35 Questions
What is the main function of Morison's Pouch?
It is a potential space between the liver and right kidney that can fill with blood or fluid.
How much of the total cardiac output does the liver receive?
27%
Which blood vessel supplies 75% of the liver's blood supply?
Hepatic portal vein
What happens during the Hepatic Arterial Buffer Response?
The hepatic artery compensates by doubling blood flow when portal vein supply decreases.
Which vessel contains all absorbed substances from the intestines except chylomicrons?
Hepatic portal vein
What percentage of the liver's oxygen supply comes from the hepatic artery?
50%
What is the function of bile in the digestive system?
Assimilation of dietary lipid
Where are bile canaliculi found?
Within the liver lobule
What is the role of cystic duct in the digestion process?
Transmitting bile to the gallbladder for concentration
What is the significance of enterohepatic circulation?
Recycling of bile acids multiple times per meal/day
How do bile-binding resins like cholestyramine affect high blood cholesterol?
Cause fecal bile acid excretion and reduce circulating bile acids
What happens if bile is excluded from the small intestine?
50% dietary lipid appears in feces
What is the primary source of new bile acids in the body?
Absorption in the intestinal epithelium
Which organelle is involved in the synthesis of new bile acids in the liver?
Smooth endoplasmic reticulum
Why does an increase in cholesterol supply benefit hepatic synthesis of new bile acids?
It is a required precursor for bile acid synthesis
What effect does lesion or starvation have on protein synthesis in the liver cells?
Decreases protein synthesis
In which organelle does glycogen degradation occur in liver cells?
Mitochondria
What is the method by which new bile acids are synthesized within liver cells?
Conjugating cholic acid with amino acids
What is the primary consequence of advanced liver disease on the circulation?
Increased cardiac output
Which condition can result from abnormal intrapulmonary vasodilation in hepatopulmonary syndrome?
Pulmonary congestion
What is a common outcome of renal hypoperfusion in liver disease?
Sodium and water retention
Which factor may contribute to excessive bleeding in chronic liver disease?
Portal hypertension
Which tests are classified under tests of hepatic synthesis?
Cholesterol and albumin
What is the primary function of transaminases in the liver?
Cell damage marker
Which condition may reflect disruption of hepatic urea synthesis?
Ammonia elevation
A patient with advanced liver disease is found to have increased sensitivity to highly protein-bound drugs. Which physiological factor contributes to this phenomenon?
Hypoalbuminemia
How does liver disease impact the response to inotropes and vasopressors during anesthesia?
Depressed response to inotropes and vasopressors
What should be considered when administering Tylenol to a patient with liver disease?
It can exacerbate liver damage
What innervates the liver and affects its blood reservoir capacity?
SNS tone
Which receptors are present in the hepatic arteries?
Alpha and beta adrenergic receptors
What is the pressure in the hepatic vein leading into the vena cava?
0 mmHg
What is a common cause of cirrhosis besides chronic alcohol abuse?
High fructose consumption
What are the clinical consequences of portal hypertension?
Abnormal fluid accumulation in the abdominal cavity
Where might portosystemic shunts form?
Rectum
What is the primary cause of portal hypertension?
Impedance to flow through the portal system
Study Notes
Liver Structure and Function
- The liver has a dual vascular supply, receiving 27% of total cardiac output, with high blood flow and low vascular resistance.
- The liver has a dual blood supply:
- Hepatic artery (300 ml/min): 25% of blood supply, mostly stromal, 50% oxygen supply, autoregulates.
- Hepatic portal vein (1050 ml/min): 75% of blood supply, mostly parenchymal, 50% oxygen supply, does not autoregulate.
Bile and Gallbladder
- Bile consists of organic molecules in an alkaline solution, produced by the liver, stored and concentrated in the gallbladder.
- Bile has three functions:
- Assimilation of dietary lipid.
- Excretion of hydrophobic molecules.
- Neutralization of gastric acid.
- Hepatocytes secrete bile into the canaliculi, which coalesce into hepatic ducts prior to the common hepatic duct.
- The cystic duct transmits bile to the gallbladder, where it is concentrated, with a volume of 20-50 ml.
Bile Acid Pool
- Bile acids undergo enterohepatic circulation multiple times per meal/day.
- The pool is insufficient to digest lipids and requires recycling.
- Enterohepatic circulation can be intentionally disrupted as a treatment for high blood cholesterol by ingesting bile-binding resins.
Liver's Location and Movement
- The liver's location, extent, and range of movements are demonstrated.
- Morison's Pouch is a potential space between the liver and right kidney, which can fill with blood or fluid.
Hepatic Synthesis and Hepatopulmonary Syndrome
- Hepatic synthesis of new bile acids requires an increased supply of cholesterol.
- The liver has an intrinsic mechanism to compensate for decreased portal venous flow.
- Hepatopulmonary syndrome is characterized by:
- Restriction-decreased compliance and atelectasis.
- Respiratory alkalosis-compensatory hyperventilation.
- Abnormal intrapulmonary vasodilation-congestion.
Pathophysiologic Consequences of Liver Disease
- Hyperdynamic circulation: low systemic vascular resistance, low blood pressure, increased cardiac output.
- Hepatopulmonary syndrome: restriction, respiratory alkalosis, abnormal intrapulmonary vasodilation.
- Renal hypoperfusion: decreased glomerular filtration rate, increased RAAS, sodium and water retention.
- Hematologic perturbations: decreased clotting factor production, prolonged prothrombin time, increased risk of bleeding.
Liver Function Tests
- Liver function tests can be classified into two categories:
- Hepatocellular damage (AST, ALT).
- Hepatic synthetic function (cholesterol, pseudocholinesterase, PT).
- Liver abnormalities can be divided into two classes based on lab tests:
- Parenchymal disorders (fibrosis, cirrhosis).
- Mechanical biliary obstructive disorders (hepatocellular damage).
Anesthesia Considerations
- Suspect a relative hypovolemia and portal hypertension.
- Assess for high cardiac output and low peripheral vascular resistance.
- May have increased sensitivity to highly protein-bound drugs.
- Lower plasma proteins may affect volume of distribution.
- Suspect esophageal varices, anticipate depressed response to inotropes and vasopressors.
Test your knowledge on the location, extent, and movements of the liver, as well as its relationship to the thoracic cage. Explore concepts like Morison's Pouch and the dual blood supply to the liver.
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