Bb Alcoholism

Front 1

What are the hallmarks of Wernike-Korsakoff syndrome?

Back 1

thiamine deficiency leading to confusion, confabulation, ataxia

Front 2

what nutritional deficiencies cause polyneuropathy in alcoholics?

Back 2

B12, folate

Front 3

What respiratory problems can be present in alcoholics?

Back 3

1. intrapulmonary shunts can occur secondary to portal htn
2. portopulmonary htn
3. frequent smokers and COPD is not uncommon

Front 4

What GI problems should you consider in an alcoholic patient?

Back 4

esophagits, gastritis, and pancreatitis lead to ulceration and GI bleeding

Front 5

How do patients with acute alcoholic hepatitis fair during surgery?

Back 5

mortality approaching 50%

Front 6

During emergency surgery in a patient with acute hepatitis or cirrhosis what additional maintenance fluid should you run?

Back 6

glucose containing solution to protect against hypoglycemia due to:
1. insufficient insulin degregation by liver
2. impaired glucose formation
3. glycogen depletion

Front 7

In patients with hepatitis or cirrhosis what should you take into account when determining the dose of a medication?

Back 7

1. protein binding (decreased albumin)
2. volume of distribution

Front 8

How does decreased albumin affect medication levels?

Back 8

some drugs (barbs, benzos, coumadin) will exist in less protein bound form and are therefore more active

Front 9

How does decreased albumin affect muscle relaxants?

Back 9

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

Front 10

What common protein is not produced in the liver?

Back 10

gamma globulin

Front 11

what coagulation factors are produced by the liver?

Back 11

all but factor VIII

Front 12

When can you use vitamin K in a patient with elevated liver enzymes?

Back 12

it doesn't correct PT in the presence of hepatocellular damage but does in the presence of biliary obstruction

Front 13

How is SCh affected by liver failure?

Back 13

liver failure must be very severe to decrease cholinesterase activity, prolongation can occur but is extremely rare

Front 14

Name some drugs that are highly metabolized on first pass through the liver?

Back 14

1. digitalis
2. versed
3. propranolol
4. meperidine
5. pentazocine
6. verapamil
7. lidocaine

Front 15

What are the effects of acute alcohol intake that can occur during anesthesia?

Back 15

1. decreased MAC
2. decreased cardiac and respiratory reserve
3. decreased gastric emptying, increased acid secretion

Front 16

What liver enzymes are typically affected by cholestatic dysfunction?

Back 16

Alk phos, 5-nucleosidase

Front 17

when do you see indirect elevation of bilirubin?

Back 17

1. excessive bilirubin production(hemolysis, ineffective erythropoiesis)
2. impaired bilirubin conjugation(gilberts, crigler-najjar)
3. reduced bilirubin uptake by the liver(heart failure)

Front 18

What happens to serum globulins in liver disease?

Back 18

increases and is very common in autoimmune hepatitis

Front 19

What are the only real test of liver function?

Back 19

albumin and PT( the others are liver destruction tests)

Front 20

Effect of acute vs chronic alcohol abuse on MAC

Back 20

Acute = decreases MAC
Chronic = increased MAC

Front 21

Cardiac problems associated with alcohol abuse

Back 21

Alcoholic cardiomyopathy leads to CHF, cardiomegaly, and arrhythmias

Front 22

Liver problems associated with alcoholism

Back 22

1. Fatty liver
2. Acute alcoholic hepatitis
3. Cirrhosis

Front 23

Describe fatty liver and its anesthetic implications.

Back 23

It is characterized by asymptomatic enlargement of the liver and usually an elevated alk phos
-Not a contraindication to surgery but if a hematologic or nutritional problem exists, it is feasible surgery should be delayed for 6-8 wks

Front 24

Describe acute alcoholic hepatitis and its anesthetic implications.

Back 24

It is characterized by enlarged liver with elevated liver enzymes. (AST higher than ALT)
-Typicall fever, N/V, and RUQ tenderness are present
-Contraindication to elective surgery
-Mortality rate with surger is high (50%)

Front 25

What is the normal role of the liver related to glucose homeostasis?

Back 25

Its role includes the formation, storage, and release of glucose by gluconeogenesis and glycogenolysis

Front 26

What functions of the body does the liver play a major role?

Back 26

1. Glucose homeostasis
2. Protein synthesis
3. Coagulation
4. Cholinesterase activity
5. Conjugation of drugs
6. Bilirubin excretion
7. Bile production

Front 27

Effect of liver dysfunction on coagulation and anesthetic management.

Back 27

-Coagulation function must be checked and corrected with FFP if necessary (clotting factors can be inadequate)
-Vit K doesn't correct PT if hepatocellular damage, but does in the setting of biliary obstruction
-Platelet levels can also be decreased bc of hypersplenism

Front 28

What are the frequent liver functions as related to drug metabolism?

Back 28

Oxidation and conjugation are frequent with reduction and hydrolysis less prominent.
-These functions make drugs more water soluble for excretion through the kidneys.

Front 29

The laboratory evaluation of liver disease focuses upon what 3 facets of liver function? What are the liver function tests that corresponds to each?

Back 29

1. Enzymatic - ALT, AST, Alk phos, 5-nucleotidase
2. Excretory - bilirubin, bile acids, serum ammonia
3. Synthetic - serum albumin, coagulation factors except VIII -> PT, and cholesterol

Front 30

Bilirubin can be elevated secondary to:

Back 30

1. increased production
2. decreased excretion

Front 31

Direct bilirubin elevations occur secondary to:

Back 31

1. hepatocellular dysfunction
2. biliary tract obstruction

Front 32

When is low albumin usually seen in liver disease? Why?

Back 32

It is frequently seen in chronic liver disease bc it has a long half life of 21 days.

Front 33

What are the Vit K dependent factors?

Back 33

II, VII, IX, and X

Front 34

What serum albumin and serum globulin levels usually reflect chronic or progressive liver disease?

Back 34

Alb < 3 gm/dl (nml 3.5-5)
Serum globulin > 4 gm/dl (nml 2-3.5)

Front 35

What features are associated with a poor prognosis in a pt with acute alcoholic hepatitis?

Back 35

1. prolonged PT which does not correct with Vit K
2. Inc total bilirubin
3. leukocytosis
4. Inc BUN or Cr