Exam 2 Tables from Hepatic & GI lecture To Know Flashcards
(241 cards)
1
Q
BOX 33.1 Selected Essential Physiologic Functions of the Liver
A
● Carbohydrate metabolism
● Gluconeogenesis
● Glycogenolysis
* Glycogenesis
● Protein synthesis
● Albumin (maintenance of osmo-
larity)
● Thrombopoietin (platelet produc-
tion)
● Amino acid synthesis
● Protein metabolism
● Bile production
● Lipid metabolism
● Lipogenesis
● Cholesterol synthesis
● Coagulation factor synthesis
● Production of factors I, II, V. VII,
IX, X, and XI
● Insulin clearance
● Drug metabolism/transformation
● Bilirubin metabolism
2
Q
What is the effect of Desflurane on hepatic artery blood flow?
A
Moderate dose-dependent
Desflurane impacts hepatic artery blood flow in a dose-dependent manner.
3
Q
What is the effect of Desflurane on portal vein blood flow?
A
Moderate dose-dependent
Desflurane also affects portal vein blood flow in a dose-dependent manner.
4
Q
What is the effect of Isoflurane on hepatic artery blood flow?
A
Minimal dose-dependent
Isoflurane’s effect on hepatic artery blood flow is minimal and dose-dependent.
5
Q
What is the effect of Isoflurane on portal vein blood flow?
A
Minimal dose-dependent
The influence of Isoflurane on portal vein blood flow is also minimal and dose-dependent.
6
Q
What is the effect of Sevoflurane on hepatic artery blood flow?
A
Minimal dose-dependent
Sevoflurane has a minimal and dose-dependent effect on hepatic artery blood flow.
7
Q
What is the effect of Sevoflurane on portal vein blood flow?
A
Minimal dose-dependent
Sevoflurane’s impact on portal vein blood flow is minimal and dose-dependent.
8
Q
What is the score for Albumin if the level is > 3.5 g/dL?
A
1 point
9
Q
What is the score for Albumin if the level is between 2.8 – 3.5 g/dL?
A
2 points
10
Q
What is the score for Albumin if the level is < 2.8 g/dL?
A
3 points
11
Q
What is the score for Bilirubin if the level is < 2 mg/dL?
A
1 point
12
Q
What is the score for Bilirubin if the level is between 2 – 3 mg/dL?
A
2 points
13
Q
What is the score for Bilirubin if the level is > 3 mg/dL?
A
3 points
14
Q
What is the score for Prolongation of Prothrombin Time / INR if it is < 4 seconds or INR < 1.7?
A
1 point
15
Q
What is the score for Prolongation of Prothrombin Time / INR if it is between 4 – 6 seconds or INR 1.7 – 2.3?
A
2 points
16
Q
What is the score for Prolongation of Prothrombin Time / INR if it is > 6 seconds or INR > 2.3?
A
3 points
17
Q
What is the score for Ascites if there is none?
A
1 point
18
Q
What is the score for Ascites if it is controlled (minimal)?
A
2 points
19
Q
What is the score for Ascites if it is refractory (moderate to severe)?
A
3 points
20
Q
What is the score for Hepatic Encephalopathy if there is none?
A
1 point
21
Q
What is the score for Hepatic Encephalopathy if it is Grade I–II (minimal to moderate)?
A
2 points
22
Q
What is the score for Hepatic Encephalopathy if it is Grade III–IV (advanced or refractory)?
A
3 points
23
Q
What is the Child-Pugh class based on?
A
The Child-Pugh class is calculated by adding the points based on five features.
24
Q
What are the classifications of the Child-Pugh class?
A
Class A = 5 or 6, Class B = 7-9, Class C = 10 & higher.
25
What do the Child-Pugh classes indicate?
The classes indicate the severity of liver dysfunction.
26
What is the prognosis associated with Class A?
Class A is associated with a good prognosis.
27
What is the life expectancy associated with Class C?
Class C is associated with limited life expectancy.
28
Cirrhosis - Nonlaparoscopic biliary surgery mortality rate
20%
29
Cirrhosis - Nonlaparoscopic biliary surgery prognostic factors
Ascites, prothrombin time, albumin
30
Cirrhosis - Peptic ulcer surgery mortality rate
54%
31
Cirrhosis - Peptic ulcer surgery prognostic factors
Prothrombin time, systolic blood pressure, hemoglobin
32
Cirrhosis - Umbilical herniorrhaphy mortality rate
13%
33
Cirrhosis - Umbilical herniorrhaphy prognostic factors
Urgent surgery
34
Cirrhosis - Colectomy mortality rate
24%
35
Cirrhosis - Colectomy prognostic factors
Hepatic encephalopathy, ascites, albumin, hemoglobin
36
Cirrhosis - Abdominal surgery for trauma mortality rate
47%
37
Cirrhosis - Emergency abdominal surgery mortality rate
57%
38
Cirrhosis - Emergency abdominal surgery prognostic factors
Child-Pugh class, urgent surgery
39
Cirrhosis - Laparoscopic cholecystectomy mortality rate
0.9% – 6%
40
Cirrhosis - Emergency cardiac surgery mortality rate
80%
41
Cirrhosis - Emergency cardiac surgery prognostic factors
Child-Pugh class
42
Cirrhosis - Elective cardiac surgery mortality rate
3% – 46%
43
Cirrhosis - Elective cardiac surgery prognostic factors
Child-Pugh class
44
Cirrhosis - Knee replacement mortality rate
0%
45
Cirrhosis - TURP (Transurethral Resection of the Prostate) mortality rate
6.7%
46
Chronic Hepatitis - Various types of surgery mortality rate
0%
47
Hepatitis C - Laparoscopic cholecystectomy mortality rate
0%
48
Acute Hepatitis - Exploratory laparotomy mortality rate
Up to 100%
49
Obstructive Jaundice - Abdominal surgery mortality rate
5% – 60%
50
Obstructive Jaundice - Abdominal surgery prognostic factors
Hemoglobin, bilirubin, malignancy
51
What is the size of Hepatitis A (HAV)?
27 nm
52
What is the genome type of Hepatitis A (HAV)?
RNA
53
What is the route of transmission for Hepatitis A (HAV)?
Fecal-oral
54
What is the incubation period for Hepatitis A (HAV)?
15–45 days (mean = 25)
55
What is the fatality rate for Hepatitis A (HAV)?
1%
56
Is there a chronic rate for Hepatitis A (HAV)?
None
57
What antibody is associated with Hepatitis A (HAV)?
Anti-HAV
58
What is the size of Hepatitis B (HBV)?
45 nm
59
What is the genome type of Hepatitis B (HBV)?
DNA
60
What is the route of transmission for Hepatitis B (HBV)?
Parenteral, sexual
61
What is the incubation period for Hepatitis B (HBV)?
30–180 days (mean = 75)
62
What is the fatality rate for Hepatitis B (HBV)?
1%
63
What is the chronic rate for Hepatitis B (HBV)?
2%–7%
64
What antibodies are associated with Hepatitis B (HBV)?
Anti-HBs, Anti-HBc, Anti-HBe
65
What is the size of Hepatitis C (HCV)?
60 nm
66
What is the genome type of Hepatitis C (HCV)?
RNA
67
What is the route of transmission for Hepatitis C (HCV)?
Parenteral
68
What is the incubation period for Hepatitis C (HCV)?
15–150 days (mean = 50)
69
What is the fatality rate for Hepatitis C (HCV)?
<0.1%
70
What is the chronic rate for Hepatitis C (HCV)?
70%–85%
71
What antibody is associated with Hepatitis C (HCV)?
Anti-HCV
72
What is the size of Hepatitis D (HDV / Delta)?
40 nm
73
What is the genome type of Hepatitis D (HDV / Delta)?
RNA
74
What is the route of transmission for Hepatitis D (HDV / Delta)?
Parenteral, sexual
75
What is the incubation period for Hepatitis D (HDV / Delta)?
30–150 days
76
What is the fatality rate for Hepatitis D (HDV / Delta)?
2%–10%
77
What is the chronic rate for Hepatitis D (HDV / Delta)?
2%–7% in co-infection, 50% in superinfection
78
What antibody is associated with Hepatitis D (HDV / Delta)?
Anti-HDV
79
What is the size of Hepatitis E (HEV)?
32 nm
80
What is the genome type of Hepatitis E (HEV)?
RNA
81
What is the route of transmission for Hepatitis E (HEV)?
Fecal-oral
82
What is the incubation period for Hepatitis E (HEV)?
30–60 days
83
What is the fatality rate for Hepatitis E (HEV)?
1%
84
Is there a chronic rate for Hepatitis E (HEV)?
None
85
What antibody is associated with Hepatitis E (HEV)?
Anti-HEV
86
BOX 33.4 Anesthetic Management of the Patient With Acute Hepatitis
Preserve hepatic blood flow:
● Use isoflurane or desflurane and avoid halothane
● Maintain normocapnia
● Avoid PEEP if possible
● Provide adequate/liberal intravenous hydration
● Consider regional anesthesia if coagulation is acceptable and the procedure allows
87
BOX 33.4 Anesthetic Management of the Patient With Acute Hepatitis: Avoid medications with potential for hepatotoxicity or inhibition of CYP450:
● Halothane
● Acetaminophen
● Sulfonamides
● Tetracycline
● Penicillin
● Amiodarone
88
BOX 33.4 Anesthetic Management of the Patient With Acute Hepatitis: Thoughtful titration of neuromuscular blocking agents may be prolonged in patients with liver disease because of:
● Reduced pseudocholinesterase activity
● Decreased biliary excretion
● Larger volume of distribution
89
BOX 33.5 Management Recommendations for the Acutely Intoxicated Patient
● Anesthetic requirement is reduced
● Acute intoxication reduces MAC
● Aspiration precautions are needed
● Full stomach, alcohol-related impaired pharyngeal reflexes
● Alcohol increases GABA receptor activity
● Enhanced effects of benzodiazepines, barbiturates, propofol, other CNS
depressants
● Alcohol inhibits NMDA receptors
● Reduces CNS excitability
90
What happens to anesthetic requirement in the presence of alcohol?
Anesthetic requirement is reduced.
91
How does acute intoxication affect MAC?
Acute intoxication reduces MAC.
92
What precautions are needed for patients with a full stomach?
Aspiration precautions are needed.
93
What are the effects of alcohol on pharyngeal reflexes?
Alcohol-related impaired pharyngeal reflexes.
94
How does alcohol affect GABA receptor activity?
Alcohol increases GABA receptor activity.
95
What is the effect of alcohol on CNS depressants?
Enhanced effects of benzodiazepines, barbiturates, propofol, and other CNS depressants.
96
What effect does alcohol have on NMDA receptors?
Alcohol inhibits NMDA receptors.
97
How does alcohol affect CNS excitability?
Reduces CNS excitability.
98
What are viral causes of cirrhosis?
HBV, HCV, HDV
99
What are biliary causes of cirrhosis?
Atresia, Stone, Tumor
100
What are autoimmune causes of cirrhosis?
Autoimmune hepatitis, PBC, PSC
101
What are vascular causes of cirrhosis?
Budd-Chiari syndrome, Cardiac fibrosis
102
What are genetic causes of cirrhosis?
CF
103
What are toxic causes of cirrhosis?
Alcohol, Arsenic, Lysosomal acid lipase deficiency
104
What are metabolic causes of cirrhosis?
Alpha-1 antitrypsin deficiency, Galactosemia, Glycogen storage disease, Hemochromatosis, Nonalcoholic fatty liver disease and steatohepatitis, Wilson disease
105
What are iatrogenic causes of cirrhosis?
Biliary injury, Drugs: high-dose vitamin A, methotrexate
106
What is the description of abnormal AST/ALT in cirrhosis?
Normal or modest increase
107
What causes AST/ALT abnormalities in cirrhosis?
Leakage from damaged hepatocytes
108
What is the description of elevated bilirubin in cirrhosis?
Increased (important predictor of mortality)
109
What causes elevated bilirubin in cirrhosis?
Cholestasis, systemic inflammation
110
What is the description of albumin changes in cirrhosis?
Decreased in advanced cirrhosis
111
What causes decreased albumin in cirrhosis?
Decreased production; sequestered in ascites
112
What is the description of prothrombin time changes in cirrhosis?
Decreased in advanced cirrhosis
113
What causes prolonged prothrombin time in cirrhosis?
Decreased hepatic production of factor V/VII
114
What is the description of sodium imbalance in cirrhosis?
Hyponatremia
115
What causes hyponatremia in cirrhosis?
Inability to excrete free water (increased ADH)
116
What is the description of anemia in cirrhosis?
Low hemoglobin, Low red blood cell count
117
What causes anemia in cirrhosis?
Folate deficiency, hypersplenism, varices
118
What is the description of thrombocytopenia in cirrhosis?
Thrombocytopenia
119
What causes thrombocytopenia in cirrhosis?
Hypersplenism, decreased hepatic thrombopoietin production
120
What should be avoided to preserve hepatic blood flow?
Avoid halothane.
121
What is the best anesthetic to preserve hepatic blood flow?
Use isoflurane.
122
What type of anesthesia should be considered if coagulation status allows?
Consider regional anesthesia.
123
What should be maintained during anesthetic management in cirrhosis?
Maintain normocapnia.
124
What should be avoided if possible during anesthetic management?
Avoid PEEP.
125
What is important for IV volume maintenance in patients with cirrhosis?
Provide generous IV volume maintenance.
126
What hepatotoxic medication should be avoided, especially in alcoholics?
Avoid acetaminophen.
127
Which classes of medications should be avoided in patients with cirrhosis?
Avoid sulfonamides, tetracyclines, and penicillins.
128
What medication should be avoided due to hepatotoxicity?
Avoid amiodarone.
129
What should be corrected to manage coagulation abnormalities?
Try to correct prothrombin time to within 2 seconds of normal.
130
What should be used if FFP fails or fibrinogen is low?
Use cryoprecipitate.
131
What should be corrected as needed for the procedure?
Correct thrombocytopenia.
132
What should be expected during surgery in patients with cirrhosis?
Expect increased surgical blood loss.
133
What hemodynamic condition should be anticipated?
Anticipate relative hypovolemia, worsened by paracentesis.
134
What should be assessed in patients with cirrhosis?
Assess for high cardiac output and low peripheral resistance.
135
What complications should be watched for during surgery?
Watch for portal hypertension or variceal bleeding.
136
What is the response to inotropes/vasopressors in cirrhosis patients?
Depressed response to inotropes/vasopressors.
137
What monitoring should be considered in cirrhosis patients?
Consider invasive monitoring.
138
What pharmacokinetic change occurs in cirrhosis?
Altered volume of distribution.
139
What happens to serum albumin and gamma globulins in cirrhosis?
Low serum albumin and high gamma globulins.
140
What is unpredictable in cirrhosis patients, especially post-ascites drainage?
Unpredictable intravascular volume.
141
What bypasses liver metabolism in cirrhosis?
Portosystemic shunting.
142
Which drugs are affected most by liver extraction in cirrhosis?
Liver-extracted drugs.
143
What is the sensitivity to sedatives in cirrhosis patients?
Increased sensitivity to sedatives.
144
TABLE 33.7: Original MELD Score Prediction of 90-Day Mortality:
MELD Score and 90-Day Mortality
Q: What is the predicted 90-day mortality for MELD score >40?
A: 71.3%
145
Q: What is the predicted 90-day mortality for MELD score 30–39?
A: 52.6%
146
Q: What is the predicted 90-day mortality for MELD score 20–29?
A: 19.6%
147
Q: What is the predicted 90-day mortality for MELD score 10–19?
A: 6.0%
148
Q: What is the predicted 90-day mortality for MELD score <9?
A: 1.9%
149
What is the trade name and dose for Esomeprazole?
Trade name: Nexium
Dose: 20–40 mg daily
150
What is the trade name and dose for Lansoprazole?
Trade name: Prevacid
Dose: 15–30 mg daily
151
What is the trade name and dose for Omeprazole?
Trade name: Prilosec
Dose: 20–40 mg daily
152
What is the trade name and dose for Pantoprazole?
Trade name: Protonix, Protonix IV
Dose: 40 mg daily (oral), 40 mg slow IV infusion
153
What is the trade name and dose for Rabeprazole?
Trade name: Aciphex
Dose: 20 mg daily
154
What is the trade name and dose for Dexlansoprazole?
Trade name: Dexilant
Dose: 30–60 mg daily
155
Where is gastrin secreted from?
G cells in the antrum and duodenum
156
What stimulates gastrin secretion?
Peptides, amino acids, antral distention, vagal and adrenergic stimulation, GRP (bombesin)
157
What are the primary effects of gastrin?
Stimulates gastric acid and pepsinogen secretion; stimulates gastric mucosal growth
158
What is a diagnostic use of gastrin?
Pentagastrin used to measure maximal gastric acid secretion
159
Where is CCK secreted from?
I cells in the duodenum and jejunum
160
What stimulates CCK secretion?
Fats, peptides, amino acids
161
What are the primary effects of CCK?
Stimulates pancreatic enzyme secretion, gallbladder contraction; relaxes sphincter of Oddi; inhibits gastric emptying
162
What is a diagnostic use of CCK?
Used in biliary imaging to assess gallbladder contraction
163
Where is secretin secreted from?
S cells in the duodenum and jejunum
164
What stimulates secretin secretion?
Fatty acids, luminal acidity, bile salts
165
What are the primary effects of secretin?
Stimulates pancreatic water and bicarbonate secretion; inhibits gastric acid secretion, motility, and gastrin release
166
What is a diagnostic use of secretin?
Provocative test for gastrinoma; measures bile flow and alkalinity
167
Where is somatostatin secreted from?
D cells in pancreas, antrum, and duodenum
168
What stimulates somatostatin secretion?
Fats, proteins, acid, other GI hormones (e.g., gastrin, CCK), glucose, amino acids
169
What are the primary effects of somatostatin?
Universal 'off switch'; inhibits GI secretion and motility, suppresses gastric acid and gastrin; promotes mucosal stability
170
What are therapeutic uses of somatostatin?
Treat carcinoid syndrome, hormone-producing tumors, variceal bleeding, GI fistulas
171
Where is GRP secreted from?
Small bowel
172
What stimulates GRP secretion?
Vagal stimulation
173
What are the primary effects of GRP?
Stimulates all GI hormones (except secretin); promotes mucosal growth
174
Where is GIP secreted from?
K cells in the duodenum and jejunum
175
What stimulates GIP secretion?
Glucose, fats, proteins, adrenergic stimulation
176
What are the primary effects of GIP?
Inhibits gastric acid and pepsin; enhances insulin release during hyperglycemia
177
Where is motilin secreted from?
Duodenum and jejunum
178
What stimulates motilin secretion?
Gastric distention, fats
179
What are the effects of motilin?
Stimulates upper GI motility; may initiate migrating motor complex
180
Where is VIP found?
Neurons throughout the GI tract
181
What stimulates VIP secretion?
Vagal stimulation
182
What is the effect of VIP?
Potent vasodilator; acts as a neuropeptide
183
Where is neurotensin secreted from?
N cells in the small bowel
184
What stimulates neurotensin secretion?
Fats
185
What are the effects of neurotensin?
Stimulates pancreatic/intestinal secretion; inhibits gastric acid; promotes bowel mucosal growth
186
Where is enteroglucagon secreted from?
L cells in the small bowel
187
What stimulates enteroglucagon secretion?
Glucose, fats
188
What are the effects of GLP-1 and GLP-2?
GLP-1: stimulates insulin, inhibits glucagon
GLP-2: enterotropic (promotes intestinal growth)
189
Where is peptide YY secreted from?
Distal small bowel and colon
190
What stimulates peptide YY secretion?
Fatty acids, CCK
191
What are the effects of peptide YY?
Inhibits gastric/pancreatic secretions and gallbladder contraction
192
Is diarrhea common in Crohn disease or ulcerative colitis?
Common in both
193
Is rectal bleeding more common in Crohn disease or ulcerative colitis?
Almost always in ulcerative colitis; less common in Crohn
194
How does abdominal pain differ between Crohn and UC?
Crohn: Moderate to severe
UC: Mild to moderate
195
Is a palpable mass found in Crohn disease or ulcerative colitis?
Sometimes in Crohn; rarely in UC (except with large tumors)
196
Are anal complaints more frequent in Crohn or ulcerative colitis?
Crohn (>50%); infrequent in UC (<20%)
197
Is ileal disease common in Crohn or ulcerative colitis?
Common in Crohn; rare in UC (only with backwash ileitis)
198
Is nodularity or fuzziness seen in Crohn disease?
No, it is seen in UC
199
What is the typical radiologic distribution pattern in Crohn vs UC?
Crohn: Skips areas
UC: Continuous from rectum upward
200
What type of ulcers are seen in Crohn disease vs UC?
Crohn: Linear, cobblestone, fissures
UC: Collar-button ulcers
201
Is toxic dilation more common in Crohn or UC?
Rare in Crohn; uncommon in UC
202
Are anal fissures, fistulas, or abscesses common in Crohn or UC?
Common in Crohn; rare in UC
203
Is rectal sparing seen in Crohn disease or ulcerative colitis?
Common (50%) in Crohn; rare (5%) in UC
204
Is granular mucosa present in Crohn disease?
No, it's seen in UC
205
Describe ulceration patterns in Crohn vs UC.
Crohn: Linear, deep, scattered
UC: Superficial, universal
206
What are examples of 5-ASA drugs used to treat Crohn disease?
Sulfasalazine, mesalamine, olsalazine, balsalazide
207
What is the difference between sulfa and sulfa-free 5-ASAs?
Sulfa-free includes mesalamine, olsalazine, and balsalazide, which are alternatives for patients allergic to sulfa drugs
208
Which antibiotics are commonly used in Crohn disease management?
Metronidazole and ciprofloxacin
209
What types of glucocorticoids are used in Crohn disease?
Classic glucocorticoids and novel formulations like controlled ileal-release budesonide
210
Name common immune modulators used in Crohn disease.
6-mercaptopurine, azathioprine, methotrexate, cyclosporine, tacrolimus, tofacitinib
211
What are the anti-TNF antibodies used in Crohn disease?
Infliximab, adalimumab, golimumab, certolizumab pegol
212
What are other biologics (non-TNF) used in Crohn disease?
Natalizumab, vedolizumab, ustekinumab
213
What causes episodic flushing in carcinoid syndrome?
Kinins and histamine
214
What areas are commonly flushed in carcinoid syndrome?
Face and neck (may appear purple)
215
What causes diarrhea in carcinoid syndrome?
Serotonin and prostaglandins E and F
216
What symptom may result from small bowel obstruction in carcinoid syndrome?
Abdominal pain
217
What type of heart disease is associated with carcinoid syndrome?
Tricuspid regurgitation and pulmonic stenosis
218
What dysrhythmias are common in carcinoid syndrome?
Supraventricular tachydysrhythmias (due to serotonin)
219
What causes bronchoconstriction in carcinoid syndrome?
Serotonin, bradykinin, and substance P
220
What causes hypotension in carcinoid syndrome?
Kinins and histamine
221
What causes hypertension in carcinoid syndrome?
Serotonin
222
What causes hepatomegaly in carcinoid syndrome?
Liver metastases
223
What causes hypoalbuminemia and pellagra-like skin lesions in carcinoid syndrome?
Niacin (vitamin B3) deficiency due to tryptophan diversion
224
What metabolic abnormality may also be present in carcinoid syndrome?
Hyperglycemia
225
What are the most common clinical signs of carcinoid syndrome?
Flushing (head/neck/upper thorax), wheezing, BP and HR changes, diarrhea
226
What preoperative tests should be done for patients with carcinoid syndrome?
CBC, electrolytes, LFTs, blood glucose, ECG, urine 5-HIAA, echocardiogram
227
What urine test confirms carcinoid syndrome?
>30 mg of 5-HIAA in 24-hour urine (normal = 3–15 mg/24 hr)
228
What medication is used to optimize patients preoperatively and continued postoperatively in Carcinoid Syndrome?
Octreotide
229
What can be used if hypotension is refractory to octreotide in Carcinoid Syndrome?
Aprotinin (kallikrein inhibitor)
230
What other medication has shown success for symptom control in some patients in Carcinoid Syndrome?
Interferon-alpha
231
Which receptor blockers must be used to counteract histamine effects in Carcinoid Syndrome?
Both H1 and H2 blockers
232
Why are anxiolytics useful preoperatively in these patients in Carcinoid Syndrome?
To reduce stress-related serotonin release
233
Which drugs should be avoided due to histamine release in Carcinoid Syndrome?
Morphine and atracurium
234
Which sympathomimetic agents should be avoided in Carcinoid Syndrome?
Ketamine and ephedrine
235
What agent is preferred to treat hypotension in carcinoid syndrome?
Alpha-agonists like phenylephrine
236
What type of anesthesia is preferred in carcinoid syndrome?
General anesthesia is preferred over regional
237
Why might desflurane or sevoflurane be beneficial in Carcinoid Syndrome?
Due to rapid recovery profiles in patients with high serotonin levels
238
Why should normothermia be maintained intraoperatively in Carcinoid Syndrome?
To prevent catecholamine-induced release of vasoactive mediators
239
What intraoperative metabolic abnormality must be monitored in Carcinoid Syndrome?
Hyperglycemia — treat with insulin
240
What events or procedures can trigger tumor cell release of vasoactive substances in Carcinoid Syndrome?
Tumor-debulking, hepatic artery embolization, interferon or chemotherapy
241
What postoperative monitoring is essential in Carcinoid Syndrome?
Close hemodynamic monitoring due to risk of continued neuropeptide release
