APEX: Flashcards > Liver > Flashcards

Liver Flashcards

(54 cards)

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1
Q

liver anatomy

A
  • receives SNS innervation from T3-11
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2
Q

liver lobule

A
  • functional unit of liver
  • arterioles = terminal branches of hepatic artery & portal vein
  • capillaries = sinusoids
  • venules = central vein
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3
Q

acinus

A
  • divided into 3 zones that correspond w/ distance from arterial O2 supply
  • zone 1 most oxygenated
  • zone 3 least oxygenated
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4
Q

kupffer cells

A

remove bacteria before blood flows into vena cava

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5
Q

bile is produced by

A

hepatocytes

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6
Q

bile is stored in

A

gallbladder

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7
Q

flow of bile

A

canaliculi (in liver) > bile duct > common hepatic duct + cystic duct (GB) = common bile duct > duodenum

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8
Q

sphincter of Oddi

A
  • controls flow of bile released from common hepatic duct
  • contraction increases biliary pressure
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9
Q

3 functions of bile

A
  • absorption of fat-soluble vit (DAKE)
  • excretory pathyway for bilirubin & prodcuts of metabolism
  • alkalinization of duodenum
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10
Q

cholecystokinin (CCK)

A
  • produced in duodenum
  • eating fat & protein increases CCK release & flow of bile from GB
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11
Q

lymph drainage

A
  • drains into space of disse
  • liver responsible for 1/2 of lymph production
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12
Q

liver receives ____% of CO

A

30%

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13
Q

hepatic artery

A
  • 25% liver blood supply
  • 50% O2 supply
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14
Q

portal vein

A
  • 75% liver blood supply
  • 50% O2 supply
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15
Q

liver blood flow

A
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16
Q

celiac artery provides blood flow to which 3 organs?

A
  1. liver
  2. spleen
  3. stomach
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17
Q

superior mesenteric artery provides blood flow to which 3 organs?

A
  1. pancreas
  2. small intestine
  3. colon
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18
Q

1 organ that receives blood flow from inferior mesenteric artery

A

colon

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19
Q

liver venous blood flow

A
  • portal vein receives blood that has passed through splanchnic circulation
  • not autoregulated
  • increased splanchnic vascular resistance decreased portal vein blood flow
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20
Q

portal perfusion pressure

A

= portal vein pressure / hepatic vein pressure

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21
Q

portal HTN

A
  • Dx:
    1. portal vein pressure > 20-30 mmHg
    2. sinusoids > 5 mmHg
  • back pressure to splanchnic organs
  • splenomegaly
  • varices: esophagus/stomach/intestine
  • risk of hemorrhage of varices
  • ascites
  • spider angiomas
  • hemorrhoids
  • encephalopathy
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22
Q

hepatic arterial flow

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A
  • if portal vein blood flow decreases, hepatic arterial buffer response increases flow through hepatic artery
23
Q

hepatic artery perfusion pressure

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A

= MAP - hepatic vein pressure

24
Q

Factors that reduce liver blood flow

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A
  • GA
  • neuraxial
  • increased splanchnic vascular resistance (SNS stimulation, pain, hypoxia, propanolol)
  • increased CVP (PPV, excess hydration, CHF)
  • BB
  • intraabdominal surgery
  • laparoscopic surgery
25
Hepatocytes produce
- all coag factors except vWF, 3, 4, 8 - thrombopoietin - A1acid glycoprotein - antithrombin - protein c, s - plasminogen - albumin
26
Hepatocytes produce all coagulation factors except
- vWF (produced by vascular endothelial cells) - factor 3 (same as above) - factor 4 (diet) - factor 8 (sinusoidal cells)
27
Factor 8 is produced by
liver sinusoidal cells & endothelial cells
28
liver metabolic functions
-glycogenesis/glycogenolysis/ gluconeogenesis - converts ammonia to urea for elimination in kidneys - storage of triglycerides - synthesis of cholesterol, lipoproteins, phospholipids - bilirubin conjugation
29
LFTs that assess synthetic function
- PT - albumin
30
LFTs that assess hepatocellular injury
- AST - ALT
31
LFTs that assess hepatic clearance
- bilirubin
32
LFTs that assess biliary duct obstruction
- alkaline phosphatase - Y glutamyl transpeptidase - 5'-nucleotidase
33
very sensitive for acute liver injury
PT
34
not sensitive for acute liver injury
albumin
35
marked increase AST & ALT
hepatitis
36
AST/ALT ratio > 2
cirrhoisis or alcoholism
37
most sensitive for biliary obstruction
5'-nucleotidase
38
hepatitis
39
Drug-induced hepatitis
- acetaminophen OD - halothane - alcohol
40
most common cause of acute liver failure in US
acetaminophen OD
41
acetaminophen OD
- max dose Tylenol = 4 g/day - glutathione = substrate for phase 2 conjugation - tylenol produces toxic metabolite N-acetyl-p-benzoquinoneimine - tylenol OD consumes glutathione in liver - leads to hepatocellular injury - Tx = oral N-acetylcysteine w/i 8 hours OD
42
Chronic hepatitis
- > 6 mo - most common cause = alcoholism - 2nd most common = hep c - increased liver enzymes + bilirubin + histologic evidence of liver inflammation - S/S: jaundice, fatigue, thrombocytopenia, glomerulonephritis, neuropathy, arthritis, myocarditis - prolonged PT - decreased albumin
43
anesthetic considerations for acute hepatitis
- delay elective surgery until LFTs normal & s/s resolved - iso or sevo - avoid PEEP - normocapnia - IVFs - regional ok if no coagulopathy - AVOID: tylenol, halothane, amiodarone, PCN, tetracycline, sulfonamides - decreased pseudocholinesterase activity (sux) - decreased biliary excretion (roc) - larger Vd
44
Anesthesia considerations alcoholism
- MAC decreased in acute intoxication - MAC increased in chronic alcoholic - alcohol potentiates GABA - alcohol inhibits NDMA - aspiration risk - assume acutely intoxicated full stomach
45
alcohol withdrawal syndrome
- s/s 6-8 hrs after blood alcohol conc returns to near normal & peaks at 24-36 hrs - early s/s = tremors, hallucinations - late s/s = increased SNS, n/v, confusion, agitation - tx = alcohol, BB, A2 agonist delirium tremens occur 2-4 days w/o alcohol - s/s = SZ, tachycardia, hypo/hypertension, combative - tx = benzos, BB
46
Wernicke-Korsakoff syndrome
- loss of neurons in cerebellum - vitamin B1 (thiamine) deficiency
47
disulfiram
- treatment for alcoholics in recovery - hepatotoxic - inhibits dopamine beta hydroxylase (NE synthesis) --hypotension
48
Cirrhosis
- cell death where healthy tissue is replaced by nodules & fibrotic tissue - reduced number of functional hepatocytes
49
MELD risk
- predicts 90 day mortality - uses bilirubin, INR, creatinine - low risk = < 10 - intermediate risk = 10-15 - * high risk = > 15 (increased M&M)
50
child-pugh score
Class C (10-15 points) = 80% risk periop mortality
51
Patho ESLD
anesthetic considerations same as acute hepatitis
52
TIPS procedure
- bypasses portion of hepatic circulation by shunting blood from portal vein to hepatic vein - significant risk for hemorrhage
53
liver transplant
- most common indication = hep C - preop: blood products - RSI
54
gallbladder
- biliary stones can cause obstructive defect that impedes flow of bile as well as pancreatic enzymes. they back up into liver & pancreas -
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