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Liver Failure and NASH Chapter 10
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Liver Failure and NASH Chapter 10

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Questions and Answers

What is the primary indication for Orthotopic Liver Transplantation (OLT) in adult populations?

  • Hemolytic anemia
  • Post-necrotic (nonalcoholic) cirrhosis (correct)
  • Viral infections
  • Hypertension

    • What is the role of cyclosporine in OLT?

  • To manage hyperkalemia
  • To treat underlying liver disease
  • To prevent acute rejection (correct)
  • To treat hemodynamic derangements

    • What is a common complication of OLT associated with the perfusion of the transplanted graft?

  • Pulmonary embolism
  • Hypoventilation
  • Hyperkalemia (correct)
  • Cardiac arrhythmia

    • What is a factor to consider in developing a differential diagnosis for hepatic dysfunction?

    <p>Evaluation of exogenous bilirubin load</p> Signup and view all the answers

    What is the primary factor contributing to the emergence of orthotropic liver transplantation as a definitive treatment option?

    <p>Advances in immunosuppressive therapy and donor organ procurement</p> Signup and view all the answers

    What is a pathologic consequence associated with acute hepatic failure?

    <p>Hepatorenal syndrome</p> Signup and view all the answers

    Which of the following is a characteristic of anesthetic management during orthotropic liver transplantation?

    <p>The anesthetic management is strongly influenced by the hemodynamic manifestations during the procedure</p> Signup and view all the answers

    What is the purpose of analyzing historical data, clinical signs, and symptoms in patients with hepatic dysfunction?

    <p>To identify the underlying cause of the dysfunction</p> Signup and view all the answers

    What is a concern related to anesthesia in patients undergoing OLT?

    <p>Hemodynamic instability</p> Signup and view all the answers

    Which of the following laboratory tests is used to categorize hepatic dysfunction as prehepatic, intrahepatic, or post-hepatic?

    <p>Serum bilirubin, aminotransferases, and alkaline phosphatase</p> Signup and view all the answers

    What is the role of tacrolimus (FK-506) in OLT?

    <p>To prevent acute rejection</p> Signup and view all the answers

    What is the primary concern for anesthesiologists when managing patients with end-stage hepatic disease?

    <p>The patient's anesthesia-related concerns are similar to those for major surgery with severe cirrhosis</p> Signup and view all the answers

    What is a potential source of sepsis in hepatic dysfunction?

    <p>Surgical site infection</p> Signup and view all the answers

    What is a consequence of hepatic carcinoma?

    <p>Portal hypertension</p> Signup and view all the answers

    What is the term used to describe the accumulation of bilirubin in the body, resulting in jaundice?

    <p>Hepatic dysfunction</p> Signup and view all the answers

    What is a factor to consider in the perioperative management of OLT?

    <p>Hemodynamic monitoring</p> Signup and view all the answers

    What is the most common cause of cirrhosis?

    <p>Chronic alcohol ingestion</p> Signup and view all the answers

    What is typically seen in cirrhosis?

    <p>Regenerating parenchymal nodules</p> Signup and view all the answers

    What is a characteristic laboratory finding in cirrhosis?

    <p>Decreased serum albumin concentration</p> Signup and view all the answers

    What is a common symptom of cirrhosis?

    <p>Fatigue and malaise</p> Signup and view all the answers

    What is a physical finding characteristic of cirrhosis?

    <p>All of the above</p> Signup and view all the answers

    What is a complication of hepatic cirrhosis that develops predictably?

    <p>Hepatic and extrahepatic complications</p> Signup and view all the answers

    What is the percentage of Americans who have fat in their liver but no inflammation or liver damage?

    <p>10% to 20%</p> Signup and view all the answers

    What is the confirmatory test for NASH?

    <p>Liver biopsy</p> Signup and view all the answers

    What is a common characteristic of NASH?

    <p>No symptoms in the early stages</p> Signup and view all the answers

    What is a complication of untreated NASH?

    <p>Cirrhosis</p> Signup and view all the answers

    What is a risk factor for the development of NASH?

    <p>Obesity</p> Signup and view all the answers

    What is a recommendation for managing NASH?

    <p>Following a balanced and healthy diet</p> Signup and view all the answers

    What is the primary goal of measuring central filling pressures during OLT?

    <p>To guide volume and blood-product replacement</p> Signup and view all the answers

    Why is it essential to warm intravenous fluids during OLT?

    <p>To prevent hypothermia and associated complications</p> Signup and view all the answers

    What is the minimum urinary output that should be maintained during OLT?

    <p>0.5 mL/kg/hr</p> Signup and view all the answers

    What is the purpose of using large-bore intravenous catheters during OLT?

    <p>To facilitate rapid infusion of large volumes of fluid</p> Signup and view all the answers

    Why is it essential to have blood-salvaging technology available during OLT?

    <p>To minimize blood loss and reduce the need for allogenic transfusions</p> Signup and view all the answers

    What is the primary reason for humidifying airway gases during OLT?

    <p>To prevent dehydration of the respiratory tract</p> Signup and view all the answers

    What is the primary goal of management during the postanhepatic phase of liver transplantation?

    <p>Maintenance of hemodynamic stability</p> Signup and view all the answers

    What is the primary mechanism of postperfusion coagulopathy after liver transplantation?

    <p>Release of sequestered heparin from the donor liver</p> Signup and view all the answers

    What is the primary role of thromboelastography (TEG) in liver transplantation?

    <p>Detection of fibrinolysis and platelet activity</p> Signup and view all the answers

    What is the purpose of administering desmopressin (DDAVP) during liver transplantation?

    <p>To improve platelet function</p> Signup and view all the answers

    What is a potential complication of over-transfusion with blood components and crystalloids during liver transplantation?

    <p>Pulmonary edema</p> Signup and view all the answers

    What is the primary reason for allowing central filling pressures to increase during liver transplantation?

    <p>To prevent reperfusion hypotension</p> Signup and view all the answers

    What is the primary purpose of infusing antifibrinolytics perioperatively during OLT?

    <p>To control hemorrhage</p> Signup and view all the answers

    What is the reason for performing serial laboratory measurements during OLT?

    <p>To monitor for potential complications</p> Signup and view all the answers

    Why is rapid-sequence induction with cricoid pressure used in OLT?

    <p>To reduce the risk of aspiration of stomach contents</p> Signup and view all the answers

    What is the reason for avoiding nitrous oxide in OLT?

    <p>It can expand air bubbles in the nonperfused donor liver</p> Signup and view all the answers

    What is the primary concern during the anhepatic phase of OLT?

    <p>Hypocalcemia due to citrate toxicity</p> Signup and view all the answers

    What is the purpose of venovenous bypass during OLT?

    <p>To reduce the risk of pulmonary hypertension</p> Signup and view all the answers

    Why is succinylcholine used during OLT?

    <p>To induce rapid onset of neuromuscular blockade</p> Signup and view all the answers

    What is the concern regarding the use of dextrose-containing intravenous fluids during OLT?

    <p>They may cause hyperglycemia</p> Signup and view all the answers

    What is the consequence of air emboli during OLT?

    <p>Air trapped in venous sinusoids and released during reperfusion of the donor liver</p> Signup and view all the answers

    Why are patients undergoing OLT typically kept intubated and mechanically ventilated in the ICU postoperatively?

    <p>To monitor for potential complications</p> Signup and view all the answers

    What is the primary purpose of infusing cold crystalloid solution through the venous structures during anastomosis?

    <p>To prevent air embolism</p> Signup and view all the answers

    What is the primary benefit of using venovenous bypass during liver transplantation?

    <p>To minimize hypotension and maintain renal and splanchnic perfusion</p> Signup and view all the answers

    What is the primary concern related to the use of venovenous bypass during liver transplantation?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of managing intraoperative electrolyte imbalances during liver transplantation?

    <p>To maintain normovolemia and optimize oxygen-carrying capacity</p> Signup and view all the answers

    What is the primary consequence of symptomatic hyperkalemia during liver transplantation?

    <p>Cardiac dysrhythmias and refractory asystole</p> Signup and view all the answers

    What is the primary benefit of using lactated Ringer's solution during liver transplantation?

    <p>None of the above</p> Signup and view all the answers

    What is the primary goal of correcting electrolyte and acid-base abnormalities before reperfusion of the grafted donor liver?

    <p>To maintain normovolemia and optimize oxygen-carrying capacity</p> Signup and view all the answers

    What is the primary benefit of using rapid transfusion devices during liver transplantation?

    <p>To allow the infusion of large volumes of warmed fluids and blood products</p> Signup and view all the answers

    What is the primary consequence of excessive sodium bicarbonate administration during liver transplantation?

    <p>All of the above</p> Signup and view all the answers

    What is the primary purpose of cannulating the internal jugular vein during venovenous bypass?

    <p>To attenuate several side effects of venovenous bypass</p> Signup and view all the answers

    Which of the following postoperative complications may be caused by herpes virus, Epstein-Barr virus, cytomegalovirus, adenovirus, or hepatitis B or C virus?

    <p>Postoperative hepatitis</p> Signup and view all the answers

    What is the most common period in which potential organ rejection occurs after transplantation?

    <p>During weeks 1 to 6 after transplantation</p> Signup and view all the answers

    What is the purpose of administering prophylactic antibacterial and antifungal agents in addition to immunosuppressive agents?

    <p>To prevent infection</p> Signup and view all the answers

    What is the possible locus of infection in postoperative patients?

    <p>Intraabdominal source, indwelling catheter, surgical wound, urinary tract, or intrapulmonary source</p> Signup and view all the answers

    What is a surgical complication that may require surgical reintervention?

    <p>Anastomotic leak or stricture of the biliary reconstruction</p> Signup and view all the answers

    What is the common cause of postoperative complications such as persistent hemorrhage, fluid volume overload, and metabolic and electrolyte abnormalities?

    <p>Surgical technical complications</p> Signup and view all the answers

    What is a critical consideration for anesthesiologists when managing patients undergoing retransplantation?

    <p>Variable degree of renal insufficiency and hypertension secondary to cyclosporine toxicity</p> Signup and view all the answers

    Why is simultaneous recipient and donor hepatectomy performed in living donor hepatic transplantation?

    <p>To reduce the time from donation to transplant</p> Signup and view all the answers

    What is a major postoperative complication in living donor hepatic transplantation?

    <p>All of the above</p> Signup and view all the answers

    What is a key advantage of living donor hepatic transplantation?

    <p>All of the above</p> Signup and view all the answers

    What is a common concern for anesthesiologists managing patients undergoing retransplantation?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of anesthetic management for patients undergoing retransplantation?

    <p>Similar to patients with end-stage liver disease</p> Signup and view all the answers

    Study Notes

    Hepatic Dysfunction

    • Hepatic dysfunction can be categorized as prehepatic, intrahepatic (hepatocellular), or post-hepatic (cholestatic) based on measurement of serum bilirubin, aminotransferases, and alkaline phosphatase.
    • Hepatic dysfunction is often multifactorial, requiring analysis of historical data, clinical signs, and symptoms, as well as serial liver function tests and search for extrahepatic causes.

    Orthotropic Liver Transplantation (OLT)

    • OLT has emerged as a definitive treatment option for patients with end-stage hepatic disease due to advances in surgical technique, immunosuppressive therapy, and donor organ procurement.
    • OLT is a therapeutic option for patients with certain viral infections who respond poorly to medical management but are physiologically salvageable.
    • In the adult population, post-necrotic (nonalcoholic) cirrhosis constitutes the most common indication for OLT.
    • Anesthesia-related concerns for patients undergoing OLT are consistent with those for patients undergoing major surgery with severe cirrhosis.
    • Multisystem effects of cirrhosis include profound hemodynamic derangements that may preexist and are exacerbated by surgical stressors.
    • Hyperkalemia and venous air embolism may be encountered with perfusion of the transplanted graft.

    Factors for Developing a Differential Diagnosis for Hepatic Dysfunction

    • Review all drugs administered
    • Check for sources of sepsis
    • Evaluate the possibility of an increased exogenous bilirubin load, such as a blood transfusion
    • Rule out occult hematoma formation
    • Rule out hemolysis
    • Assess for evidence of hypotension, hypoventilation, and hypovolemia
    • Assess for congestive heart failure and renal insufficiency
    • Consider the possibility of immune-mediated hepatotoxicity

    Pathologic Consequences Associated with Acute Hepatic Failure

    • Portal hypertension
    • Esophagogastric varices
    • Ascites
    • Hyperdynamic circulation
    • Anemia
    • Coagulopathy
    • Arterial hypoxemia
    • Hepatorenal syndrome
    • Hypoglycemia
    • Gallstones
    • Hepatic encephalopathy
    • Hepatic carcinoma

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    Description

    This quiz covers key points on liver failure, including the categorization of hepatic dysfunction and treatment options such as orthotropic liver transplantation. Test your knowledge on liver disease and its management.

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