liver - Anesthesia and the HepatoBiliary System Gurdip...

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1 Anesthesia and the HepatoBiliary System Gurdip Bhatia, MD Charles E. Smith, MD MetroHealth Medical Center Case Western Reserve University Cleveland, Ohio March 30, 2004
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2 Objectives Hepatic Physiology Mechanisms of Hepatocellular Injury Acute Parenchymal Liver Disease Assessment of Liver Function Preoperative Considerations Intraoperative Considerations
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3 Objectives Chronic Parenchymal Liver Disease Preoperative Considerations Intraoperative Considerations Postoperative Liver Dysfunction Anesthetic Considerations
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4 Hepatic Physiology Liver Blood Flow 25% of Cardiac output Hepatic artery ~25% of blood flow Portal vein ~ 75% of blood flow Hepatic Veins empty into the inferior vena cava
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5 Splanchnic Circulation Fig 17.1
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6 Hepatic Microcirculation Portal Axis consists of a terminal portal venule, a hepatic arteriole and a bile ductule Liver Acinus functional microvascular unit Zone 1- rich in Oxygen, mitochondria Oxidative metabolism, synthesis of glycogen Zone 2- transition Zone 3- lowest in Oxygen, anaerobic metabolism, Cytochrome P-450 Biotransformation of drugs, chemicals, and toxins Most sensitive to damage due to ischemia, hypoxia, congestion
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7 Microvascular Structure Fig 17.3
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8 Regulation of Liver Blood Flow Intrinsic Regulation Autoregulation Metabolic control Hepatic Arterial Buffer Response Decreases in portal blood flow causes increased hepatic arterial blood flow Extrinsic Regulation Neural Control Hormones Effects of Anesthesia
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9 Regulation of Liver Blood Flow Individual anesthetics Isoflurane and Sevoflurane preserve Hepatic blood flow Upper Abdominal Surgery Hepatic blood flow reduced by 60 % Regional Subarachnoid Block of T4 Reduces 20% of Hepatic blood flow
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10 Functions of the Liver - I Metabolic Protein: Albumin major protein, Coagulation factors except Factor VIII Carbohydrates: Glucose homeostasis via gluconeogenesis and glycogenolysis Lipids: Degraded to Acetylcoenzyme, a key molecule in synthesis of ATP, Cholesterol and Phospholipids
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Functions of the Liver-II Bilirubin conjugation and secretion Bile formation Hematologic function Hematopoiesis 9 th to 24 th
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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liver - Anesthesia and the HepatoBiliary System Gurdip...

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