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NURS 6901 LIVER/HEPATOBILIARY EXAM WITH QUESTIONS AND VERIFIED ANSWERS
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NURS 6901 LIVER/HEPATOBILIARY EXAM WITH QUESTIONSAND VERIFIED ANSWERS
What are the physiologic functions of the liver? (8) - ANSWER 1. Stores blood (1
L)
2. Immune function
3. Bile
4. Drug metabolism
5. Vitamin storage (A,B, D, iron)
6. Energy (glycolysis/gluconeogenesis)
7. Aids in digestion
8. Clotting! Synthesizes Factors 1, 2, 5, 7, 9, 10, 11
Blood supply to the liver - ANSWER Has dual supply from
-Hepatic artery (25-30% supply, comes from abdominal aorta)
-Portal vein (70-75% of supply, delivers partially de-oxygenated blood from
pancreas, gallbladder, intestines/stomach, spleen, and normal pressure is 6-10)
What will lab values look like with someone who has liver disease? - ANSWER 1.
Aminotransferases (up)
2. Alk phos (up)
3. Bilirubin (up)
4. INR (up)
5. Albumin (down)
What are some anesthetic things that affect the liver? - ANSWER 1. Volatiles
,2. Opioids
3. IV anesthetics
4. Neuromuscular blockers
5. Mechanical ventilation
How do volatiles affect the liver? - ANSWER -There is a dose-dependent decrease
in hepatic blood flow (In response to low MAP, splanchnic circulation will
vasoconstrictor)
-Iso and servo cause less of this and are preferred in liver patients
-Refrain from halothane (hepatotoxicity and halothane hepatitis)
How do opioids affect the liver? - ANSWER -All opioids are associated with
Sphincter of Oddi spasm (can be treated with atropine, glyco, nitro, opioid
antagonists, glucagon)
-Remi is NOT dependent on liver metabolism
-All other opioids are dependent on hepatic metabolism and should be titrated to
affect
How are neuromuscular blocker affected by liver disease? - ANSWER -Succ may
be prolonged
-NDMR should be titrated to TOF (if there is third spacing present, an increased
dose may be required due to increased volume of distribution)
How is the liver affected my mechanical ventilation? - ANSWER -Positive
pressure ventilation reduces hepatic blood flow
-Alkalosis and hypocapnia reduce hepatic blood flow
What is acute liver failure? - ANSWER This is encephalopathy and coagulopathy
(INR >1.5) in a patient with no previous hx of liver disease in the last 26 weeks
-Can be drug causes (acetaminophen and non-acetaminophen), ischemic, injury, or
autoimmune
What are anesthetic implications for someone with acute liver failure? - ANSWER
, 1. Mange ICP
2. Trx possibility
3. Correct coagulopathies (especially with invasive procedures)
Replace platelet <10 k, fibrinogen , 100
4. Monitor hemodynamics and treat hypotension (looking both at CV and fluid
status)
What is hepatitis? - ANSWER -This an generic term for inflammation of the liver
-Can be acute, viral, drug-related (ETOH), chronic, and autoimmune
What is the anesthetic management of someone with hepatitis? - ANSWER 1.
Preserve hepatic blood flow
-Use iso/des
-Maintain normocapnia
-Avoid peep
-Liberal hydration
-Consider regional anethesia
2. Avoid medications that can cause hepatoxicity (amiodarone, acetaminophen,
halothane)
3. Thoughtful titration of NMB agents (can be prolonged)
-Decreased pseudocholinesterase
-Increased volume of distribution
-Decreased biliary excretion
What is cirrhosis? - ANSWER This is histologic development of regenerative
nodules of fibrous bands in response to chronic liver
What are the systemic effects of cirrhosis? - ANSWER 1. Ascites
2. Varices
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