Hepatic Test III Flashcards

Question

What are the s/s of Hep A?

Answer 1

Asymptomatic to acute liver failure *Does not progress chronic disease.*

Answer 2

Pooled gamma globulin

Answer 3

Hepatitis B

Answer 4

- Sex - Blood

Answer 5

Hepatitis B immunoglobulin

Answer 6

Hepatitis C

Answer 7

- Sex - Blood - Parenteral drug use 35-70 days

Answer 8

- Sofosbuvir - Interferon w/ ribavirin - other antivirals

Answer 9

Hepatitis B

Answer 10

- Oral/Fecal

Answer 11

NO treatments, usually self-limiting

Answer 12

Acetaminophen greater than 4 g/day

Answer 13

Model for End-Stage Liver Disease (predicts mortality based on symptomology).

Answer 14

100% mortality in the hospitalized patient.

Answer 15

Safe to undergo elective surgery.

Answer 16

Needs optimization to undergo elective surgery.

Answer 17

Elective surgery is contraindicated. **Acute hepatitis is also a contraindication to elective surgery.**

Answer 18

**Hepatic cell death** (this means meds will stick around longer, patients will have encephalopathy d/t increased ammonia, etc.) Clots will rapidly develop and then break down. Impaired ability to synthesize clotting factors. Thrombocytopenia. Decrease levels of Protein C and Anti-thrombin III

Answer 19

- Portal HTN - ↓ circulating volume

Answer 20

- Hepatorenal Syndrome - ↑ H₂O and Na⁺ retention

Answer 21

Chronic Lung Disease and SOB from fluid retention and ascites. Treatments: Diuresis and give O2

Answer 22

Accumulation of ammonia

Answer 23

↓ PaCO₂ = ↓ HBF ↑ PaCO₂ = ↑ HBF

Answer 24

All of the choices are correct. The liver can metabolize all your macromolecules and muscle relaxants, with the exception of atracurium, nimbex, and Sch.

Answer 25

Kupffer Cells

Answer 26

All of the choices are correct. *Liver disease will cause wide spread vitamin deficiencies, hypoalbuminemia, and hypoglycemia.*

Answer 27

Splenomegaly Esophageal Varices Right Heart Failure

Answer 28

Colloids (Albumin)

Answer 29

exaggerated

Answer 30

24 - 72 hours

Answer 31

Trans-jugular Intrahepatic Portosystemic Shunt is a procedure to create new connections between the hepatic and portal veins to relieve pressure for late-stage liver disease.

Answer 32

**High hepatic extraction ratio** High Extraction Ratio Drugs are cleared through the liver. (Propofol, Opioids, Lidocaine, Verapamil, Beta-blockers). This drugs will stick around longer with impaired HBF.

Answer 33

Through the hepatic duct, into the gall bladder

Answer 34

Through the ampulla of vater

Answer 35

25% of CO Portal vein 75% Hepatic artery 25% 50% Venous 50% artery

Answer 36

↑Alk Phosphatase,↑GGT,↑bilirubin

Answer 37

-Hepatic arterial blood flow and venous blood flow are inversely related

Answer 38

Risk factors: Obesity, ↑cholesterol, DM, pregnancy, female, family hx 80% asymptomatic Sx: RUQ pain, referred to shoulders N/V, indigestion fever (acute obstruction) Tx: IVF, abx, pain management Lap Cholecystectomy

Answer 39

*Hepatocytes secrete bile through bile ducts, into CHD→ GB & CBD GB stores bile to deliver during meals, CBD secretes bile directly into duodenum

Answer 40

Stone obstructing CBD→ biliary colic Initial sx: N/V, cramping, RUQ pain Cholangitis sx: fever, rigors, jaundice Tx: Endoscopic removal of stone via ERCP Endoscopic Retrograde Cholangiopancreatography

Answer 41

Endoscopist threads guidewire through Sphincter of Oddi, into Ampulla of Vater to retrieve stone from pancreatic duct or CBD GA, usually prone w/left tilt (tape ETT to left) Glucogon may be required in the event of Oddi Spasm

Answer 42

indirect" bilirubin is PB to albumin, transported to liver, conjugated into to its H20-soluble “direct” state, excreted into bile

Answer 43

Imbalance between bilirubin synthesis & conjugation

Answer 44

caused by an obstruction, causing reflux of conjugated bilirubin into the circulation

Answer 45

5 most common types (A, B, C, D, E) B & C are more chronic HCV is most common viral hepatitis requiring liver transplant in US Newer tx have significantly reduced HCV in the US population Tx b/o HCV genotype (75% type 1), HCV stage, +/- cirrhosis 12 week course Sofosbuvir/Velpatasvir Provides 98-99% clearance of genotype 1A/1B

Answer 46

- On the rise in America -Most common cause of cirrhosis -underreported due to stigma plt <50,000 transfuse

Answer 47

Malnutrition Muscle wasting Parotid gland hypertrophy Jaundice thrombocytopenia Ascites Hepatosplenomegaly Pedal edema *Sx of ETOH withdrawal may occur 24-72h after stopping Lab Values ↑Mean corpuscular volume (MCV) ↑Liver enzymes ↑ɣ-glutamyl-transferase (GGT) ↑Bilirubin Blood ethanol (acute intox)

Answer 48

On the rise in US Dx: hepatocytes contain >5% fat Rx: Obesity, Insulin resistance, DM2, Metabolic syndrome Progresses to NASH, cirrhosis, hepatocellular carcinoma NAFLD & NASH have become additional leading causes of liver transplant in US Dx: Imaging and histology Liver biopsy= gold standard in distinguishing NAFLD from other liver dx Tx: Diet, exercise Liver transplant is indicated for advanced fibrosis, cirrhosis, related complications

Answer 49

Predominantly effects women May be asymptomatic, acute, or chronic +autoantibodies & hypergammaglobulinemia AST/ALT may be 10-20x norm in acute AIH Tx: steroids, azathioprine (immunosuppressant) 60-80% achieve remission; relapse is common Liver transplant indicated when tx fails or acute liver failure ensues

Answer 50

Most common cause: Acetaminophen OD Normally reversible after drug is removed

Answer 51

Wilsons Disease Alpha-1 Antitrypsin Deficiency Hemochromatosis

Answer 52

AKA hepatolenticular degeneration Autosomal recessive disease characterized by impaired copper metabolism Copper buildup leads to oxidative stress in the liver, basal ganglia, and cornea Sx: range from asymptomatic to sudden-onset liver failure along with neurologic & psychiatric manifestations Dx: Lab tests (serum ceruloplasmin, aminotransferases, urine copper level) Possible liver biopsy for copper level Tx: Copper-chelation therapy & oral zinc to bind copper in the GI tract

Answer 53

α-1 antitrypsin proteins protect the liver & lungs from neutrophil elastase neutrophil elastase is an enzyme that disrupts tissues of the lungs and liver Incidence 1: 16,000 to 1: 35,000, although it is likely underdiagnosed α-1 antitrypsin deficiency is the #1 genetic cause of liver transplant in children Dx: confirmed w/ α-1 antitrypsin phenotyping Tx: pooled α-1 antitrypsin is effective for pulmonary sx; however, it doesn’t help with liver disease Liver transplant is the only curative treatment for liver disease in α-1 antitrypsin deficiency

Answer 54

Excessive intestinal absorption of iron May be genetic or caused by repetitive blood transfusions or iron infusions Excess iron accumulates in organs and causes damage to the tissues Pt's may present with cirrhosis, heart failure, diabetes, adrenal insufficiency, or polyarthropathy Labs reveal elevated AST/ALT, transferrin saturation, and ferritin Dx: genetic mutation testing Echocardiogram & MRI diagnose cardiomyopathies and liver abnormalities Liver bx may quantify iron levels in the liver and assess the level of damage Tx: weekly phlebotomy, iron-chelating drugs, liver transplant

Answer 55

Autoimmune, chronic inflammation of the larger bile ducts Intrahepatic and extrahepatic Fibrosis in biliary tree→strictures (beads on string appearance)→ cirrhosis, ESLD Males>Females, onset ̴40’s Sx: Fatigue, itching, deficiency of fat-soluble vitamins (A,D,E,K), cirrhosis Labs: ↑alkaline phosphatase and ɣ-glutamyl-transferase, +auto-antibodies Dx: MRCP or ERCP showing biliary strictures w/ dilated bile ducts Liver biopsy reinforces dx, but isn't always performed No drug treatments are proven to be effective Liver transplant is only long term treatment Re-occurrence is common after transplant d/t autoimmune nature

Answer 56

Previously known as biliary cirrhosis Autoimmune, destruction of bile ducts with periportal inflammation & cholestasis Can lead to liver scarring, fibrosis, cirrhosis Females > Males; often dx'd in middle-ages Thought to be c/b exposure to environmental toxins in genetically susceptible individuals Sx: jaundice, fatigue, & itching Labs: ↑Alk Phos,↑GGT, + Antimitochondrial antibodies Imaging: CT, MRI, & MRCP to r/o bile duct obstructions Liver biopsy reveals bile duct destruction and infiltration w/lymphocytes Tx: No cure, but exogenous bile acids slow progression

Answer 57

Portal HTN HVPG >5 ↑vascular resistance within the portal venous system Ascites Most common complication of cirrhosis Portal-HTN leads to ↑blood volume & peritoneal accumulation of fluid Management: ↓Salt diet, albumin replacement Transjugular Intrahepatic Portosystemic Shunt (TIPS) Reduces P-HTN and ascites Bacterial Peritonitis Most common infection r/t cirrhosis Requires abx

Answer 58

Present in ̴50% cirrhosis pts Hemorrhage is most lethal complication Beta blockers help reduce risk Prophylactic endoscopic variceal banding & ligation Refractory bleeding → balloon tamponade Buildup of nitrogenous waste d/t poor liver detoxification Neuropsychiatric symptoms (cognitive impairment → coma) Tx: Lactulose, Rifaximin to ↓ammonia-producing bacteria in gut

Answer 59

Hepatorenal Syndrome Excess production of endogenous vasodilators (NO, PGs)→↓SVR→↓RBF Tx: Midodrine, Octreotide, Albumin Hepatopulmonary Syndrome Triad of chronic liver dz, hypoxemia, intrapulmonary vascular dilation Platypnea (hypoxemia when upright) d/t R to L intrapulmonary shunt Portopulmonary HTN Pulmonary HTN accompanied by portal HTN Systemic vasodilation triggers production of pulmonary vasoconstrictors Tx: PD-I’s, NO, prostacyclin analogs, and endothelin receptor antagonists Transplant is only cure

Answer 60

bilirubin, albumin, PT, encephalopathy, ascites

Answer 61

score based on bilirubin, INR, creatinine, sodium

Answer 62

Careful history & physical Standard preop labs: CBC, BMP, PT/INR Low threshold for invasive monitoring ↑Risks aspiration, HoTN, hypoxemia Colloids > crystalloids for resuscitation Alcoholism increases MAC of volatile anesthetics Drugs may have slow onset/prolonged DoA Succs and Cisatracurium are ideal (not liver-metabolized) Although plasma cholinesterase may be decreased in severe liver dz Bleeding/coagulation management

Answer 63

“TIPS” procedure to manage portal HTN Stent or graft placed btw hepatic vein and portal vein Shunts portal flow to systemic circulation Reduces the portosystemic pressure gradient Indications: Refractory variceal hemorrhage Refractory ascites Contraindications: Heart Failure Tricuspid regurgitation Severe pulmonary HTN

Answer 64

Resection to remove neoplasms, leaving adequate tissue for regeneration Tolerable amount of resection d/o preexisting liver disease and function Up to 75% removal is tolerated in pts with normal liver function Anesthetic considerations: Invasive monitoring Blood products available Adequate vascular access for blood/pressors Surgeon may clamp IVC or hepatic artery to control blood loss Standard practice is to maintain low CVP by fluid restriction prior to resection to reduce blood loss Patients often require post op PCA Liver resection often causes postop coagulation disturbanc

Answer 65

Definitive tx for ESLD Alcoholic liver disease is the most common indication > Fatty liver, HCC Living donor: surgeries timed together, minimal ischemic time Brain dead donors: kept HD stable to for organ perfusion Intraop Mgmt: Maintain hemodynamics (Pressors/Inotropes readily available) A-line, CVC, PA cath, TEE Control coagulation

Hepatic Test III Flashcards

(95 cards)