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Anesthesia Principles 2 (Broadbent) > Liver and Gallbladder (Apex) > Flashcards

Liver and Gallbladder (Apex) Flashcards

1
Q

The ______ is the functional unit of the liver.

A

lobule

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2
Q

Hepatocytes in zone ____ are most susceptible to ischemic injury

A

3

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3
Q

_____ cells remove bacteria from portal blood before the blood enters the systemic circulation

A

Kupffer

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4
Q

Bile is produced by _____ and stored in the _______.

A

hepatocytes
gallbladder

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5
Q

Bile pathway to duodenum:

A

canaliculi—> bile duct —> common hepatic duct —-> common bile duct —> ampulla of Vater—> duodenum

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6
Q

_____ and ______ drain into the space of Disse before they enter into the ______ duct.

A

lymph and proteins
lymphatic

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7
Q

The liver receives SNS innervation from ____-______

A

T3-T11

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8
Q

There are _______ to _____ lobules in the liver

A

50,000-100,000

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9
Q

Zone __ has the highest concentration of CYP450 enzymes

A

3

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10
Q

How much CO does the liver receive?

A

30% or 1500ml/min from dual blood supply

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11
Q

The portal vein provides ____% of the total liver blood flow and provides ___% of the liver’s oxygen supply.

A

75%
50%

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12
Q

The hepatic artery provides __% of the total liver blood flow and provides __% of the liver’s oxygen supply.

A

25%
50%

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13
Q

A decrease is portal vein flow will cause…. How does liver disease affect this?

A

an increase in hepatic artery flow
severe liver disease impairs this response which makes the diseased liver more susceptible for hypoperfusion

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14
Q

Portal Perfusion = ________ - ________.
Normal portal vein pressure =

A

Portal Vein pressure - Hepatic Vein pressure
7-10 mmHg
Portal HTN = >20-30 mmHg

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15
Q

Portal HTN reduces blood flow to the liver which produces back pressure on the ______ organs. Vascular engorgment accounts for _______ and ______ in the esophagus, stomach, and intestines.

A

Splanchic
splenomegaly and varices

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16
Q

Physiologic consequences of Portal HTN include:

A

ascites, spider angiomas, hemorrhoids, and encephalopathy

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17
Q

Both ______ and ______ reduce MAP and CO which can reduce liver blood flow in a dose-dependent fashion.

A

GA and neuraxial

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18
Q

Hepatocytes produce: (3)

A

-Thrombopoietin
-Alpha -1- acid glycoprotein
-Factor 7

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19
Q

Vitamin K is required to synthesize factors…….and proteins……(anticoagulant)

A

2,7,9,10 (procoagulants)

S,C,Z (anticoagulants)

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20
Q

Factor 8 is produced by the liver ______ cells and ______ cells (not by hepatocytes)

A

sinusoidal cells
endothelial cells

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21
Q

______ is a reservoir for acidic drugs.

A

Albumin

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22
Q

________ glycoprotein is a reservoir for basic drugs.

A

Alpha-1-acid glycoprotein

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23
Q

The liver produces all plasma proteins except for ______.

A

immunoglobulins (gamma globulins)

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24
Q

The liver clears ______ from the circulation which makes patients with liver failure at risk for ______.

A

insulin
hypoglycemia

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25
The liver converts ammonia to ____ which is eliminated by the ____.
urea kidney
26
Failure to clear ______ leads to hepatic encephalopathy.
ammonia
27
Old RBCs are broken down by the _______ cells in the ______.
reticuloendothelial cells spleen
28
Spleen: Hemoglobin------> _______---->_______
heme ----> unconjugated bilirubin (neurotoxic)
29
What coagulation Factors are NOT produced in the Liver?
von Willenbrand factor (vascular endothelial cells) Factor 3 (vast. endothelial cells) Factor 4 (calcium comes from diet)
30
Glucose is stored as glycogen =
Glucogenisis
31
Glycogen is cleaved into glucose:
Glycogenolysis
32
Glucose is created from non-carbohydrate sources (magically)
Gluconeogensis
33
Test for Hepatocellular injury:
AST (10-40 units/L) ASL (10-50 units/L)
34
Test for Synthetic Function:
PT (12-14 secs) Albumin (3.5-5.0 g/dL)
35
Test for Hepatic Clearance:
Bilirubin (0-11 units/L)
36
Test for Biliary duct obstruction:
Alkaline phoshatase
37
__________ _____ is very sensitive for acute hepatic injury because Factor __ has a half-life of only __-__ hours.
Prothrombin time 7 4-6 hours
38
The _____ ___ ____ controls the flow of bile released from the common hepatic duct.
Sphincter of Oddi
39
______ of the sphincter of Oddi increase biliary pressure. Caused by ____.
Contraction Opioids (more potent = greater increase in biliary pressure)
40
Hypercapnea and acidosis causes .........
increased liver flow
41
Pre-hepatic jaundice is caused by _____ ______.
increased hemolysis
42
Hepatic jaundice is caused by ____ ____.
liver impairment
43
Post-hepatic jaundice is caused by:
a blockage of bile ducts
44
AST/ALT ratio > __ suggests cirrhosis or alcoholic liver disease
2
45
Hepatitis ___ is the most common form of viral hepatitis. oral-fecal route.
A
46
Chronic hepatitis is characterized by hepatic inflammation that exceeds ____ months.
6
47
Antidote for acetaminophen overdose
Oral N-acetylcysteine
48
Most common cause of chronic hepatitis. Second most common?
alcoholism 2nd = hepatitis C
49
S/S of chronic hepatitis
jaundice, fatigue, thrombocytopenia, glomerulonephritis, neuropathy, arthritis, myocarditis
50
Chronic Hepatitis: ___ is prolonged and ____ is decreased
PT albumin
51
Hepatotoxic drugs that inhibit CYP450
-tylenol -halothane -amio -antibiotics (pcn, tetracyclines, sulfonamides)
52
Max dose of Acetaminophen Tx?
4g in 24hrs Tx= N-acetylcysteine
53
Acutely intoxicated patient anesthetic considerations:
-decrease MAC (increase in chronic) -aspiration precautions -alcohol inhibits NMDA receptors -alcohol impairs pharyngeal reflexes
54
Cirrhosis has a reduction in the # of functional ______ and ______.
hepatocytes and sinusoids
55
MELD score predicts _____ mortality with patients with ESLD
90 day
56
MELD- three factors that measure hepatic function: Score (low, intermediate, high risk)
bilirubin, INR, serum creatinine (BIC) Low risk= <10 Intermediate = 10-15 High = >15
57
Volatile agents preferred for Liver Disease:
Iso and Sevo (less decrease in hepatic blood flow) Halothane bad for liver! (halothane hepatitis)
58
Muscle relaxant drug of choice for liver disease
Cistatricurium
59
TIPS procedure bypasses a portion of the hepatic circulation by shunting blood from the ______ vein (inflow) to the ____ vein (outflow).
portal vein hepatic vein
60
TIPS procedure reduces: Main risk?
portal pressure back pressure on splanchin organs reduces likelihood of bleeding from esophageal varicose ascites Main risk= hemorrhage
61
Severe liver disease impairs the liver's ability to clear ________ substances from systemic circulation. This leads to a _______ circulation (_______ + ______)
-vasodilating -high cardiac output -low SVR
62
The common bile duct and pancreatic duct form the_______ which leads to the ________
Ampulla of Vater Sphincter of Oddi
63
You can relax the sphicter of Oddi with........
-glucagon, naloxone or nitroglycerin -glycopyrolate and atropine
64
Biliary stones cause obstruction of bile. If these substances can't move into the ______ ______ they back up into the _____ and ______.
small intestine liver and pancrease
65
How much bile does the gallbladder hold?
30-50cc
66
3 main functions of Bile
Emulsify and enhance absorption of ingested fats and fat-soluble vitamins. Provide an excretory pathway for bilirubin, drugs, toxins, and immunoglobulin A (IgA) Maintain duodenal alkalization
67
Cholecystitis characteristics and s/s:
Acute obstruction of the cystic duct -Patients present with acute, severe, midepigastric pain that often radiates to right abdomen.
68
Labs for Cholecystitis
increase in plasma bilirubin, alkaline phosphatase, amylase, and WBCs.
69
Cholecystitis: Free abdominal air suggests?
ruptured viscus with perforation of gallbladder. (Free air = emergency ex-lap)
70
Cholelithiasis /Choledocholithiasis=
Acute obstruction of the common bile duct.
71
Cholelithiasis /Choledocholithiasis: Charcot triangle
fever, chills, upper quadrant pain
72
Surgical treatment for Choledocholithiasis (stones in the common bile duct)
ERCP (endoscopic retrograde cholangiopancreatography)
73
Cholecystectomy Anesthesia Considerations:
Post-op pain Nausea and vomiting Peritoneal irritation from CO2 Intravascular volume restoration
74
Cholecystectomy: Open approach involves a _____ upper quadrant abdominal incision which will _____ lung volume and _____ pain.
right decrease increase
75
______ duct and the ______ duct join the common hepatic duct before it empties into the ______
cystic duct pancreatic duct duodenum

Anesthesia Principles 2 (Broadbent) (4 decks)

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