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Perf Tech 3 > 5. Splanchnic Response- Exam 1 > Flashcards

5. Splanchnic Response- Exam 1 Flashcards

1
Q

define viscera

A

internal organs located within the ventral body cavity

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2
Q

define thoracic cavity and its sections

A

Above the diaphragm

  • Left pleural cavity
  • Right pleural cavity
  • Mediastinal Cavity (includes pericardial_
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3
Q

define abdominoplevic cavity and its sections

A

below the diaphragm

  • Abdominal cavity (stomach, liver, spleen, GI, kidneys)
  • Pelvic cavity (last part of large intestine and reproductive organs)
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4
Q

what is the purpose for body cavities

A

protect organs and allow space for organ movement like inflation of lungs or contraction of heart

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5
Q

splanchnic circulation refers to what

A

vasculature within the abdominopelvic cavity prior to the iliac bifurcation with the exception of the renal vessels

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6
Q

Why are the kidneys not considered part of the splanchnic system

A

due to the positioning, function, independent autoregulation, and direct aortic and IVC drainage

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7
Q

what are the 4 limit to splancnhnic/CPB research

A
  1. small sample size
  2. conflicting data
  3. controlling for other variables
  4. difficulty monitoring abdominal viscera and correlating to outcomes
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8
Q

what does the stomach do

A

store and break down ingested food via acids and enzymes (chyme)

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9
Q

what controls the release of contents from the stomach to the small intestine

A

pyloric sphincter

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10
Q

how long is the small intestine

A

20 ft

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11
Q

what % of nutrient absorption occurs in the small intestine

A

90%

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12
Q

describe the duodenum

A

first 10” of small intestine

serves as mixing bowl for chyme and digestive enzymes from liver and pancreas

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13
Q

describe the jejunum

A

approx 8’ of small intestine (middle portion)

primary site of chemical digestion and nutrient absorption

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14
Q

describe the illeum

A

last 12’ of small intestine

large concentration of lymphoid nodules to protect SI from bacteria in the large intestine

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15
Q

how long is the large intestine

A

5 ft

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16
Q

how much nutrient absorption takes place in the large intestine? what does it absorb?

A

small amount of nutrient absorption

primarily vitamins from bacterial byproducts, fluid and bicarb resorption

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17
Q

what is the main function of the large intestine

A

compaction and storage of chyme into fecal matter

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18
Q

how does CPB effect intestinal blood flow

A

increases intestinal blood flow due to decreased resistance

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19
Q

the increase in intestinal blood flow during CPB is independent of what?

A

temp, pH, or pCO2

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20
Q

in general, intestinal BF during CPB seems to be independent of what and dependent on what

A

independent of MAP

dependent on flow

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21
Q

extensive use of vasoCONSTRICTORS during CPB exacerbates the risk of what

A

inadequate mesenteric perfusion

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22
Q

cardiac surgery is associated with a relatively low incidence of what? but those complications cause what?

A

low incidence of GI complications but those complications cause a vastly disproportionate level of mortality.

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23
Q

risk= [formula]

A

probability * severity

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24
Q

what is the primary function of the pancreas

A

production of digestive enzymes and buffers (NaHCO3) to neutralize acidic chyme

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25
Q

the pancreas has several arterial blood sources from where

A

splenic, hepatic and superior mesenteric

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26
Q

the pancreas is primarily an _____ organ (__%), but ______ function is vital. Why the disparity

A

exocrine organ 99%
endocrine organ 1%
-produce a tone of digestive enzymes

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27
Q

endocrine portion of the pancreas: _____/_____ (1%)

A

islets of langerhans/pancreatic islets

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28
Q

endocrine portion of the pancreas contains what 4 cells

A

alpha, beta, delta, and F cells

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29
Q

endocrine portion of the pancreas: function of alpha cells

A

produce glucagon

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30
Q

endocrine portion of the pancreas: function of beta cells

A

produce insulin

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31
Q

endocrine portion of the pancreas: function of delta cells

A

produce somatostatin/tropin to suppress insulin and glucagon release

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32
Q

endocrine portion of the pancreas: function of F cells

A

pancreatic polypeptide; inhibits gall bladder contraction and some regulation of enzyme production

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33
Q

exocrine portion of the pancreas is made up of what cells

A

acinar cells (99%)

34
Q

exocrine portion of the pancreas contains what 4 enzymes

A

amylase, lipase, nuclease, and proteolytic enzymes

35
Q

exocrine portion of the pancreas: function of amylase

A

break down starch/carbs

36
Q

exocrine portion of the pancreas: function of lipase

A

break down lipids

37
Q

exocrine portion of the pancreas: function of nuclease

A

break down nucleic acids

38
Q

exocrine portion of the pancreas: function of proteolytic enzymes

A

proteases attack large proteins and peptidases break small peptides into amino acids

39
Q

how is the autoregulation of the pancreas on CPB

A

poor

40
Q

what is a common indicator for pancreatic injury

A

elevated amylase concentration- did not correlate to neg post-op symptoms

41
Q

amylase is more _____ while lipase is more ______

A

amylase is more sensitive

lipase is more specific

42
Q

what is the % incidence for pancreatitis in adults

A
  1. 1-0.8%

- -but carries a high mortalilty

43
Q

what are risk factors for pancreatitis

A

CPB time

hypotension secondary to low cardiac output syndrome

44
Q

mild pancreatitis has what % mortality

A

50%

45
Q

severe pancreatitis has what % mortality

A

67-100%

46
Q

what is the % incidence for pancreatitis in peds

A

4-8%

-much higher than adults

47
Q

what are the lab tests for pancreatitis in peds

A

trypsinogen-2

trypsin-2-alpha-1-antitrypsin

48
Q

the spleen has what kind of pulp

A

red and white

49
Q

what is the purpose of the spleens red pulp

A

big filter and storage site

50
Q

what is the purpose of the spleens white pulp

A

lymphoid tissues

51
Q

post-splenectomy patients have a high risk for what and a greater risk for what?

A

substantially greater risk of infection

33% greater risk of future MIs

52
Q

what is the largest visceral organ thats also multifuncitonal

A

liver

53
Q

what is the blood flow through the hepatic artery and portal vein

A

hepatic artery= 400 ml/min

portal vein= 1000 ml/min

54
Q

the liver drains to the ___ just below the diaphragm so use caution while placing the venous cannula to avoid _____ and ______

A

IVC

obstruction and portal HTN

55
Q

the liver serves as a large

A

blood reservoir

56
Q

all blood leaving the absorptive sections of the GI tract flows into the liver via the? what does this allow? what determines this?

A

hepatic portal vein

  • allows nutrients and toxins to be removed, stored, or allowed into the systemic circulation.
  • intrinsic regulation determines nutrient storage or release
57
Q

the liver removes damaged formed elements or pathogens via

A

kupfer cells

58
Q

the liver synthesizes what

A

plasma proteins

59
Q

the liver removes what 3 things by various mechanisms

A

antibodies, toxins, hormones

60
Q

the liver depends on coagulation factors for what

A

carboxylation of vitamin k

61
Q

how much bile is produced in the liver each day

A

1 liter

62
Q

bile is necessary for what? where is it stored and when is it released

A

necessary for lipid digestion
stored in gall bladder and released upon lipid detection in the duodenum (cholecystokinin stimulates bile production and gallbladder contraction)

63
Q

over concentrated bile leads to what

A

gall stones

64
Q

hepatic blood flow ____ slightly during CPB. Perfusion is ____ with ____ flow

A

increased
increased
increased

65
Q

what is the primary factor in decreased clearance of drugs

A

hypothermia- although not all drugs illustrate a decrease in clearance

66
Q

does a clear link exist that shows CPB has a direct negative impact on the liver

A

nope

67
Q

what 3 things may show hepatic markers of injury

A

valve procedures
transfusions
prolonged CPB times

68
Q

what are the 4 main hepatic tests

A

albumin
Serum glutamic oxaloacetic transaminase (SGOT)
total bilirubin
alkaline phosphatase (ALP)

69
Q

describe the albumin test

A

hepatic FUNCTION lab

70
Q

describe the SGOT test and the other 3 that are similar

A

specific hepatocellular leakage enzyme test
– Also can be:
Asparate aminotransferase (AST)
Serum glutamic pyruvic transaminase (SGPT)
Alanine aminotransferase (ALT)

71
Q

describe the total bilirubun test

A
  • -unconjugated= water INsoluble [crosses blood brain barrier in babies only- a UV light will help make it more water soluble so they can pee it out]
  • -direct= water soluble
72
Q

describe the ALP test

A

specific to the livers biliary tree and represents biliary damage or cholestasis

73
Q

dopaminergic drugs (dopamine/dobutamine) help to do what? why?

A

help dilate splanchinc vessels during massive pressor administration for sepsis
–pressors constrict vessels while these drugs allow splanchinc flow at the same time

74
Q

what drug is a selective D1 agonists with NO beta effects and is therefore the best choice for splancnic perfusion

A

Fenoldapam mesylate (corlopam)

75
Q

unlike the brain or kidneys during CPB- the autoregulatory response to splanchnic circulation is ?

A

muted

76
Q

how does creating higher pressures effect splanchnic perfusion

A

higher pressures do not seem to aid in splanchnic perfusion except to liver (overcome portal and IVC pressures)

77
Q

what is necessary in future studies to identify true causes of injury and formulate a plan of organ protection

A

more controlled studies with improved monitoring equipment

78
Q

what one constant shows a higher incidence of post op complications

A

longer cpb times

- in theory increased flow should reduce complications

79
Q

what may ameliorate some short term dysfunction but has not been proven to reduce gross injury

A

pulsatile flow

80
Q

does OPCAB show any benefits

A

nope

81
Q

what pre-existing conditions predispose patients to a higher incidence of risk of injury

A

ulcer, advanced age, atherosclerosis, redo procedures and combined procedures

Perf Tech 3 (15 decks)

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