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25 Cards in this Set

  • Front
  • Back
basic functional unit of the liver is the....
hepatic lobule (50,000-100,000) (hepatocytes envelop central vein)
blood supply to liver by....
hepatic artery and portal vein, combined blood joins in hepatic sinusoidal channels. Endothelial cells and Kupffer's cells line the sinusoids.
liver drainage path...
from hepatic veins to IVF.
hepatic blood flow/volume?
1500ml blood per minute, 25-30% from hepatic artery and 70-75% from portal vein. (25-30% of CO).
Predominant role of liver?
filter. 99% of bacterial load cleansed by Kupffer cells (macrophages)
hepatic blood reservoir size?
Large (350ml) reservoir for systemic blood.
Splanchnic blood flow vessels supple the....

innervation?
liver, gallbladder, omentum, spleen and pancreas

innervated b splanchnic nerves derived from spinal nerves T3-T11.
alpha/beta liver receptors?
portal circulation; only alpha receptors,

hepatic arterial circulation: both alpha/beta.
Adequate liver oxygenation not an issue because of.....
Adequate liver oxygenation not an issue because of large percent of CO perfusion, great permeability of hepatic sinuses and the close proximity of hepatic cells to sinuses.
Blood from the gut contains large numbers of ______.

_____ clease these.
bacteria

kupffer cells(macrophages) line the hepatic sinuses
________ results in a large amount of lymph which is nearly equal in _____ ceoncentration to the plasma.
endothelial cells that line the hepatic sinuses allow diffusion of large plasma protiens and other substances into the extravascular spaces of the liver

protien
What allows the liver to function as a circulatory reservoir?
the low resistance of hepatic sinusoids
hepatic artery flow is autoregulated in accordance with...

Portal blood flow is dependent on...
metabolic demand, i.e oxygen consumption


portal flow dependent on the combined venous outflow from the spleen and GI tract.

a decrease in one or the other affects a compensatory increase in the other.
produces arterial hepatic vasoconstriction....
sympathetic outflow from hypotension, hypovolemia, hypercarbia, hypoxia and light anesthesia.
what is the most profound etiologic factor that results in decreased hepatic blood flow...
abdominal surgery
______ volatile anesthetics are implicated in reduction of hepatic blood flow.
ALL, especially halothane (25%) (abolishes vasocontrictor response to hypercarbia)

d/t decreased SBP...

30% drop in flow with sympathectomy with SAB, epidural
Essential liver physiologic functions...
bile production
protein synthesis
glycogen storage
protein metabolism
insulin clearance
lactate conversion into glucose
drug metabolism/transformation
glycogen is formed by...
gluconeogenesis from lactate

and from AA's(alanine) and glycerol
glucose level are maintained during periods of fasting by...
glycogenolysis
hypoglycemia in liver disease from
poor insulin clearance, a decrease in glycogen capacities and impairment of gluconeogenesis
____ is the major secretion of the liver...volume?

contains?

released in response to?

impairment s/s?
Bile

1 liter/day

from hepatocytes in liver

contains phospholipids, cholesterol conjugated bilirubin (the end product of hemoglobin metabolism), bile salts, and other substances.

stored and concentrated in the gallbladder

CCK, presence of fat and protien in the duodunem

assists in absorption of fat soluble vitamins (AEDK)

steattorhea, vik K deficiency and delayed removal of active drug metabolites
a vit K deficiency results in...
coagulopathy (2,7,9,10)

all factors made in liver except 8.

50% factor activity needed for normal clotting

a perturbation in bile production ultimately manifests as impaired production o f vit K dependent factors.
intrahepatic obstruction of blood flow leads to...
portal HTN

leads to splenomegaly

thrombocytopenia from plt sequestration
the liver produces all protiens except...

therefore....
immunoglobulins

liver disease causes a decrease in plasma oncotic pressure and a decrease in drug binding(exaggeration of effects, esp with barbs)

larger non-depolarizer dose d/t increased VD

decreased plasma cholinesterase (esters, sux, miv)
liver protien metabolism
synthesis of lipoprotiens
deamination of AA's into carbs and fats for ATP production though citric acid cycle oxidation
productin of urea for the removal of ammonia (formed by deaminiation and gut bacteria)

production of clotting factors (fibrinogen, prothrombin and others)