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20 Cards in this Set
- Front
- Back
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How does the liver affect glucose homeostasis?
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formation, storage, and release of glucose by gluconeogenesis and glycogenolysis
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What is the half life of albumin and how does this affect acute liver dysfunction?
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23 days; acute dysfunction will generally not decrease serum albumin levels
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With what levels of decreased albumin do you see increased drug sensitivty for drugs that bind to albumin?
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<2.5g/dL
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What is the cause of clotting deficiency with liver dysfunction?
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decreased factor production and vit K deficiency from lack of bile production
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Why do patients with liver dysfunction get thrombocytopenia?
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hepatosplenomegaly
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When do you see decreased cholinesterase activity in liver disease?
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prolonged and severe liver disease
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What hypotensive medication is contraindicated in severe liver disease?
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SNP
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What happens with impairment of bile production?
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steatorrhea and vit K deficiency
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What determines hepatic blood flow?
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perfusion pressure - splanchnic vascular resistance
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How do surgical incisions affect hepatic blood flow?
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surgical incisions decrease hepatic blood flow, the closer the surgical site to the liver, the greater the reduction in hepatic blood flow
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Albumin less than what level leads to ascites?
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<3.5
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What is more specific for the diagnosis of liver disease ALT or prothrombin time?
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ALT
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What hepatitis virus is most commonly transmitted in blood transfusions?
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hepatitis B
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What are the pathologic changes to the liver with cirrhosis?
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liver parenchymal destruction with replacement by collagen
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what are physiologic changes associated with cirrhosis?
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hyperdynamic circulation leading to cardiomyopathy and CHF, hypoxemia secondary to right to left intrapulmonary shunt, hypoglycemia, anemia secondary to GI bleeding an lack of folate due to malnutrition, renal failure, hepatic encephalopathy, portal htn, ascites
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Why is acute alcoholic hepatitis a contraindication to elective surgery?
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carries a 50% mortality weight
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Should you do surgery in patients with cirrhosis?
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not elective surgery
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What is the only nondepolarizer that undergoes significant liver metabolism?
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vecuronium
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Why should you be cautious of narcotics in patients with biliary dysfxn?
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choledochoduodenal sphincter spasm(incidence is very low)
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A patient with cirrhosis that is on sodium restriction preop, how should you manage their fluid intraop?
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preservation of intravascular volume and urine output take precedence intraop
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