Prodigy- Liver

Question 1

What is the largest internal organ in the human body?

Answer 1

The liver

Question 2

Liver is located between T__ & T___

Answer 2

T7 - T11

7-11 - Indians, drink their liver to death

Question 3

How much blood can the liver store up to?

Answer 3

1L

Question 4

What supplies blood flow to the GB?

Answer 4

the cystic artery

Question 5

What stimulates the GB to contract after eating?

Answer 5

CCK (cholecystokinin)

Question 6

What is formed as a byproduct of deamination?

Answer 6

Ammonia

Question 7

In pts with liver failure, the low albumin leads to increased free fraction of the drug, which can prolong your DOA of vec/roc/panc….. however, it is often necessary to give an INCREASED induction dose in order to reach the intended clinical effect… why?

Answer 7

Bc low protein = decreased oncotic pressure = more fluid moves to intersistial space, increasing the volume of distribution

Question 8

What is gluconeogenesis stimulated by and what does it form?

Answer 8

stimulated by reduced glycogen stores.

-forms glucose from noncarb substances: pyruvate, lactate, and amino acids

Question 9

Vitamin K is a (water/fat) soluble vitamin required for the absorption of what clotting factors?

Answer 9

2, 7, 9, 10

Question 10

What lab value changes would reflect vitamin K deficiency

Answer 10

prolonged PT with a normal PTT

Question 11

IV Vitamin K improves PT in what time frame?

Answer 11

6-8 hours

Question 12

If your patient is on orlistat, what should you consider?

Answer 12

Checking PT/PTT
-if PT is prolonged and PTT is normal, may have a coagulopathy due to vitamin K deficiency and it needs to be corrected prior to surgery.

Question 13

Which metabolism pathways are the P450 isoenzymes a part of?

Answer 13

Oxidation, Reduction, and Conjugation

Just not hydrolysis bc that happens outside of the liver

Question 14

Which is more specific to liver damage, AST or ALT

Answer 14

ALT (L = Liver)

Question 15

AST/ALT don’t indicate liver function; they are an assessment of what?

Answer 15

cellular damage

Question 16

How do you differentiate alcoholic hepatitis vs viral hepatitis

Answer 16

etoh will have a AST/ALT ratio > 2

viral hepatitis will have a AST/ALT ratio < 1

Question 17

if the alk phos is significantly more elevated than the AST/ALT, what is most likely the cause?

Answer 17

Bile obstruction

Question 18

in patients with an AST/ALT ratio > 2, which level is usually higher?

Answer 18

AST

Question 19

Increased resistance to blood flow to the liver is known as what

Answer 19

Portal hypertension

Question 20

pt’s with a MELD score > ____ carry a 100% 3-month mortality rate

Answer 20

> 40

Question 21

T/F- an elevation in liver enzymes less than twice the normal value is relatively common after abdominal surgery

Answer 21

True

-usually resolves within 48hours

Question 22

T/F - volatile agents increase liver blood flow

Answer 22

True

Question 23

Which opioid should be avoided in liver disease

Answer 23

Meperidine

Question 24

Which is the only opioid unaffected by hepatic disease?

Answer 24

Remi

Question 25

Will acute liver failure result in the prolongation of sux?

Answer 25

No - bc pseudocholinesterase has a half life of about 2 weeks

Question 26

``` All of the following could precipitate hepatic encephalopathy in patients with cirrhosis except: A. Gastrointestinal hemorrhage B. Diuretic administration C. Hyperkalemia D. Azotemia ```

Answer 26

C.

Question 27

``` Venous blood from the gallbladder drains into the A. portal vein B. hepatic artery C. cystic vein D. hepatic vein ```

Answer 27

A

Question 28

``` The gallbladder normally stores about _____ mL of bile. A. 50 B. 500 C. 100 D. 25 ```

Answer 28

A

Question 29

A patient is in steep Trendelenburg position during a laparoscopic cholecystectomy. The patient suddenly exhibits a decrease in oxygen saturation, subcutaneous crepitation over the chest, and an increase in end-tidal CO2. The first step you should take is A. Begin chest compressions B. Hyperventilate the patient C. Tell the surgeon to turn off the insufflator D. Administer epinephrine 100 mcg IV

Answer 29

C

Question 30

``` The preferred treatment of cholecystitis due to cholelithiasis is A. opioids and antibiotics B. laparoscopic cholecystectomy C. cholecystostomy tube D. open cholecystectomy ```

Answer 30

B

Question 31

``` Which anesthetic agent is metabolized by the liver to the greatest degree? A. Sevoflurane B. Isoflurane C. Nitrous oxide D. Desflurane ```

Answer 31

A

Question 32

``` Hepatic blood flow can decrease substantially during abdominal surgery. This is most likely due to A. propofol-induced hepatitis B. the effects of volatile anesthetics C. histamine release D. prostaglandin release ```

Answer 32

D. | thought to be from the retractors

Question 33

``` Alcoholic hepatitis is characterized by alcohol abuse, liver dysfunction, and A. an AST/ALT ratio less than 1 B. encephalopathy C. a prolonged PT D. jaundice ```

Answer 33

D

Question 34

Bile performs several functions, one of which is to A. keep the duodenum alkaline B. excrete IgM C. produce pseudocholinesterase D. enhance the absorption of water-soluble vitamins

Answer 34

A