Lecture #31: AD Men vs. Women?

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Presentation transcript:

Lecture #31: AD Men vs. Women? Male>Female Male<Female http://alcalc.oxfordjournals.org/content/37/4/388 Females = open circles Males = closed squares Male=Female

Lecture #31: Example: 70 kg and 20 years old

Influence of Disease I-Hepatic and Cardiovascular Diseases Lecture #32 Influence of Disease I-Hepatic and Cardiovascular Diseases

Review: Liver Lobes of Liver 5-8 – Right Lobe 2-3 – Left Lobe http://healthfixit.com/location-and-pictures-of-different-organs-in-the-abdomen/ https://upload.wikimedia.org/wikipedia/commons/b/b7/2423_Microscopic_Anatomy_of_Liver.jpg https://en.wikipedia.org/wiki/Liver Lobes of Liver 5-8 – Right Lobe 2-3 – Left Lobe 4 – Quadrate Lobe 1 – Caudate Lobe

Review: Liver Lobule Liver acinus Liver anicus Central Vein, Hepatic Vein or Hepatic Venule Liver acinus Central Vein, Hepatic Vein or Hepatic Venule Liver anicus http://illuminationstudios.com/archives/150/structure-of-a-hepatic-lobule #1 Portal Triad #2 #3

Review: Liver acinus Q Liver acinus Bile duct Bile canaliculus Central Vein, Hepatic Vein or Hepatic Venule Sinusoid Septal Branch Space of Disse Hepatocyte Q Kupffer cell Hepatocyte Bile canaliculus Space of Disse Sinusoidal Lumen Kupffer cell http://www.nature.com/nrgastro/journal/v1/n2/fig_tab/ncpgasthep0055_F1.html http://www.nature.com/nri/journal/v6/n3/fig_tab/nri1784_F1.html http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774973/ Septal = Separating Branch http://www.solvobiotech.com/images/uploads/murine_hepatocita_011.jpg Hepatocytes Hepatocytes Hepatic artery branch Portal vein branch Bile duct Endothelial cell with fenestrae (100 nm in diameter) Dendritic cell Stellate cell Pit cell

http://journal.diabetes.org/clinicaldiabetes/v17n21999/Pg73.htm

Liver Fibrosis http://www.jci.org/articles/view/24282/figure/1

Hepatic (Liver) Diseases Chronic Persistent Hepatitis (book) Chronic hepatitis without piecemeal necrosis (1994) Chronic Active Hepatitis (book) Chronic hepatitis with piecemeal (periportal) necrosis with or without fibrosis (1994) Cirrhosis

Liver Diseases: Chronic Persistent Hepatitis Chronic hepatitis without piecemeal necrosis Symptoms Fatigue Lack of appetite Nausea and vomiting asymptomatic Causes Autoimmune diseases (lupus) Hepatitis B (HBV) Hepatitis C (HCV) Hepatitis D (HDV) Drugs Cryptogenic hepatocyte that is undergoing apoptosis. https://en.wikipedia.org/wiki/Councilman_body

Liver Diseases: Chronic Active Hepatitis Chronic hepatitis Periportal piecemeal necrosis interface hepatitis with or without fibrosis Symptoms malaise muscle and joint pain fever nausea vomiting diarrhea headache piecemeal (periportal) necrosis Causes Autoimmune diseases (lupus) Hepatitis B (HBV) Hepatitis C (HCV) Hepatitis D (HDV) Drugs Cryptogenic https://en.wikipedia.org/wiki/Hepatitis piecemeal necrosis is synonymous with interface hepatitis Parenchyma functional part of the liver

Liver Diseases: Cirrhosis Causes

http://medschool.swmed.edu/images/drugs/DL00006.jpg

b-lactam antibiotic penicillins cephalosporins https://en.wikipedia.org/wiki/Β-lactam_antibiotic penicillin cephalosporins

opioid analgesic http://www.change-pain.com/grt-change-pain-portal/GRT-CHANGE-PAIN-PORTAL_Home/Picture_Library/203600166.jsp http://flipper.diff.org/app/items/6280

Why is volume distribution greatly increased?

Child-Pugh Score https://en.wikipedia.org/wiki/Child-Pugh_score Normal albumin 3.5-5.5 g/dl: http://emedicine.medscape.com/article/2054430-overview Normal bilirubin <1.23 mg/dl https://en.wikipedia.org/wiki/Bilirubin

Red- chronic persistent hepatitis, chronic active hepatitis, cirrhosis

Cardiovascular Diseases circulatory shock malignant hypertension Extremely high Develops rapidly congestive heart failure https://en.wikipedia.org/wiki/Heart_failure

Indocyanine Green Clearance medical diagnostic dye local anesthetic Indocyanine Green Clearance (mL/min/kg) https://en.wikipedia.org/wiki/Indocyanine_green https://en.wikipedia.org/wiki/Lidocaine Squares – Normal Closed Circles – mild congestive heart failure Open Circles – severe congestive heart failure

Remifentanil (ng*ml-1) opioid analgesic Remifentanil (ng*ml-1) Hemorrhagic shock http://anesthesiology.pubs.asahq.org/Article.aspx?articleid=2026459