Liver/Bili Flashcards
(32 cards)
most common cause of cholestasis and treatment
obstruction of the biliary tract outside the liver (gallstones, strictures, infection, or ischemia)
cholecystectomy
temporary treatment for acute cholecystitis
decompression and drainage of the gallbladder w cholecystectomy tube
6 indications for cholecysectomy
symptomatic cholelithiasis, acute cholecystitis, chronic cholecystitis, biliary dyskinesia, GB polyps or carcinoma, choledocholithiasis
what is cholangiography
cystic duct is opened and dye is injected into the biliary tree and xrays are taken to identify stones or abnormalities –> CBD exploration to ERCP performed if needed
respiratory considerations with CBD surgery (pre-op)
-pain –> reduced FRC, hypoventilation, atelectasis, tachypnea, respiratory alkalosis
-sepsis –> tachypnea & respiratory alkalosis
CV considerations for GB sx
-hypovolemia (vomiting, reduced PO intake) –> resuscitate
-exaggerated effects with reverse Trend + insufflation (impaired venous return)
-epigastric discomfort can mimic MI
GI considerations for GB sx
-peritonitis, abdominal distension, paralytic ileus
-consider full stomach RSI
-if n/v check electrolytes
what is the sphincter of oddi
smooth muscle that surrounds the end of the CBD and pancreatic duct and allows bile to flow into the small intestine during digestion
what meds and conditions can cause sphincter of oddi to spasm
opioids
acute cholecystitis (raises GB intraluminal pressure)
what medication is the treatment for sphincter of oddi spasms
glucagon 0.5-1mg per surgeon request
–reduces intraluminal pressure of the GB
what is an ERCP
-easiest and least invasive way to enter the bile duct to diagnose and treat conditions of the liver, bile duct, and pancreas (stones or stenosis). can relieve obstruction of bile/panc ducts
Respiratory considerations for ERCP
-airway eval and assess the need for GETA
-may have limited access to the airway intra-procedure
-if ascites and pleural fluid accumulation –> impaired ventilation and increased aspiration risk
CV considerations for ERCP
hypotension and ECG changes are common
hepatic considerations for ERCP
coagulopathy, altered drug metabolism, and other metabolic disturbances
renal considerations for ERCP
may have ARF (high BUN/Cr) due to volume depletion
in what case may volume depletion be severe and require resuscitation pre-op
acute pancreatitis
whta type of anesthesia is used for ERCP
deep sedation vs GA (if complex, high asp risk, or uncooperative, +/- RSI)
Anesthetic Considerations for ERCP
-position
-access
-ETT
-GI
-other
-prone with head turned, arms by side
-1 PIV, +/- art line
-risk for R mainstem or extubation by scope
-decompress the stomach
-place bit block and have glucagon available
what is the most important predictor of short-term survival s/p hepatic resection
intra-op blood loss
where does bleed occur from during hepatic resection
intrahepatic branches of portal and hepatic veins
anatomic vs non-anatomic liver resections
anatomic =veins/arteries dissected and mobilized before resection of liver parenchyma.
non-anatomic= only the tumor w 1-2cm margin is removed, not the entire lobe or segment (good for cirrhosis or chronic hepatitis)
CV/resp liver resection pre-op considerations
-Ascites effect on respiratory mechanics
- tumor size and location may impede venous return
-anticipate high EBL
what does the liver produce? except?
-all clotting factors ex factor 8
-have coags and T&S
Anes for liver resection:
-anes
-lines
-position
-EBL & tx
-GETA/RSI/epidural
-2 PIV, art line, foley, +/- CVC & TEE
-supine
-250-750 –> IVF, albumin, blood
