AP EXAM 3- hepato 1

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Anonymous
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208084
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AP EXAM 3- hepato 1
Updated:
2013-03-18 19:05:56
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emory aa anesthesia ap
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ap exam 3 lecture 3/18/13 part 1
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  1. The liver is what percent of body weight in:
    a) an adult
    b) neonate
    • a) 2%
    • b) 5%
  2. the liver has ____ lobes
    2
  3. the liver has ____ surgical segments
    8
  4. what are the 2 functional units of the liver?
    • lobule
    • acinus
  5. the liver has a large vascular capacity.  It contains __-___ ml blood/ 100gm tissue, and ___-___% of total blood volume.
    • 25-30
    • 10-15
  6. hepatic blood flow is ____% venous
    70!
  7. Total hepatic blood flow=
    1200-1400 ml/min
  8. total hepatic blood flow is what percentage of cardiac output?
    25%
  9. the portal vein receives a large percentage of blood flow from what 2 organs? (with percentages)
    • stomach- 20%
    • Intestine- 60%
  10. define hepatic acinus:
    functional microvascular unit, cluster of parenchimal cells, formed about a VERTICAL axis.
  11. the vertical axis of acinus consists of: (thbl)
    • terminal portal venule
    • hepatic arteriole
    • bile duct
    • lymph vessels and nerves
  12. hepatic blood flow: ____flow, _____ resistance
    • high
    • low
  13. the liver is a reservior for _______.
    blood
  14. normal amount of blood in liver, _____ ml. Can expand up to ____L
    • 450
    • 1
  15. what organ contains up to half of body lymph?
    LIVER
  16. Sinusoids are permeable to _____ and ______.  This can lead to _____  with high vascular pressure.
    • fluids and proteins
    • ascites
  17. what is the hepatic artery system?  describe time scale.
    with low venous flow, hepatic artery can compensate.  can perfuse entire organ.  this adjustment can occur within MINUTES!
  18. Is the liver compliant?
    yes- highly
  19. liver compliance is:
    2-3ml/mmHg per 100g liver
  20. raising venous pressure by 1mmHg results in an increase of _____.  normal is 210-250 mls, ________ is about 600 ml.
    • 40-50ml
    • capacitance
  21. During sympathetic stimulation, 6% of blood volume is mobilized by the ______, 12% by the ______, and 3% by the intestine.
    liver, spleen, intestine
  22. Liver flow has 2 modes of control- Intrinsic
    • autoregulation
    • -h.a. vasoconstriction
    • -myogenic resp to smooth musc. stretch
    • -local blood flow- arterial

    • metabolic control
    • -arterial hypoxemia
    • -decrease in blood pH
    • -hyperosmolarity
  23. Liver flow has 2 modes of control- Extrinsic
    • Neural control
    • -vagus/splancnic
    • -symp stim decreases bf
    • -500ml can be expelled in seconds
    • Humoral
    • -epi (a-vasoconstriction, b-vasodilation)
    • -glucagon
    • -angiotensin
    • -vasopressin
  24. Name 2 anesthetic related techniques that decrease hepatic flow:
    • anything that decreases cardiac output
    • regional anesthesia
  25. Name an anesthetic related techniques that decrease portal venous flow:
    Controlled ventilation
  26. does NITROPRUSSIDE alter hepatic flow?
    NO
  27. What type of surgery can decrease hepatic blood flow up to 60%?
    Abdominal
  28. which anes gasses are best for hepatic flow management?
    • ISO first
    • sevo close second
  29. what is a reliable predictor of chronic liver dz?
    Serum Albumin
  30. Albumin: vital to maintenance of ______
    • oncotic pressure. 
    • produced in liver
  31. what are the vitamin K dependent factors?
    II, VII, IX, X
  32. what are the non-K dependent factors?
    V, XI, XII, XIII, fibrinogen
  33. What test is a good indicator of
    1) acute hepatic disfunction
    2) vit k dep factor deficiency
    PT
  34. What four things does the liver metabolize?
    • amino acids
    • carbs
    • fat
    • bilirubin

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