Liver and GI Flashcards

Question

How do you grade prep liver dysfunction?

Answer 1

``` MELD Score Child-Turcotte -Pugh Score Encephalopathy Ascites Bilirubin Albumin PT (INR) Primary biliary cirrhosis ```

Answer 2

``` AST and ALT Alkaline phosphatase 5’Nucleotidase GGT Serum bilirubin Prothrombin Time Albumin (normal 3.5-5.0 g/dl) Complete CBC Coagulation studies Serum electrolytes and glucose levels Serum ammonia levels Platelet count >100,000 Toxicology ```

Answer 3

``` Increased levels of endogenous vasodilators such as vasoactive intestinal peptide High cardiac output Decreased systemic vascular resistance Hyperdynamic circulatory state Arteriovenous shunting Portal hypertension Pre-operative EKG is warranted ```

Answer 4

Respiratory: Ascites impairs the movement of the diaphragm resulting in decreased FRC Right to left shunting secondary to arterivenous shunting Fluid balance: Ascites and edema offer evidence of derangement in fluid status Correction of volume status with attention to central filling pressures

Answer 5

Cholestatic disease predisposes towards Vitamin K deficiency Biliary obstruction coagulopathy results from a deficiency of factors dependent on Vitamin K (II,VII, IX, X) Absorption of Vitamin K depends on Bile Salt excretion into GI tract Long term biliary obstruction can cause liver dysfunction interfering with protein synthesis

Answer 6

Treatment is to correct with parental Vitamin K FFP is necessary if emergent surgery or presence of hepatic injury Expected findings Increased peripheral vasodilation Increased CO Increased portal venous pressure Decreased portal venous blood flow

Answer 7

Preoperative evaluation should focus on signs and symptoms of encephalopathy, bleeding, jaundice ascites, and hemodynamics) Lab findings Electrolytes, BUN, creatinine, serum glucose, H/H, liver enzymes, bilirubin, coagulation studies, and abg

Answer 8

Most common cause of chronic liver disease Fat accumulation in the liver exceeding 5% Risk factors include NIDDM and obesity Asymptomatic but elevated liver enzymes (AST & ALT) found on physical exam Produces some degree of hepatocyte necrosis which promotes the accumulation of inflammatory cells in liver Leads to cirrhosis Weight loss (even 5 lbs) can reverse the elevated liver enzymes

Answer 9

``` malaise nausea anorexia Weakness abdominal discomfort hepatomegaly jaundice ``` Results in: Steatosis (fatty liver) Alcoholic hepatitis (precursor Cirrhosis) Cirrhosis

Answer 10

Within 6-8 hours of ETOH withdrawal patient may become tremulous Alcohol hallucinosis and grand mal seizures occur within 24 hours DTs usually appear within 72 hours of withdrawal and are preceded by tremulousness, hallucinations or seizures Treatment is with benzodiazepines

Answer 11

``` Anorexia weakness nausea vomitting abd pain hepatomegaly ascites jaundice spider nevi metabolic encephalopathy Hyperdynamic circulation high CO low PVR Gastroesophageal variceal Intrapulmonary shunting Ventilation Perfusion mismatch Arterial hypoxemia due to Intra-pulmonary vascular dilations (IPVD) Ascites and Edema Coagulation disorders Endocrine disorders Hepatic encephalopathy Portal Hypertension ```

Answer 12

Hemostasis Coagulation Fibrinolysis

Answer 13

Disorders of coagulation rapidly develop in patients with severe liver failure Factors II, V, VII, IX, X all reduced in liver failure PT and INR elevated Thrombocytopenia Abnormal fibrinogen

Answer 14

Abnormal platelet function Decreased platelet function Increased bleeding time

Answer 15

Vitamin K deficiency Coumadin Therapy Heparin Therapy

Answer 16

Vitamin K is necessary for the hepatic synthesis of Factors II, VII, IX, X, and Protein S and Protein C

Answer 17

Vitamin K deficiency develops in patients on parenteral nutrition, biliary obstruction, pancreatic insuff, malabsorption, GI obstruction and rapid GI transit Effects of Vitamin K deficiency include prolonged PT, PTT

Liver and GI Flashcards

(41 cards)