Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Adv Pr III > Liver > Flashcards

Liver Flashcards

(72 cards)

Start Studying
1
Q

What is the acinus

A

Microvascular unit of the liver. Hepatic arteriole, portal venule, bile ductile, and lymph vessels and nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Zone 1: ___ zone. Cells are closest to what, receive what, and major site of what

A

Periportal. Portal axis. Rich in oxygen. Oxidative metabolism and conversion of ammonia to urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Zone 2: ____ ____. What it is

A

Midzonal region. Transition zone, anatomic reserve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Zone 3: ___ cells, at ___, receive blood that has what. Least what. Major site of

A

Pericentral. Margin of acinus. Has exchanged gases and metabolites w cells in zones 1 and 2. Least resistant to metabolic and anoxic damage. Cyp450 and anaerobic metab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SNS stim of liver __-__ does what

A

T3-11, inc hepatic vascular resistance (less blood vol), inc glycogenolysis and gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PNS stim of liver does what

A

Increases glucose uptake and glycogen synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hepatic arterioles have a myogenic response that does what

A

Keeps local bf constant despite bp changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the hepatic arterial buffer response

A

Portal venous flow dec- adenosine builds up- arteriolar res dec and arterial flow inc. portal venous flow inc- adenosine washed out- arteriolar res inc and hepatic arterial flow dec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Changes in __ or ___ of portal blood associated with inc in hepatic arterial flow

A

Ph or pa02

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

___ ___ increases hepatic arterial and portal venous flow

A

Postprandial hyperosmolarity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the IVC do that can lead to ascites

A

Pressures of 10-15 inc hepatic lymph flow, leads to sweating free fluid from liver to abd cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anesthetics and liver disease impair what response

A

Ability of liver to decrease bf/vol in response to sns stim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Coag factors formed by liver

A

All except vwfIII, III, and IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Vitamin k dependent factors made in liver

A

PT/factor II, VII, IX, X, proteins c and s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Opioid effects on sphincter of oddi antagonized by 5.

A

VAs, narcan, nitro, atropine, glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which zone of liver most vulnerable to toxic metabolites of tyelenol

A

Zone 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is intrinsic clearance

A

Fraction of delivered drug load that’s metabolized during a single pass thru liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

High clearance means what, which drugs 3

A

Hepatic clearance approaches the rates at which they transverse the liver. Lido, benadryl, metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Low clearance (IC) means what, ex of drugs 3

A

Hepatic clearance rel independent of hepatic bf. Diazepam, tyelenol, warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

4 tests of hepatocellular damage

A

AST, alt, ldh, gst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Assessments of bile flow (4)

A

Alk phos, 5 nucleotides, ggt, bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Assessment of hepatic synthetic function 2

A

Albumin, pt/inr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Idiosyncratic rxns leading to hepatitis 4

A

Nsaids, va, anti htn, anticonvulsants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk factors to halothane depatitis

A

Prior exposure, >40 y/o, obesity, female, Mexican, mult brief exposures with short duration, enzyme induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
% metabolism of volatile agents
Halothane 46%, enflurane 6%, sevo 3%, iso 1%, des .02%
26
Most to least: hepatic bf and oxygenation decrease w GA and VA
Hal, enf, des, iso, sevo
27
How nitrous effects liver
Inc sns- vasoconstrict sphlanchnic/portal flow. B12 deficiency (methionine synthase)
28
Alcoholic liver disease: 3 forms
Steatosis, alcoholic hepatitis, cirrhosis
29
Hallmark of end stage cirrhosis
Portal htn
30
Hyperdynamic circ in cirrhosis: ___ CO, ___ SVR, ___ BP, ___ filling pressures, ____ hr
Hi CO, low SVR, low/nml BP, nml/inc SV, nml filling pressures, hi/nml hr
31
Hepatopulm syndrome: intrapulm _____, type I v II
Shunting. I precapillary II arteriovenous
32
Hepatopulm syndrome: 0xyhgb curve shifts where. VQ mismatch leads to what
Right (inc 2,3 dpg). Imp HPV, pleural effusions, ascites, diaphragm dysfunction
33
Treatment of cirrhosis w portal htn and suites 5
Na and fluid restriction, diuretics (spironolactone or amigo ride), paracentesis
34
Cirrhosis renal abn: reduction in __ and __ excretion
Sodium and water
35
Hepatorenal synd: ____renal failure, ___ gfr, ___ renal tubular func and ___ renal histology
Pre, low, preserved, nml
36
Type 1 hepatorenal syndrome
Progressive oliguria, rapid creat rise, poor prognosis
37
Type 2 hepatorenal syndrome
Moderate, more stable impairment, in pts w refractory ascites
38
Hepatorenal treatment: aimed at what, 4 options
Reversing patho cause= sphlanchnic arterial vasodilation. AVP, octreotide, albumin, transplant
39
4 cirrhosis heme/coag abn
Anemia, dec vit k dep factors (long PT), thrombocytopenia and thrombopathy, dysfibrinogenemia
40
Endocrine disorders in cirrhosis
Dec ability of muscle to uptake insulin, inc GH and glucagon, hypoglycemia, feminization males/amenorrhea females
41
Factors assoc w hepatic encephalopathy 4
Inc ammonia produc, fluid/lyte/acid base imbalance generates ammonia, alt liver/brain func, reduced hepatic metabolism
42
3 overall fx of cirrhosis cholestatic disease
Cv dysfunction, coag disorders (vit k def), renal vulnerability
43
Cv effects of cholestatic disease
Imp contractility, less resp to NE/Isuprel/ang II, dec SVR, inc CO
44
MELD: what it is, how to calc
Non subjective factor risk score. Creatinine (adults w dialysis biweekly value=4) bilirubin, INR
45
Child Pugh score: what makes it up. What c means
Albumin, pt, inr, bilirubin, ascites, encephalopathy. Elective sx contraindicated
46
Ways to optimize liver pt preop
Correct etoh dependency, coagulopathy, ph, lyte abn (esp K), malnutrition, anemia, varicies, hepatic encephalopathy
47
How to correct PT/INR in liver pt, when. What for emergency
Few days prior. Vit k IV, factor VII, FFP in emergency
48
How benzos metab differently
Inc cerebral uptake, dec clearance, longer e 1/2
49
How precedex diff
Dec clearance, longer e 1/2
50
How propofol response dif, DOC w what
Single dose response similar, recovery may be longer post gtt. Encephalopathy
51
Morphine: e 1/2, PB, sedative and resp fx
Prolonged, decreased, exaggerated
52
Demerol: clearance, half life, SE
50% dec clearance, double e 1/2, neuro toxic
53
Fentanyl: clearance, effect of gtt
Decreased. Exaggerated fx
54
Sufentanil: kinetics, e 1/2
Similar. Infusions and repeat doses may prolong effect
55
Alfentanil: e 1/2, DOA, effects
Doubled, prolonged, enhanced
56
NMB: ____ Vd, ____ initial dose. Advanced disease reduces elim of: 4= inc DOA
Inc, higher. Vec, roc, panc, miva
57
2 NMB not dep on hepatic elim
Atra and cis
58
NMB fx prolonged in liver/why. ___ vd, ___ initial dose.
Sux. Dec cholinesterase levels. Inc, higher
59
Intra op: ____ response to catecholamines, why
Decreased. Circulating vasodilators (bile acid, glucagon)
60
Intra op: consider ___ dose of catecholamines or add ____ to support bp
Increased, vaso
61
Patients with biliary obstruction are intolerant of ___ ____
Blood loss
62
Assess what 4 things when deciding if CVP or PA placement for liver pt
Hypovolemia, abd compartment syndrome, distributive shock, CHF
63
Local/mac case: what is necessary to avoid which SE
Adequate sedation. Minimize SNS stim which could lead to dec hepatic bf/02
64
GA in liver pt: airway and gas options
RSI or awake ett. Sevo, iso doc. N20 ok
65
Which symptoms defined as fulminant hepatic failure
Encephalopathy within 2-8 weeks of symptoms w surgery
66
Hepatocellular causes of post op jaundice
Drugs (anesthetics), ischemia (shock, hypotension, sx retraction), viral hepatitis
67
What TIPS does on a basic level
Used for end stage liver pts to dec portal pressure and dec portal htn SE. connects PBF into hepatic vein
68
TIPS: anesthesia types, what if variceal bleed, pts typically have what
MAC unless long sx/sick then general. Resusc w fluid and blood. Severe coagulopathy
69
Concerns of what could happen in TIPS procedure
Ptx, neck vessel injury, cardiac dysrhythmias from catheter, hemorrhage, pulm edema and CHF w low cardiac reserve
70
Techniques other than fluid and blood to dec blood loss in hepatic resection
Pressers, intermittent portal triad clamp, ischemic pre conditioning
71
Hepatic resection: which position in OR and why
Modest t-berg, reduce intrahepatic venous p, inc preload and CO, reduce VAE risk
72
Hepatic resection postop: fluid type and why
IVF w phosphates to help liver regeneration and avoid hypophosphatemia

Adv Pr III (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions