increased SNS and RAAS

Question 30

Renal changes that accompany ESLD include

Answer 30

renal hypoperfusion hepatorenal syndrome (renal failure)

Question 31

Hematologic changes that accompany ESLD include

Answer 31

anemia reduce factor production thrombocytopenia

Question 32

What is a TIPS procedure?

Answer 32

it reduces portal pressure by shunting blood from the portal vein to the hepatic vein

Question 33

Match each phase of liver transplantation with its MOST likely complication: pre-anhepatic phase anhepatic phase neohepatic phase hyperkalemia pulmonary aspiration of gastric contents profound reduction of cardiac output

Answer 33

pre-anhepatic phase- pulmonary aspiration of gastric contents anhepatic phase- profound reduction of cardiac output neohepatic phase- hyperkalemia

Question 34

The most common indication for liver transplant is

Answer 34

hepatitis C

Question 35

Other common indications for liver transplant include

Answer 35

alcoholic liver disease malignancy

Question 36

The surgical procedure of liver transplant can be divided into the following phases

Answer 36

pre-anhepatic phase anhepatic phase neohepatic phase

Question 37

Post-reperfusion syndrome is defined as

Answer 37

systemic hypotension more than 30% below baseline for at least 1 minute during the first 5 minutes of reperfusion of the donor liver

Question 38

Treatment of post-reperfusion syndrome is

Answer 38

supportive vasopressors correcting electrolyte abnormalities correcting acid-base

Question 39

Preoperative considerations for liver transplant include

Answer 39

ensure adequate supply of blood products patients are coagulopathic so careful during invasive procedures (NGT, a-line, etc.) hepatic encephalopathy--> avoid anxiolytic Hyper or hyponatremic d/t volume overload & sodium retention

Question 40

If the patient has esophageal varices, can you still do TEE?

Answer 40

yes as long as transgastric views are avoided

Question 41

If the patient suffers from hepatic encephalopathy,

Answer 41

then avoid anxiolytic premedication

Question 42

The pre-anhepatic phase begins with

Answer 42

surgical incision

Question 43

The pre-anhepatic phase ends with

Answer 43

cross-clamping of the portal vein, hepatic artery, and IVC

Question 44

Surgical objectives of the pre-anhepatic phase include

Answer 44

surgical incision mobilization of liver structures mobilization of vascular structures isolation of bile duct