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

5. Splanchnic Response- Exam 1 Flashcards

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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
the pancreas has several arterial blood sources from where
splenic, hepatic and superior mesenteric
26
the pancreas is primarily an _____ organ (__%), but ______ function is vital. Why the disparity
exocrine organ 99% endocrine organ 1% -produce a tone of digestive enzymes
27
endocrine portion of the pancreas: _____/_____ (1%)
islets of langerhans/pancreatic islets
28
endocrine portion of the pancreas contains what 4 cells
alpha, beta, delta, and F cells
29
endocrine portion of the pancreas: function of alpha cells
produce glucagon
30
endocrine portion of the pancreas: function of beta cells
produce insulin
31
endocrine portion of the pancreas: function of delta cells
produce somatostatin/tropin to suppress insulin and glucagon release
32
endocrine portion of the pancreas: function of F cells
pancreatic polypeptide; inhibits gall bladder contraction and some regulation of enzyme production
33
exocrine portion of the pancreas is made up of what cells
acinar cells (99%)
34
exocrine portion of the pancreas contains what 4 enzymes
amylase, lipase, nuclease, and proteolytic enzymes
35
exocrine portion of the pancreas: function of amylase
break down starch/carbs
36
exocrine portion of the pancreas: function of lipase
break down lipids
37
exocrine portion of the pancreas: function of nuclease
break down nucleic acids
38
exocrine portion of the pancreas: function of proteolytic enzymes
proteases attack large proteins and peptidases break small peptides into amino acids
39
how is the autoregulation of the pancreas on CPB
poor
40
what is a common indicator for pancreatic injury
elevated amylase concentration- did not correlate to neg post-op symptoms
41
amylase is more _____ while lipase is more ______
amylase is more sensitive | lipase is more specific
42
what is the % incidence for pancreatitis in adults
0. 1-0.8% | - -but carries a high mortalilty
43
what are risk factors for pancreatitis
CPB time | hypotension secondary to low cardiac output syndrome
44
mild pancreatitis has what % mortality
50%
45
severe pancreatitis has what % mortality
67-100%
46
what is the % incidence for pancreatitis in peds
4-8% | -much higher than adults
47
what are the lab tests for pancreatitis in peds
trypsinogen-2 | trypsin-2-alpha-1-antitrypsin
48
the spleen has what kind of pulp
red and white
49
what is the purpose of the spleens red pulp
big filter and storage site
50
what is the purpose of the spleens white pulp
lymphoid tissues
51
post-splenectomy patients have a high risk for what and a greater risk for what?
substantially greater risk of infection | 33% greater risk of future MIs
52
what is the largest visceral organ thats also multifuncitonal
liver
53
what is the blood flow through the hepatic artery and portal vein
hepatic artery= 400 ml/min | portal vein= 1000 ml/min
54
the liver drains to the ___ just below the diaphragm so use caution while placing the venous cannula to avoid _____ and ______
IVC | obstruction and portal HTN
55
the liver serves as a large
blood reservoir
56
all blood leaving the absorptive sections of the GI tract flows into the liver via the? what does this allow? what determines this?
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
the liver removes damaged formed elements or pathogens via
kupfer cells
58
the liver synthesizes what
plasma proteins
59
the liver removes what 3 things by various mechanisms
antibodies, toxins, hormones
60
the liver depends on coagulation factors for what
carboxylation of vitamin k
61
how much bile is produced in the liver each day
1 liter
62
bile is necessary for what? where is it stored and when is it released
necessary for lipid digestion stored in gall bladder and released upon lipid detection in the duodenum (cholecystokinin stimulates bile production and gallbladder contraction)
63
over concentrated bile leads to what
gall stones
64
hepatic blood flow ____ slightly during CPB. Perfusion is ____ with ____ flow
increased increased increased
65
what is the primary factor in decreased clearance of drugs
hypothermia- although not all drugs illustrate a decrease in clearance
66
does a clear link exist that shows CPB has a direct negative impact on the liver
nope
67
what 3 things may show hepatic markers of injury
valve procedures transfusions prolonged CPB times
68
what are the 4 main hepatic tests
albumin Serum glutamic oxaloacetic transaminase (SGOT) total bilirubin alkaline phosphatase (ALP)
69
describe the albumin test
hepatic FUNCTION lab
70
describe the SGOT test and the other 3 that are similar
specific hepatocellular leakage enzyme test -- Also can be: Asparate aminotransferase (AST) Serum glutamic pyruvic transaminase (SGPT) Alanine aminotransferase (ALT)
71
describe the total bilirubun test
- -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
describe the ALP test
specific to the livers biliary tree and represents biliary damage or cholestasis
73
dopaminergic drugs (dopamine/dobutamine) help to do what? why?
help dilate splanchinc vessels during massive pressor administration for sepsis --pressors constrict vessels while these drugs allow splanchinc flow at the same time
74
what drug is a selective D1 agonists with NO beta effects and is therefore the best choice for splancnic perfusion
Fenoldapam mesylate (corlopam)
75
unlike the brain or kidneys during CPB- the autoregulatory response to splanchnic circulation is ?
muted
76
how does creating higher pressures effect splanchnic perfusion
higher pressures do not seem to aid in splanchnic perfusion except to liver (overcome portal and IVC pressures)
77
what is necessary in future studies to identify true causes of injury and formulate a plan of organ protection
more controlled studies with improved monitoring equipment
78
what one constant shows a higher incidence of post op complications
longer cpb times | - in theory increased flow should reduce complications
79
what may ameliorate some short term dysfunction but has not been proven to reduce gross injury
pulsatile flow
80
does OPCAB show any benefits
nope
81
what pre-existing conditions predispose patients to a higher incidence of risk of injury
ulcer, advanced age, atherosclerosis, redo procedures and combined procedures

Perf Tech 3 (15 decks)

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