Hepatic Anatomy & Physiology and Anesthetic Implications

Vocabulary-style flashcards covering hepatic anatomy, physiology, laboratory tests, hepatitis classifications, and anesthetic management and implications for liver patients.

Liver Total Weight

Approximately $1500-1600\,g$, representing approximately $2\%$ of total body weight in an adult.

Hepatic Blood Flow

Normally $100\,mL/100\,g$ of tissue per minute, which is $1500\,ml/min$ or $25\%$ to $30\%$ of resting cardiac output.

Portal Vein

Provides $75\%$ of hepatic blood flow and $35\%$ to $50\%$ of oxygen delivery; blood is partially deoxygenated with an $O_2$ saturation of $85\%$.

Hepatic Artery

Provides $25\%$ of hepatic blood flow and $50\%$ to $65\%$ of oxygen delivery; supply is dependent on metabolic demand.

Falciform Ligament

An anatomical landmark that divides the liver into two lobes of unequal size.

Lobules

Functional units of the liver ($50,000-100,000$ total) consisting of plates of hepatocytes arranged around a central vein.

Sinusoids

Channels where blood from the hepatic artery and portal vein co-mingle before being drained into the central vein.

Kupffer cells

Macrophages lining the sinusoids responsible for removing bacteria, endotoxins, viruses, and cellular debris from circulation.

Reservoir Function

The liver normally holds $450\,ml$ ($10\%$ of total blood volume) and can shift up to $300\,ml$ to central circulation during hemorrhage.

Plasma Protein Synthesis

The liver produces all plasma proteins (except immunoglobulins) and all coagulation factors except factors $III$, $VIII$, and von Willebrand.

AST/ALT ratio > 2

A laboratory finding suggestive of cirrhosis or alcoholic liver disease.

5 nucleotidase (5NT)

A specific laboratory indicator for biliary obstruction.

Sphincter of Oddi Spasm

A potential effect of all opioids, with the order of potency being Fentanyl > morphine > meperidine > butorphanol > nalbuphine.

Postoperative Jaundice (Most Common Cause)

Overproduction of bilirubin caused by the reabsorption of a large hematoma or RBC breakdown following transfusion.

Chronic Hepatitis

Persistent hepatic inflammation for longer than $6$ months as evidenced by LFTs.

Hepatitis D (Delta virus)

A virus that may be transmitted via fecal or blood routes but uniquely requires the presence of Hepatitis B virus in the host.

Cirrhosis

A serious progressive disease where healthy tissue is replaced with nodules and fibrotic tissue, leading to reduced functioning hepatocytes and portal hypertension.

Child-Pugh Score

A perioperative risk assessment examining five factors: Albumin, PT, bilirubin, ascites, and encephalopathy.

Cisatracurium

The non-depolarizing neuromuscular blocking agent (NMDA) of choice for patients with liver disease due to its nonhepatic metabolism.

Citrate Toxicity

A condition in liver patients receiving RBC transfusions where unmetabolized citrate binds to calcium, leading to symptomatic hypocalcemia and prolonged QT intervals.

TIPS Procedure

Transjugular intrahepatic portosystemic shunt; involves shunting blood from the portal vein to the hepatic vein to reduce portal pressure.

Restrictive Volume Management

A strategy for hepatic resection aiming for low CVP to decrease hepatic venous pressure and minimize bleeding during dissection.