Anesthesia and Liver Diseases

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  9.1.09 ANAESTHESIA AND LIVER ANAESTHESIA AND LIVER DISEASEDISEASE Dr.Pratheeba Durairaj ,M.D,D.A,Dr.Pratheeba Durairaj ,M.D,D.A,  Liver FunctionsLiver Functions  The liver conjugates bilirubin, produced from the The liver conjugates bilirubin, produced from the degradation of the haemoglobindegradation of the haemoglobin - water-soluble form of bilirubin is then excreted - water-soluble form of bilirubin is then excreted into the bile ducts into the bile ducts  The bile salts produced by the liver are passed to the The bile salts produced by the liver are passed to the gut - necessary for the absorption of the fat-soluble gut - necessary for the absorption of the fat-soluble  vitamins A, D,  and !  vitamins A, D,  and !  #ynthesis of proteins - most clotting factors, #ynthesis of proteins - most clotting factors, albumin albumin  Lipid metabolism - cholesterol and triglycerides Lipid metabolism - cholesterol and triglycerides synthesised here synthesised here  $arbohydrate metabolism - synthesis and brea%down $arbohydrate metabolism - synthesis and brea%down of glycogen &t stores glycogen and releases glucose of glycogen &t stores glycogen and releases glucose into the blood when the blood glucose falls for any into the blood when the blood glucose falls for any reason reason  'iotransformation of drugs either by oxidation or 'iotransformation of drugs either by oxidation or conjugation - render them water-soluble - more conjugation - render them water-soluble - more easily excreted easily excreted    )ati %onjugasi bilirubin, dihasil%an dari degradasi hemoglobin)ati %onjugasi bilirubin, dihasil%an dari degradasi hemoglobin  'entu% yang larut dalam air bilirubin %emudian dibuang %e 'entu% yang larut dalam air bilirubin %emudian dibuang %e dalam saluran empedudalam saluran empedu  *aram empedu yang diprodu%si oleh hati dilewat%an %e usus - *aram empedu yang diprodu%si oleh hati dilewat%an %e usus -  yang diperlu%an untu% penyerapan vitamin larut lema% A, D,   yang diperlu%an untu% penyerapan vitamin larut lema% A, D,  dan ! dan !  #intesis protein - fa%tor yang paling pembe%uan, albumin #intesis protein - fa%tor yang paling pembe%uan, albumin  +etabolisme lipid - %olesterol dan trigliserida disintesis di sini +etabolisme lipid - %olesterol dan trigliserida disintesis di sini  +etabolisme %arbohidrat - sintesis dan pemecahan gli%ogen +etabolisme %arbohidrat - sintesis dan pemecahan gli%ogen  ang menyimpan gli%ogen dan melepas%an glu%osa %e dalam  ang menyimpan gli%ogen dan melepas%an glu%osa %e dalam darah %eti%a glu%osa darah turun untu% alasan apapun darah %eti%a glu%osa darah turun untu% alasan apapun  'iotransformasi obat bai% oleh o%sidasi atau %onjugasi - 'iotransformasi obat bai% oleh o%sidasi atau %onjugasi - membuat mere%a larut dalam air - lebih mudah di%eluar%an membuat mere%a larut dalam air - lebih mudah di%eluar%an   &mpaired liver function&mpaired liver function   Direct efectsDirect efects  )ypoglycemia, Lactic acidosis , )yper metabolism, )ypoglycemia, Lactic acidosis , )yper metabolism,  Aotemia and &mpaired urea synthesis  Aotemia and &mpaired urea synthesis   .aundice appears when serum bilirubin exceeds /0  .aundice appears when serum bilirubin exceeds /0 1mol2l 1mol2l  Defects in cholesterol metabolism together with intra-Defects in cholesterol metabolism together with intra-hepatic cholestasis may lead to production of poor hepatic cholestasis may lead to production of poor 3uality bile and malabsorbtion of fat and fat-soluble 3uality bile and malabsorbtion of fat and fat-soluble  vitamins  vitamins  4educed synthesis of proteins such as albumin, clotting 4educed synthesis of proteins such as albumin, clotting factors, thyroid binding globulin and pseudo-factors, thyroid binding globulin and pseudo-cholinesterase cholinesterase   &mpaired hormone biotransformation, reduced &mpaired hormone biotransformation, reduced production of modulator proteins and reduced protein production of modulator proteins and reduced protein binding lead to increased circulating levels of hormones binding lead to increased circulating levels of hormones such as insulin, thyroxine, T/, aldosterone and oestrogen such as insulin, thyroxine, T/, aldosterone and oestrogen
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