Liver

Question 1

which structure is responsible for eliminating bacteria from the liver?

Answer 1

Kupffer cell

Question 2

Functional unit of liver

Answer 2

Lobule (also states acinus elsewhere - apparently is referenced as smallest functional unit of liver)

Question 3

Where are kupffer cells located

Answer 3

Sinusoids

Question 4

Collect bile? This bile is produced by ?

Answer 4

Canaliculi

Hepatocytes

Question 5

Zone of lobule with highest concentration of CYP450 enzymes

Answer 5

zone 3

Question 6

Function as arterioles

Answer 6

Terminal branches of:

• Hepatic artery
• Portal vein

Question 7

Capillaries of Lobule

Answer 7

Sinusoids

Question 8

Venules of Lobule

Answer 8

Central vein

Question 9

Lobule anatomy

Answer 9

Question 10

Lymph and proteins drain into:

Answer 10

The space of Disse (between hepatocyte and sinusoid)

Question 11

The liver is responsible for about _____ the lymph production in the body

Answer 11

half

Question 12

Blood flow/oxygenation to the liver:

• % Cardiac output:
• The hepatic artery provides:
• The portal vein provides:

Answer 12

• 30%
• The hepatic artery provides: 25% flow, 50% O2
• The portal vein provides: 75% flow, 50% O2

Question 13

Increased splanchnic vascular resistance _______ portal vein blood flow. Increased Splanchnic VR Caused by:

Answer 13

Reduces

• SNS stim
• pain
• hypoxia
• hypercarbia

Question 14

Severe liver disease ______ the hepatic arterial buffer response to inadequate blood flow

Answer 14

Abolishes

Question 15

Perioperative factors that reduce Liver blood flow:

Answer 15

• Increased Splanchnic vascular resistance
• Increased CVP
• Some B.Blockers - propanolol reduces CO and increases Splanchnic VR
• Intraabdominal surgeries
• Laparoscopic procedures

Question 16

Coagulation factors Not produced by hepatocytes:

Which one is still produced in liver but not by hepatocytes?

Answer 16

• Factor 3
• Factor 8 (still in liver by sinusoids)
• vWf
• Also calcium is a clotting factor not from liver

Question 17

The liver produces all the plasma proteins except?

Answer 17

Immunoglobulins (gamma gobulins)

Question 18

AST/ALT: values indicate?

Answer 18

• Both elevated: Hepatitis
• AST/ALT ratio >2: Cirrhosis or alcoholic liver disease

Question 19

Values most indicitive of Biliary duct obstruction

Answer 19

5-nucleotidase

(enzymes spill into circulation when obstruction, will see alkaline phos and y-glutamylpeptidase too)

Question 20

Pre-hepatic liver disease labs?

Answer 20

elevated Bilirubin (unconjugated)

Question 21

Most common cause of Hepatits? Second?

Answer 21

Most common ETOH

Second: Hep C

Question 22

What is depleted in Acetaminophen toxicity and what depletes it?

Answer 22

Glutathione is depleted

NAPQI (N-Acetyl-p-benzoquinoneamine) depletes it, a metabolite of Acetominophen

Question 23

Hepatotoxic drugs:

Answer 23

• Halothane
• Acetominophen
• Amiodarone
• Antibiotics: PCN, Tetracycline, Sulfonamides

Question 24

MELD (Model of end-stage Liver disease) classification: Numbers and criteria

Answer 24

Low risk: < 10

Int risk: 10-15

High risk: > 15

BIC

Bilirubin, INR, Cr

(predicts 90-day mortality)

Question 25

Child-Pugh score risk numbers, and Factors:

Answer 25

Class A (5-6 points) - 10% risk perioperative mortality Class B (7-9 points) - 30% Class C (10-15 points) - 80% AB-APE Albumin, Bilirubin, Ascites, PT, Encephalopothy

Question 26

pre-anhepatic phase

Answer 26

* ends with cross-clamping * Aspiration risk high

Question 27

Anhepatic phase

Answer 27

* significantly reduced preload and CO * worsening coagulopathy/bleeding

Question 28

Neohepatic phase

Answer 28

key complications: * hyperkalemia * hypocalcemia * cytokine release * lactic acidosis * embolic debris * hypovolemia * hypotension * pulm HTN * hypothermia * cardiac arrest

Question 29

Post-reperfusion syndrome

Answer 29

Defined as: * hypotension \>30% below baseline for at least 1 min in first 5 min of reperfusion * Common: 10-60% incidence

Question 30

LFTs: Synthetic function of Liver

Answer 30

* PT (very sensitive) * Albumin (not sensitive)

Question 31

LFTs: Hepatocellular Injury

Answer 31

* ALT * AST

Question 32

LFTs: Hepatic clearance of Liver

Answer 32

Bilirubin

Question 33

LFTs: biliary duct obstruction

Answer 33

* Alkaline Phos (not sensitive) * Y-Glutamyl transpeptidase (more sensitive) * 5-nucleotidase (most sensitive)