Podcast
Questions and Answers
What is the primary indication for Orthotopic Liver Transplantation (OLT) in adult populations?
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?
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?
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?
What is a factor to consider in developing a differential diagnosis for hepatic dysfunction?
What is the primary factor contributing to the emergence of orthotropic liver transplantation as a definitive treatment option?
What is the primary factor contributing to the emergence of orthotropic liver transplantation as a definitive treatment option?
What is a pathologic consequence associated with acute hepatic failure?
What is a pathologic consequence associated with acute hepatic failure?
Which of the following is a characteristic of anesthetic management during orthotropic liver transplantation?
Which of the following is a characteristic of anesthetic management during orthotropic liver transplantation?
What is the purpose of analyzing historical data, clinical signs, and symptoms in patients with hepatic dysfunction?
What is the purpose of analyzing historical data, clinical signs, and symptoms in patients with hepatic dysfunction?
What is a concern related to anesthesia in patients undergoing OLT?
What is a concern related to anesthesia in patients undergoing OLT?
Which of the following laboratory tests is used to categorize hepatic dysfunction as prehepatic, intrahepatic, or post-hepatic?
Which of the following laboratory tests is used to categorize hepatic dysfunction as prehepatic, intrahepatic, or post-hepatic?
What is the role of tacrolimus (FK-506) in OLT?
What is the role of tacrolimus (FK-506) in OLT?
What is the primary concern for anesthesiologists when managing patients with end-stage hepatic disease?
What is the primary concern for anesthesiologists when managing patients with end-stage hepatic disease?
What is a potential source of sepsis in hepatic dysfunction?
What is a potential source of sepsis in hepatic dysfunction?
What is a consequence of hepatic carcinoma?
What is a consequence of hepatic carcinoma?
What is the term used to describe the accumulation of bilirubin in the body, resulting in jaundice?
What is the term used to describe the accumulation of bilirubin in the body, resulting in jaundice?
What is a factor to consider in the perioperative management of OLT?
What is a factor to consider in the perioperative management of OLT?
What is the most common cause of cirrhosis?
What is the most common cause of cirrhosis?
What is typically seen in cirrhosis?
What is typically seen in cirrhosis?
What is a characteristic laboratory finding in cirrhosis?
What is a characteristic laboratory finding in cirrhosis?
What is a common symptom of cirrhosis?
What is a common symptom of cirrhosis?
What is a physical finding characteristic of cirrhosis?
What is a physical finding characteristic of cirrhosis?
What is a complication of hepatic cirrhosis that develops predictably?
What is a complication of hepatic cirrhosis that develops predictably?
What is the percentage of Americans who have fat in their liver but no inflammation or liver damage?
What is the percentage of Americans who have fat in their liver but no inflammation or liver damage?
What is the confirmatory test for NASH?
What is the confirmatory test for NASH?
What is a common characteristic of NASH?
What is a common characteristic of NASH?
What is a complication of untreated NASH?
What is a complication of untreated NASH?
What is a risk factor for the development of NASH?
What is a risk factor for the development of NASH?
What is a recommendation for managing NASH?
What is a recommendation for managing NASH?
What is the primary goal of measuring central filling pressures during OLT?
What is the primary goal of measuring central filling pressures during OLT?
Why is it essential to warm intravenous fluids during OLT?
Why is it essential to warm intravenous fluids during OLT?
What is the minimum urinary output that should be maintained during OLT?
What is the minimum urinary output that should be maintained during OLT?
What is the purpose of using large-bore intravenous catheters during OLT?
What is the purpose of using large-bore intravenous catheters during OLT?
Why is it essential to have blood-salvaging technology available during OLT?
Why is it essential to have blood-salvaging technology available during OLT?
What is the primary reason for humidifying airway gases during OLT?
What is the primary reason for humidifying airway gases during OLT?
What is the primary goal of management during the postanhepatic phase of liver transplantation?
What is the primary goal of management during the postanhepatic phase of liver transplantation?
What is the primary mechanism of postperfusion coagulopathy after liver transplantation?
What is the primary mechanism of postperfusion coagulopathy after liver transplantation?
What is the primary role of thromboelastography (TEG) in liver transplantation?
What is the primary role of thromboelastography (TEG) in liver transplantation?
What is the purpose of administering desmopressin (DDAVP) during liver transplantation?
What is the purpose of administering desmopressin (DDAVP) during liver transplantation?
What is a potential complication of over-transfusion with blood components and crystalloids during liver transplantation?
What is a potential complication of over-transfusion with blood components and crystalloids during liver transplantation?
What is the primary reason for allowing central filling pressures to increase during liver transplantation?
What is the primary reason for allowing central filling pressures to increase during liver transplantation?
What is the primary purpose of infusing antifibrinolytics perioperatively during OLT?
What is the primary purpose of infusing antifibrinolytics perioperatively during OLT?
What is the reason for performing serial laboratory measurements during OLT?
What is the reason for performing serial laboratory measurements during OLT?
Why is rapid-sequence induction with cricoid pressure used in OLT?
Why is rapid-sequence induction with cricoid pressure used in OLT?
What is the reason for avoiding nitrous oxide in OLT?
What is the reason for avoiding nitrous oxide in OLT?
What is the primary concern during the anhepatic phase of OLT?
What is the primary concern during the anhepatic phase of OLT?
What is the purpose of venovenous bypass during OLT?
What is the purpose of venovenous bypass during OLT?
Why is succinylcholine used during OLT?
Why is succinylcholine used during OLT?
What is the concern regarding the use of dextrose-containing intravenous fluids during OLT?
What is the concern regarding the use of dextrose-containing intravenous fluids during OLT?
What is the consequence of air emboli during OLT?
What is the consequence of air emboli during OLT?
Why are patients undergoing OLT typically kept intubated and mechanically ventilated in the ICU postoperatively?
Why are patients undergoing OLT typically kept intubated and mechanically ventilated in the ICU postoperatively?
What is the primary purpose of infusing cold crystalloid solution through the venous structures during anastomosis?
What is the primary purpose of infusing cold crystalloid solution through the venous structures during anastomosis?
What is the primary benefit of using venovenous bypass during liver transplantation?
What is the primary benefit of using venovenous bypass during liver transplantation?
What is the primary concern related to the use of venovenous bypass during liver transplantation?
What is the primary concern related to the use of venovenous bypass during liver transplantation?
What is the primary goal of managing intraoperative electrolyte imbalances during liver transplantation?
What is the primary goal of managing intraoperative electrolyte imbalances during liver transplantation?
What is the primary consequence of symptomatic hyperkalemia during liver transplantation?
What is the primary consequence of symptomatic hyperkalemia during liver transplantation?
What is the primary benefit of using lactated Ringer's solution during liver transplantation?
What is the primary benefit of using lactated Ringer's solution during liver transplantation?
What is the primary goal of correcting electrolyte and acid-base abnormalities before reperfusion of the grafted donor liver?
What is the primary goal of correcting electrolyte and acid-base abnormalities before reperfusion of the grafted donor liver?
What is the primary benefit of using rapid transfusion devices during liver transplantation?
What is the primary benefit of using rapid transfusion devices during liver transplantation?
What is the primary consequence of excessive sodium bicarbonate administration during liver transplantation?
What is the primary consequence of excessive sodium bicarbonate administration during liver transplantation?
What is the primary purpose of cannulating the internal jugular vein during venovenous bypass?
What is the primary purpose of cannulating the internal jugular vein during venovenous bypass?
Which of the following postoperative complications may be caused by herpes virus, Epstein-Barr virus, cytomegalovirus, adenovirus, or hepatitis B or C virus?
Which of the following postoperative complications may be caused by herpes virus, Epstein-Barr virus, cytomegalovirus, adenovirus, or hepatitis B or C virus?
What is the most common period in which potential organ rejection occurs after transplantation?
What is the most common period in which potential organ rejection occurs after transplantation?
What is the purpose of administering prophylactic antibacterial and antifungal agents in addition to immunosuppressive agents?
What is the purpose of administering prophylactic antibacterial and antifungal agents in addition to immunosuppressive agents?
What is the possible locus of infection in postoperative patients?
What is the possible locus of infection in postoperative patients?
What is a surgical complication that may require surgical reintervention?
What is a surgical complication that may require surgical reintervention?
What is the common cause of postoperative complications such as persistent hemorrhage, fluid volume overload, and metabolic and electrolyte abnormalities?
What is the common cause of postoperative complications such as persistent hemorrhage, fluid volume overload, and metabolic and electrolyte abnormalities?
What is a critical consideration for anesthesiologists when managing patients undergoing retransplantation?
What is a critical consideration for anesthesiologists when managing patients undergoing retransplantation?
Why is simultaneous recipient and donor hepatectomy performed in living donor hepatic transplantation?
Why is simultaneous recipient and donor hepatectomy performed in living donor hepatic transplantation?
What is a major postoperative complication in living donor hepatic transplantation?
What is a major postoperative complication in living donor hepatic transplantation?
What is a key advantage of living donor hepatic transplantation?
What is a key advantage of living donor hepatic transplantation?
What is a common concern for anesthesiologists managing patients undergoing retransplantation?
What is a common concern for anesthesiologists managing patients undergoing retransplantation?
What is a characteristic of anesthetic management for patients undergoing retransplantation?
What is a characteristic of anesthetic management for patients undergoing retransplantation?
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
- 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.
