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Liver: Blood Supply and Implications of Cirrhosis

Liver: Blood Supply and Implications of Cirrhosis. By Canh Nguyen. Blood Supply. BLOOD 1500 ml/min 25-30% hepatic artery 70-75% portal vein OXYGEN 45-50% hepatic artery 50-55% portal vein. Cirrhosis - causes. Alcoholic Hepatitis Biliary Hemochromatosis Wilson’s disease

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Liver: Blood Supply and Implications of Cirrhosis

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  1. Liver: Blood Supply and Implications of Cirrhosis By Canh Nguyen

  2. Blood Supply • BLOOD • 1500 ml/min • 25-30% hepatic artery • 70-75% portal vein • OXYGEN • 45-50% hepatic artery • 50-55% portal vein

  3. Cirrhosis - causes Alcoholic Hepatitis Biliary Hemochromatosis Wilson’s disease Alpha-1 antitrypsin deficiency

  4. Cirrhosis - GI • Portal hypertension • GI varices • Treatment – vasopression, somatostatin and propanolol

  5. Cirrhosis - Heme • Anemia – bleeding, RBC destruction, suppressed bone marrow and nutritional deficiency (folate and vitamin K) • Thrombocytopenia – splenomegally • Decreased coagulation factors

  6. Cirrhosis – coagulation • All coagulation factors produced by liver except factor VIII and von willebrand • Vitamin K deficiency • Enhanced fibrinolysis (tPA cleared by liver)

  7. Cirrhosis - Cardiac • Hyperdynamic • Cardiomyopathy (EtOH) • Peripheral vasodilitation • Congestive Heart Failure

  8. Cirrhosis - Pulmonary • Pulmonary AV shunting • Atelectasis – Acites fluid

  9. Cirrhosis - Neuro • Enephalopathy secondary to nitrogenous waste • Asterixis • Hyperreflexia

  10. Hepatic - Renal • Average life expectancy – 6 months • Unknown cause • Decreased renal perfusion • Hyponatremia, Hypokalemia, azotemia

  11. Cirrhosis - Renal • Sensed intravascular depletion • Peripheral vasodilitation • Portal hypertension • Diuretics (zaroxolyn, lasix, spironolactone)

  12. Cirrhosis - Drugs • Low albumin – less bound • Amide LA (bupivacaine, dibucaine, etidocaine, lidocaine, mepivacaine, prilocaine, ropivacaine) • Vecuronium • Halothane • Narcotics

  13. Cirrhosis - anesthesia • Thiopental – redistributes to fat • Atricurium – Hoffman elimination • Isoflurane – low metabolism

  14. Question – K type • Anesthetic agents primarily biotransformed by the liver include • 1. Mepivacaine • 2. Tetracaine • 3. Lidocaine • 4. Procaine B

  15. Question • The liver receives its blood supply from • A. hepatic artery only • B. portal vein only • C. both the hepatic artery and portal vein • D. vessels that run in the center of the lobule • E. the superior mesenteric artery C

  16. Question • In the patient with cirrhosis • A. serum albumin levels with be elevated • B. excessive sodium is lost in the urine • C. pancuronium is more effective • D. serum gamma globulin level will be low • E. less thiopental is required for induction E

  17. Question – K type • The blood supply to the liver is by two vessels, the hepatic artery and portal vein. These vessels differ in that • 1. 60% of the blood supply comes from the hepatic artery • 2. portal vein provides 50% of the oxygen • 3. portal vein blood is more fully saturated than hepatic artery blood • 4. the portal vein supplies the bulk of the nutrients to the liver C

  18. Question – K type • A cirrhotic patient • 1. cannot produce normal amounts of protein as a result of hepatocyte dysfunction • 2. will always have jaundice, since bilirubin will accumulate • 3. may not metabolize succinylcholine normally • 4. will not be able to metabolize lidocaine as a result of a lack of pseudocholinesterase B

  19. Question – K type • Management of ascites secondary to cirrhosis include • 1. spironolactone • 2. indomethacin • 3. sodium restriction • 4. administration of captopril B

  20. Works Cited • Dershwitz, Mark. The MGH Board Review of Anesthesiology, 5th ed. Appleton & Lange, 1999. • Morgan, G.E., Makhail, M.S., Murray, M.J. Clinical Anesthesiology, 3rd ed. Lange, 2002.

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