Episode 278: Liver Physiology

Liver physiology encompasses a complex dual blood supply system where the portal vein and hepatic artery contribute equally to oxygenation despite differing flow volumes. Hepatocellular injury triggers fibrous tissue replacement, leading to portal hypertension and systemic complications such as encephalopathy and coagulopathy. Clinical assessment relies on markers of cellular damage, including ALT and AST, alongside functional indicators like PT, INR, and albumin. Acute liver failure presents a high mortality risk primarily due to cerebral edema and elevated intracranial pressure, necessitating precise management of ammonia levels and perfusion. Furthermore, patients with chronic liver disease often exhibit hyperdynamic cardiac states and are prone to hepatorenal and hepatopulmonary syndromes. Anesthetic management requires careful consideration of altered drug metabolism, increased volume of distribution, and the potential for prolonged neuromuscular blockade, emphasizing the need for tailored perioperative strategies in patients with significant hepatic dysfunction.