1. Lecture #31: AD Men vs. Women?
Male>Female
Male<Female
Females = open circles
Males = closed squares
Male=Female

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

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

4. Review: Liver Lobes of Liver 5-8 – Right Lobe 2-3 – Left Lobe
Lobes of Liver
5-8 – Right Lobe
2-3 – Left Lobe
4 – Quadrate Lobe
1 – Caudate Lobe

5. 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 #1
Portal Triad #2 #3

6. 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
Septal = Separating Branch
Hepatocytes
Hepatocytes
Hepatic artery
branch
Portal vein
branch
Bile duct
Endothelial cell
with fenestrae
(100 nm in diameter)
Dendritic
cell
Stellate
cell
Pit cell

8. Liver Fibrosis

9. 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

10. 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.

11. 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
piecemeal necrosis is synonymous with interface hepatitis
Parenchyma functional part of the liver

12. Liver Diseases: Cirrhosis
Causes

14. b-lactam antibiotic penicillins cephalosporins
penicillin
cephalosporins

15. opioid analgesic

16. Why is volume distribution greatly increased?

17. Child-Pugh Score https://en.wikipedia.org/wiki/Child-Pugh_score
Normal albumin g/dl:
Normal bilirubin <1.23 mg/dl

19. Red- chronic persistent hepatitis, chronic active hepatitis, cirrhosis

20. Cardiovascular Diseases
circulatory shock
malignant hypertension
Extremely high
Develops rapidly
congestive heart failure

21. Indocyanine Green Clearance
medical diagnostic dye
local anesthetic
Indocyanine Green Clearance
(mL/min/kg)
Squares – Normal
Closed Circles – mild congestive heart failure
Open Circles – severe congestive heart failure

22. Remifentanil (ng*ml-1)
opioid analgesic
Remifentanil (ng*ml-1)
Hemorrhagic shock