Anesthetic considerations of liver disease and injury

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Questions and Answers

What is a common cause of chronic liver disease that often leads to cirrhosis?

Hepatitis C (correct)

Hepatitis E

COPD

Hepatitis A

Which of the following is a characteristic feature of cirrhosis?

Normal liver function

Fibrosis and regenerative nodules (correct)

Excessive bile production

Increased liver size without scarring

Portal hypertension in liver disease is primarily caused by:

Decreased blood flow to the portal vein

Increased hepatic artery blood flow

Reduced bile production

Increased resistance to blood flow within the liver due to fibrosis (correct)

Which complication of liver disease is characterized by low blood pressure, high cardiac output, and systemic vasodilation?

Cirrhotic cardiomyopathy Signup and view all the answers

What is the hallmark sign of hepatic encephalopathy?

Altered mental status due to neurotoxin accumulation Signup and view all the answers

Ascites, a common complication in liver disease, is primarily due to:

Portal hypertension and low plasma proteins Signup and view all the answers

In patients with liver disease, esophageal varices develop as a result of: (select 2)

High intra-portal pressure Signup and view all the answers

Hepatorenal syndrome is primarily characterized by: (select all that apply)

High sodium levels and decreased urine output Signup and view all the answers

Which of the following markers is used to evaluate liver excretory function and is typically elevated in liver disorders involving bile flow obstruction?

Alkaline phosphatase Signup and view all the answers

The triad of liver disease, unexplained hypoxemia, and intrapulmonary vascular dilation defines which liver disorder?

Hepatopulmonary syndrome Signup and view all the answers

In chronic liver disease, hypoalbuminemia is typically due to:

Reduced liver synthesis of plasma proteins Signup and view all the answers

Which test is commonly prolonged in liver disease due to the liver's inability to produce certain clotting factors?

Prothrombin Time (PT) Signup and view all the answers

Nonalcoholic fatty liver disease (NAFLD) is most closely associated with which of the following conditions?

Metabolic syndrome Signup and view all the answers

Which of the following is considered the end-stage result of chronic liver disease?

Cirrhosis Signup and view all the answers

Portal hypertension occurs primarily as a result of:

Increased resistance to blood flow in the liver due to fibrosis Signup and view all the answers

Hepatic hydrothorax, a complication of cirrhosis, results from:

Fluid movement from the abdominal cavity to the pleural space Signup and view all the answers

In chronic cholestatic liver disease, impaired bile flow and increased biliary pressure can lead to:

Hepatocyte destruction and possible infection Signup and view all the answers

Which vitamin deficiency is most likely in patients with chronic cholestatic liver disease?

Vitamin K Signup and view all the answers

Which liver disease is associated with hemolysis, elevated liver enzymes, and a low platelet count, particularly in pregnancy?

HELLP syndrome Signup and view all the answers

Which of the following drugs are known to be hepatotoxic? (Select all that apply)

Halothane Signup and view all the answers

What is one method of medical management for cirrhosis?

Use nonselective beta blockers to increase splanchnic vasoconstriction to lower portal pressure Signup and view all the answers

What is postpulmonary hypertension?

Pulmonary hypertension in conjunction with portal hypertension Signup and view all the answers

What is a major cause of mortality related to ascites?

Infection Signup and view all the answers

Why do we slowly correct hyponatremia in patients with ascites?

To prevent osmotic demyelination syndrome Signup and view all the answers

What is the end result of portal hypertension?

Varices Signup and view all the answers

What is a common treatment for chronic cholestatic disease?

Endoscopic Retrograde Cholangiopancreatography (ERCP) Signup and view all the answers

What causes a disrupted balance between bleeding and clotting in liver injury?

All of the above Signup and view all the answers

Why does hypercoagulability occur in chronic cholestatic disease?

All of the above Signup and view all the answers

What are the treatment options for hepatocellular carcinoma? (Select all that apply)

Surgical resection Signup and view all the answers

What is the most common cause of elevated liver enzymes in adults?

Non-alcoholic fatty liver disease Signup and view all the answers

What is nonalcoholic steatohepatitis (NASH)?

The most severe form of nonalcoholic fatty liver disease (NAFLD) Signup and view all the answers

What is typical of a liver biopsy of a patient with NASH?

Steatosis with inflammation and fibrosis Signup and view all the answers

What is the preferred neuromuscular blocking agent to use in patients with liver failure?

Cisatracurium (Hoffman elimination) Signup and view all the answers

What should be performed before elective surgery when a patient presents with transaminase levels greater than 2 times the normal level?

Comprehensive liver function workup Signup and view all the answers

What do elevated alkaline phosphatase (alk phos) and elevated transaminases preoperatively indicate?

Biliary disease requiring a preoperative workup Signup and view all the answers

Which of the following anesthetic drugs should be avoided in patients with liver failure?

Both Midazolam and Precedex Signup and view all the answers

Which volatile anesthetic is preferred in patients with liver disease due to its property of increasing hepatic artery blood flow?

Sevoflurane Signup and view all the answers

Propofol, Thiopental, Etomidate, Methohexital do NOT adversely affect the liver beyond decreased HBF

True Signup and view all the answers

What is the response to vasopressors in patients with liver disease or injury?

Reduced responsiveness to pressors and catecholamines Signup and view all the answers

What is Porphyria?

A rare genetic disorder affecting heme production Signup and view all the answers

How does the minimum alveolar concentration (MAC) change in an acutely intoxicated patient?

MAC decreases Signup and view all the answers

How does the minimum alveolar concentration (MAC) change in a chronic alcoholic patient?

Increased Signup and view all the answers

When do symptoms of alcohol withdrawal typically occur after the last drink?

48-72 hours Signup and view all the answers

Which of the following should be avoided during anesthesia maintenance? (Select all that apply)

Hypocapnia Signup and view all the answers

What causes altered volume of distribution of drugs in liver disease? (Select all that apply)

Reduced protein binding Signup and view all the answers

Why are anticoagulants potentiated in liver disease?

Decreased production of clotting factors Signup and view all the answers

Patients with liver disease are at risk for which complications on induction? (Select all that apply)

Aspiration Signup and view all the answers

How does the body respond to portal hypertension?

Splanchnic vasodilation resulting in low systemic vascular resistance and compensatory high cardiac output Signup and view all the answers

What is the TIPS (transjugular intrahepatic portosystemic shunt) procedure used to treat?

Both A and B Signup and view all the answers

How is the TIPS (Transjugular Intrahepatic Portosystemic Shunt) procedure performed?

A hepatic vein is accessed via the internal jugular vein, and a shunt is placed between the hepatic vein and the portal vein to bypass the liver. Signup and view all the answers

Study Notes

Liver Disease

Hepatitis C is a common cause of chronic liver disease that can lead to cirrhosis.
Cirrhosis is characterized by fibrosis and regenerative nodules in the liver.
Portal hypertension is caused by increased resistance to blood flow in the liver, due to fibrosis.
Cirrhotic cardiomyopathy is characterized by low blood pressure, high cardiac output, and systemic vasodilation.
The hallmark sign of hepatic encephalopathy is altered mental status due to neurotoxin accumulation.
Ascites, a common complication in liver disease, is due to portal hypertension and low plasma proteins.
Esophageal varices develop as a result of collateral circulation from portal hypertension.
Hepatorenal syndrome is characterized by elevated blood urea nitrogen (BUN) due to kidney dysfunction secondary to liver disease.
Alkaline phosphatase is a marker used to evaluate liver excretory function and is typically elevated in liver disorders involving bile flow obstruction.
The triad of liver disease, unexplained hypoxemia, and intrapulmonary vascular dilation defines hepatopulmonary syndrome.
Hypoalbuminemia in chronic liver disease is typically due to reduced liver synthesis of plasma proteins.
Prothrombin Time (PT) is commonly prolonged in liver disease due to the liver's inability to produce certain clotting factors.
Metabolic syndrome is most closely associated with nonalcoholic fatty liver disease (NAFLD).
Cirrhosis is considered the end-stage result of chronic liver disease.
Increased resistance to blood flow in the liver due to fibrosis is the primary cause of portal hypertension.
Hepatic hydrothorax, a complication of cirrhosis, results from fluid movement from the abdominal cavity to the pleural space.
Impaired bile flow and increased biliary pressure can lead to hepatocyte destruction and possible infection in chronic cholestatic liver disease.
Vitamin K deficiency is most likely in patients with chronic cholestatic liver disease.
HELLP syndrome is associated with hemolysis, elevated liver enzymes, and a low platelet count, particularly in pregnancy.

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Description

This quiz covers key concepts related to liver diseases, focusing on mechanisms and complications like hepatitis C, cirrhosis, and portal hypertension. Test your understanding of conditions such as hepatic encephalopathy and ascites, and learn about important markers like alkaline phosphatase.