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19 Cards in this Set
- Front
- Back
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What are the hallmarks of Wernike-Korsakoff syndrome?
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thiamine deficiency, confusion, confabulation, ataxia
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what nutritional deficiencies cause polyneuropathy in alcoholics?
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B12, folate
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What respiratory problems can be present in alcoholics?
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intrapulmonary shunts can occur secondary to portal htn, portopulmonary htn, they are also frequent smokers
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What GI problems should you consider in an alcoholic patient?
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esophagits, gastritis, pancreatitis
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How do patients with acute alcoholic hepatitis fair during surgery?
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mortality approaching 50%
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During emergency surgery in a patient with acute hepatitis or cirrhosis what additional maintenance fluid should you run?
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glucose containing solution to protect against hypoglycemia(insufficient insulin degregation by liver, impaired glucose formation, glycogen depletion)
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In patients with hepatitis or cirrhosis what should you take into account when determining the dose of a medication?
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protein binding(decreased albumin), volume of distribution
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How does decreased albumin affect medication levels?
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some drugs(barbs, benzos, coumadin) will exist in less protein bound form and therefore more active
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How does decreased albumin affect muscle relaxants?
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the effect is difficult to predict; pancuronium results in increased volume of distribution so initial dose must be larger, but the half life might be prolonged
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What common protein is not produced in the liver?
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gamma globulin
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what coagulation factors are produced by the liver?
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all but factor VIII
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When can you use vitamin K in a patient with elevated liver enzymes?
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it doesn't correct PT in the presence of hepatocellular damage but does in the presence of biliary obstruction
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How is SCh affected by liver failure?
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liver failure must be very severe to decrease cholinesterase activity, prolongation can occur but is extremely rare
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Name some drugs that are highly metabolized on first pass through the liver?
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digitalis, versed, propranolol, meperidine, pentazocine, verapamil, lidocaine
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What are the effects of acute alcohol intake that can occur during anesthesia?
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decreased MAC, decreased cardiac and respiratory reserve, decreased gastric emptying, increased acid secretion
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What enzymes are typically affected by cholestatic dysfunction?
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ALP, 5-nucleosidase
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when do you see indirect elevation of bilirubin?
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excessive bilirubin production(hemolysis, ineffective erythropoiesis), impaired bilirubin conjugation(gilberts, crigler-najjar), reduced bilirubin uptake by the liver(heart failure)
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What happens to serum globulins in liver disease?
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increases and is very common in autoimmune hepatitis
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what are the only real test of liver function?
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albumin and PT( the others are liver destruction tests)
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