APP 2 - Liver disease

ABCDEFGHI of liver functions

a = albumin, b = bilirubin, c = coagulation, d = drug metabolism, e = elimination, f = fat metabolism, g = glucose/glycogen, h = hormone metabolism, I = immune

proteins produced in liver

albumin, fibrinogen, y-globulin, ceruloplasmin

normal albumin

3.5-5.5

in acute liver disease a __________ in albumin will not be seen because of albumin's long half life (20 days)

decrease

albumin of <2.5 =

decreased protein binding, increased drug sensitivity

where does bilirubin come from?

breakdown of RBCs

how is bilirubin transported to the liver

bound to albumin

how is bilirubin made more water soluble?

bound with glucuronic acid

how much bile per day does the liver make?

1 L

impaired bile production causes?

steatorrhea and vit k deficiency

what can cause increased unconjugated bilirubin

hemolysis, impaired uptake of bilirubin, impaired conjugation

liver makes all clotting factors except?

4, 8

liver disease causes __________ clotting factors and ___________ platelets

decreased, decreased

thrombocytopenia comes from _____________

hepatosplenomegaly

vit k deficiency comes from _____________

lack of bile production

which clotting factors require vit K

2, 7, 9 ,10

liver disease causes drugs to __________

accumulate

which drugs tend to accumulate?

lidocaine, meperidine, propranolol, metoprolol, verapamil, narcotics, versed

liver disease cause _________ elimination

decreased

decreased elimination leads to build up of __________

ammonia

what is the clinical sign of defective excretion?

fetor hepaticus

liver disease and fat metabolism

impaired transport, fatty infiltration of liver

fatty liver disease labs

increased ALT, AST

liver's role in glucose/glycogen

forms, stores, and releases glucose

liver stores _______ of glycogen that can be broken down over _______

75 gm, 24 hr

liver disease and hormone metabolism

deceased steroid and thyroid hormone breakdown

__________ cells in liver clear toxins

kupffer

liver disease causes impaired kupfffer cells which predisposes to?

multisystem organ failure

how many lobes does the liver have

four lobes

liver receives ______% of CO

25

hepatic artery delivers _____% of total blood flow and _______% of liver's oxygen supply

25, 50

portal vein provides _______% of total blood flow and ________% of liver's oxygen supply

75, 50-55

hepatic blood flow =

perfusion pressure - splanchnic vascular resistance

volatile anesthetics _________ hepatic perfusion pressure

decrease

hepatic venules are innervated by ____________

T3-T11 sympathetic fibers

3 classes of liver dysfunction

pre, intra, post

prehepatic labs

increased unconjugated bilirubin, normal transaminases, normal alkaline phosphatase

intrahepatic liver dysfunction is also known as __________

hepatocellular disease

intrahepatic causes

hepatitis, cirrhosis, Tylenol

intrahepatic labs

increased conjugated bilirubin, increased transaminases, normal/slightly increased alkaline phosphatase, hypokalemia

posthepatic causes

bile duct obstruction, sepsis

posthepatic labs

increased conjugated bilirubin, normal/slightly increased transaminases, increased alkaline phosphatase

extrahepatic causes of liver dysfunction

DISH - drugs, infection, sepsis + systemic disease, hemolysis + hematoma + hypoperfusion

the most common reason for abnormal liver function is?

metabolic dysfunction associated steatotic liver disease (MASLD)

best lab test to assess liver function in acute liver disease?

PT

most common liver diseases

hepatitis, cirrhosis, bile obstruction

hepatitis _____ is most likely to cause chronic issues

B

hepatitis _____ is most associated with post-transfusion hepatitis

C

cirrhosis causes ________ flow from hepatic artery and ___________ flow from portal vein

increased, decreased

types of cirrhosis

alcoholic, postnecrotic, biliary

biliary cirrhosis AE

pruritus, prolonged PT, can lead to primary liver cell carcinoma

cirrhosis complications (6)

portal vein HTN, esophageal varices, chronic GI bleeding, ascites, hyperdynamic circulation, hepatic encephalopathy

how can esophageal varices be treated?

TIPS or splenorenal shunt

what is the neuro disorder secondary to alcoholism and vitamin deficiencies?

wernicke-korsakoff syndrome

what vitamins are deficient in WK syndrome?

thiamine (vit B1)

hepatopulmonary syndrome (HPS)

reduced oxygen due to dilated pulmonary vasculature, causes shunt

most common cause of cirrhosis

alcoholism

an absolute contraindication to elective surgery is ________________

acute alcoholic hepatitis

acute alcohol intoxication leads to _________ MAC

decreased

chronic alcohol intoxication leads to _______ MAC

increased

what system is used to classify severity of cirrhosis

Child-Pugh

Child-Pugh factors (5)

ascites, bilirubin, albumin, PT, encephalopathy

MELD scale is used for?

rank pts awaiting liver transplant

3 parameters of MELD

bilirubin, creatinine, INR

for liver disease pts give _________ narcotics and __________ non- depolarizing NMB

decreased, increased

most common cause of death in chronic liver disease?

hemorrhage

most common cause of death in acute liver disease?

cerebral edema

TIPS stands for?

transjugular intrahepatic portosystemic shunt

TIPS procedure

advanced liver disease, help portal HTN, link portal vein with hepatic vein

splenorenal shunt

advanced liver disease, help portal HTN, shunt from spleen to kidney