HepaticFunction - Anesthesia and Hepatic Function Scott F....

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Unformatted text preview: Anesthesia and Hepatic Function Scott F. MacKinnon, M.D. 35 yo male with chronic Hep c presents for lumbar laminectomy 66 yo homeless male with extensive etoh abuse history presents for pelvic exenteration 32 yo gravida2 para1 for emergent c-section. Severe RUQ pain, ALT>6000 Anatomy Largest Gland: 1.8kg/1.4kg M/F Glisson’s Capsule(except porta hepatis) Capsular Peritoneum support Lobes vs segments Contains 10-15% of TBV Vascular Supply 25% of total CO: 120ml/min/100gm Hepatic Artery(25%;50%DO2) Portal Vein(75%;50%DO2) Portal Vein: nutrients, multiple tributaries Regulation of Hepatic Blood Flow Dual Supply One primarily for oxygenation, substrates One for providing vital services Watershed regions Intrinsic vs Extrinsic Intrinsic Modulation Hepatic Arterial buffer response Modulated by adenosine More Evident in Post-prandial state Extrinsic Modulation Catecholamines Hormones vasopressin Major Physiologic functions of Liver Blood Reservoir-500ml may be expelled Anesthetics may suppress this Vasoconstrictor response impaired of abscent in cirrhotics Regulator of Blood coagulation All factors from liver except vwbf Vitamin K precursors(2,7,9,10) Bile enables absorption of vitamin K Thrombopoietin Also clears activated factors Endocrine Functions of Liver IGF-1, Angiotensinogin, Thrombo T4-T3, TBG Corticosteroids, aldosterone, estrogen, insulin-all are deactivated by liver LFT’s Hepatocellular damage Obstruction Synthetic function Uptake/conjugation/excretion Other Indices of Hepatocellular...
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This note was uploaded on 12/28/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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HepaticFunction - Anesthesia and Hepatic Function Scott F....

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