FINAL Flashcards
1
Q
Cardiac Output using Ohm’s law
A
(MAP-CVP/SVR) x 80
2
Q
Partial pressure of substance (outside body)
A
Patm x % of molecules
3
Q
Partial pressure of inspired gas (PiO2)
A
% x (Patm-PH20) partial pressure of H20 is 47
4
Q
Pressure of oxygen in alveoli (PAO2)
A
[FiO2 x (Patm - PH20)] - PaCO2/0.8
5
Q
How do you calculate A-a gradient and what is the normal?
A
PAO2- PaO2 (5-15 mmHg)
6
Q
Law of Laplace (sphere/alveoli)
A
P= 2T/R
7
Q
Compliance
A
Delta V/Delta P or (TV/PIP-PEEP)
8
Q
Boyle’s Law/Ideal gas law
A
PV=nRT (as pressure drops, volume increases)
9
Q
Alveolar Ventilation
A
(TV-DV) x RR
10
Q
How do you calculate dead space (DV)?
A
2 ml/kg of IBW or PaCO2-PeCO2/PaCO2 (take % and apply to TV)
11
Q
Total O2 Content
A
(1.39 x Hgb x %sat) + 0.003 PO2
12
Q
Dissolved CO2
A
PaCO2 x 0.067
13
Q
IBW
A
Women 105 + 5 lbs for every in over 5’ Men 106 + 6 for every in over 5’
14
Q
Calculating Stroke Volume
A
EDV-ESV
15
Q
Calculating EF
A
(EDV-ESV)/EDV x 100
16
Q
Calculating MAP
A
1) SBP-DBP 2) divide by 3 3) add that to diastolic
17
Q
Pulse Pressure
A
SBP-DBP
18
Q
Coronary Perfusion Pressure
A
DBP- LVEDP
19
Q
What % of CO does the liver get?
A
25%
20
Q
What are the functional units of the liver?
A
hepatic lobule or acinus
21
Q
Normal hepatic blood flow
A
1500 mL/min
22
Q
How much blood flow comes from the hepatic artery?
A
25-30%
23
Q
How much blood flow comes from the portal vein?
A
70-75%
24
Q
O2 sat of blood from portal vein
A
60-85%
25
How much oxygen does the hepatic artery supply?
45-50% of requirements
26
How much oxygen does the portal vein supply?
50-55% of requirements
27
Mean BP of hepatic artery
40-70
28
Mean BP of portal vein
5-10
29
Why is the dual supply to the liver important?
makes it resistant to hypoxia
30
Hepatic arterial flow is dependent on...
autoregulation
31
Portal vein flow is dependent on...
blood flow to GI tract and spleen
32
What happens to liver blood flow after meals?
increases
33
What vessels converge to form the hepatic portal vein?
superior mesenteric, inferior mesenteric, and splenic veins
34
Receptors in Hepatic artery vs portal vein
artery- alpha and beta vein- only alpha
35
Kupffer cells
remove bacteria and endotoxin entering the blood stream from the portal circulation- part of reticuloendothelial system
36
Metabolic functions of the liver
carbs, fats, proteins, drugs
37
Final products of carb digestion
glucose, fructose, galactose
38
Hepatic conversion of fructose and galactose into ? makes ? metabolism the final common pathway for most carbs
glucose
39
Cells use ? to produce ? either aerobically via the citric acid cycle or anaerobically via glycolysis
glucose; ATP
40
Anion gap
(Na+K)-(Cl+HCO3)
41
plasma osmolarity
2(Na+K)+0.055(glucose)+0.36(BUN)
42
Aortic root pressure
1/3(LVP-aortic root P)
43
Coronary perfusion pressure
DBP-CVP
44
Cerebral perfusion pressure
MAP-ICP or MAP-CVP
45
Filtration fraction
GFR/RBF
46
Glomerular filtration pressure
MAP-(colloidal P+glomerular P)
47
Glucose is stored in hepatocytes as ?
glycogen
48
gluconeogenesis
liver produces glucose from lactate, pyruvate and amino acids (maintains normal glucose)
49
What stimulates and what inhibits gluconeogensis?
stimulates- glucocorticoids, catecholamines, glucagon, thyroid hormones inhibits- insulin
50
Glycogenolysis
release of glucose back into circulation
51
What stimulates glycogenolysis?
surgical stress, SNS stimulation
52
Liver makes plasma proteins except?
immunoglobulins
53
What coagulation factors does the liver NOT make?
VIII, vWF
54
What is produced by the liver that is important in regards to succinylcholine?
pseudocholinesterase
55
The liver combines 2 ammonia with CO2 to produce?
urea- excreted by kidneys
56
What are excess carbs and proteins converted into?
fatty acids
57
Fatty acids are oxidized into...
acetyl CoA
58
Acetyl CoA is used...
in cirtic acid cycle to produce ATP
59
Where is Acetyl CoA stored?
liver and adipose tissue
60
Obstructive vs. parenchymal disorders of the liver
obstructive- affect biliary excretion parenchymal- generalized hepatocellular dysfunction
61
What liver test is considered a true test of function?
serum bilirubin- reflects liver's ability to take up, proess, and secrete bilirubin
62
Normal serum bilirubin
less than 1.2-1.5 mg/dL
63
van den Bergh reaction
indirect positive- unconjugated bilirubin biphasic- both unconjugated/conjugated direct positive- conjugated
64
What does high unconjugated bilirubin mean?
hemoglobin is being broken down too fast or the liver can't process it fast enough (neurotoxic --\> encephalopathy)
65
What does high conjugated bilirubin mean?
bilirubin is backing up in the liver
66
normal albumin
3.5-5.3 g/dL
67
What does low albumin indicate?
liver disease, nephrotic syndrome- half life is 14 days, so values are normal in acute liver disease
68
Prothrombin time (PT)- what is it and normal range?
measures how long it takes for clot to form (activity of fibrinogen, prothrombin, and factors V, VII, X)- 10-14 seconds
69
Normal platelet count
150,000-450,000 mm3
70
What does a prolonged PT mean?
severe liver disease (unless Vit K deficiency is present)
71
Transaminases
enzymes released into circulation as result of hepatocellular injury/death (AST and ALT)
72
AST
associated with cell necrosis (liver, brain, heart tissues)
73
ALT
LIVER CELLS ONLY- indicate cell inflammation
74
Blood ammonia is cleared by the liver and converted into?
urea
75
Normal ammonia levels
47-65 mmol/L
76
What does an elevation in ammonia indicate?
disruption of urea synthesis, severe hepatocellular damage, can cause encephalopathy
77
What do inhalation agents do to hepatic blood flow?
DECREASE- halothane is the worst \*(isoflurane is the least- causes arterial dilation that can actually increase hepatic BF)
78
What does regional anesthesia do to hepatic blood flow?
decrease by lowering arterial BP
79
What does general anesthesia do to hepatic blood flow?
decreases by lowering arterial BP and CO
80
Which nervous system enhances gastric fluid secretion and motility?
PNS
81
Emptying of liquids from stomach begins within ? of ingestion- solids begin after ?
1 minute; 15-137 minutes
82
What is responsible for facilitating the emptying of liquids from the stomach?
contraction of gastric fundus
83
What is responsible for controlling the emptying of solids from the stomach?
antral contractions
84
What substances are ABSORBED in the stomach?
highly lipid soluble substances (ETOH, ASA)
85
What empties faster from the stomach, isoosmolar or hyperosmolar fluids?
iso-osmolar (could drink up to 150 ml of water right before induction)
86
What condition causes delayed gastric emptying that is not related to fluid type or volume?
diabetic gastroparesis
87
What medications delay gastric emptying?
opioids, beta agonists, TCA's, aluminum hydroxide antacid, ETOH, smoking
88
What causes complete gastric stasis?
TPN
89
ASA Fasting Guidelines
90
What is the most abundant lymphocyte?
neutrophils
91
What do neutrophils do?
seek out, ingest, and kill bacteria- first line of defense (increase in number during infection)
92
What do eosinophils do?
weak phagocyte- released with foreign proteins like parasites
93
What do basophils do?
similar to mast cells- contain histamine and heparin- usually active with allergic reactions
94
What do monocytes do?
precursor to macrophages- contain lysosomes and peroxides, breakdown dead tissue
95
What cells are in the second line of defense vs third line of defense?
Second- phagocytic WBCs Third- lymphocytes, antibodies
96
Humoral immunity
production of antibodies by B cells
97
What do macrophages do?
phagocytosis, destruction- present antigen to helper T cells and secrete cytokines
98
What do NK cells do?
destruction of virus infected "self" cells and tumor cells, secrete cytokines - do not require antigen stimulation
99
What do helper T cells do?
secrete cytokines that stimulate helper T cell proliferation and activation of B lymphocytes, cytotoxic T lymphocytes, macrophages
100
What do cytotoxic T cells do?
engage antigen and secrete perforins into foreign cell, secrete granzymes that destroy target cell
101
B cells are to ? immunity as T cells are to ? immunity
humoral; cell mediated
102
Summary of the Immune Response
103
ABO Blood Groups
104
Factor I
fibrinogen- forms clot
105
Factor II
prothrombin
106
Factor III
tissue factor/thromboplastin
107
Factor IV
Calcium
108
vWF
von Willebrand- mediates adhesion
109
Factor IX
Christmas Factor
110
Factor XI
fibrin stabilizing factor- crosslinks fibrin
111
Which factors depend on the presence of Vitamin K for synthesis in the liver?
prothrombin, Factors VII, IX, X
112
The clotting cascade
113
which lab value monitors the extrinsic pathway?
PT/INR
114
Which lab value evaluates the intrinsic pathway?
PTT and ACT
115
Extrinsic pathway mnemonic
for 37 cents you can purchase the extrinsic pathway
116
Intrinsic pathway mnemonic
If you can't buy the intrinsic pathway for 12, you can get it for 11.98
117
FCP mnemonic
The FCP can be purchased at the 5 and dime for 1 or 2 dollars on the 13th of the month
118
normal aPTT
25-32 seconds
119
Normal INR
1.5-2.5
120
Mediators responsible for procoag, anticoag, and fibrinolytic activities
121
What is FFP
fluid portion of whole blood that contains clotting factors and inhibitors, source of antithrombin III
122
What is FFP given for?
dilutional coagulopathy (factors consumed or diluted)- microvascular bleeding, MTP, warfarin reversal, vWF disease, antithrombin III deficiency
123
Should FFP be cross matched?
whenever possible
124
What is cryo?
precipitate collected off the top of FFP as it is thawed- contains I, VIII, XIII, vWF, Protein C
125
What is cryo given for?
microvascular bleeding, vWF disease
126
What are PRBCs given for?
bleeding, to increase O2 carrying capacity
127
What blood product can be given unmatched?
platelets
128
What are platelets used for?
MTP, active bleeding
129
What is a condition characterized by widespread thrombosis and spontaneous hemorrhage that can be caused by sepsis, incompatible blood transfusion, cancer, or pregnancy?
DIC
130
What happens in the proximal convoluted tubule?
major reabsorption of nutrients (2/3)
131
What happens in the loop of Henle?
establishment of osmotic gradient- promotes water reabsorption
132
Difference between thin descending and thick ascending limbs of the loop of Henle
thin- very permeable to water thick- not very permeable to water- pumps to move solutes
133
What happens in the DCT?
further adjustments in composition of tubular fluid- combination of secretion and reabsorption
134
What happens in the collecting duct?
carries tubular fluid through the osmotic gradient in the renal medulla (more fine tuning)
135
Na in the nephron
reabsorbed along the entire nephron (2/3 within the PCT)
136
What do the principal cells of the DCT/CD do?
reabsorb Na and H20, excrete K- normally impermeable to water unless acted upon by ADH
137
What do the alpha intercalated cells of the DCT/CD do?
secrete H (stimulated by aldosterone)- reabsorb K by H-K-ATPase
138
K in the nephron
2/3 reabsorbed in the PCT, 20% in ascending thick limb, either reabsorbed or secreted in the DCT and CD depending on dietary K intake (fine tuning)
139
Path of CSF
lateral ventricles -\> foramen of Monro -\> 3rd ventricle -\> aqueduct of Sylvius -\> 4th ventricle -\> Luschka and Magende -\> subarachnoid space -\> arachnoid villi and venous drainage
140
Average cerebral blood flow
50-60 mL/100 g of brain tissue/minute, or 740-900 ml/min
141
What % of CO does the brain receive?
15%
142
Regulation of cerebral blood flow
143
Affect of CBF in response to CO2
increased CO2 leads to increased CBF (CO2+H20--\> carbonic acid --\> H ions, which lead to vasodilation of cerebral vessels)
144
Substances that increase the acidity of the brain will do what?
increase H ion concentration, which will increase CBF
145
What does increased H concentration do to neuronal activity?
depresses it- "CO2 is a great anesthetic"
146
Affect of oxygen deficiency on CBF
a decrease in cerebral tissue PO2 below 30 mmHg increases cerebral blood flow
147
CBF is autoregulated between arterial pressure limits of?
around 60-160 (CBF is severely decreased below 50 mmHg)
148
What happens to the CBF autoregulation curve in patients with chronic HTN?
shifts to the right
149
CBF Autoregulation
150
Role of SNS on CBF
when MAP rises quickly, SNS constricts brain arteries to prevent high pressure from reaching small vessels (prevents vascular hemorrhage)
151
What has a higher metabolic rate, gray or white matter?
gray matter
152
What is normal CPP (cerebral)?
80-100 mmHg \<50= slowing on EEG 25-40= flat EEG sustained \<25= irreversible brain damage
153
Decreases in CPP results in?
cerebral vasodilation (and vice versa)
154
What does hypothermia do to CMR and CBF?
decreases both
155
How quickly is CSF formed?
30 mL/hr
156
What produces CSF?
choroid plexus
157
What absorbs CSF?
arachnoid villi
158
C3-5
diagphragm
159
thumb dermatome
C6
160
pinky/ulnar dermatome
C8
161
nipple line dermatome
T4- think cardiac accelerator fibers
162
groin dermatome
L1
163
belly button dermatome
T10
164
knee dermatome
L4-5
165
xiphoid dermatome
T7
166
What concentrations are higher in CSF than plasma?
sodium, chloride, magnesium
167
What concentrations are lower in the CSF than plasma?
potassium, calcium, bicarbonate, glucose
168
specific gravity and pH of CSF
1.002-1.009; 7.32
169
Growth hormone releasing hormone (GHRH)
-released from hypothalamus -targets anterior pituitary -causes increased growth hormone secretion
170
Growth hormone inhibiting hormone (GHIH)
-released from hypothalamus -targets anterior pituitary -causes decreased GH secretion
171
Thyrotropin releasing hormone (TRH)
-released by hypothalamus -targets anterior pituitary -increases TSH secretion
172
Corticotoprin releasing hormone (CRH)
-released by hypothalmus -targets anterior pituitary -increases ACTH secretion
173
gonadotropin-releasing hormone (GnRH)
-released by hypothalamus -targets anterior pituitary -increased secretion of LH and FSH
174
Prolactin-releasing hormone (PRH)
-released by hypothalamus -targets anterior pituitary -increased prolactin secretion
175
Prolactin-inhibiting hormone (PIH)
-released by hypothalamus -targets anterior pituitary -decreases prolactin secretion
176
Antidiuretic hormone (ADH)
-released by posterior pituitary -targets kidneys -increases water reabsorption
177
Oxytocin
-released by posterior pituitary -targets uterus and mammary glands -increases uterine conractions, increased milk expulsions
178
Growth hormone/somatotropin
-released by anterior pituitary -targets most tissues -increases growth, amino acid uptake and protein synthesis, glycogen synthesis, blood glucose levels
179
Thyroid stimulating hormone (TSH)
-released by anterior pituitary -targets thyroid -increases TH secretion
180
Adrenocorticotropic hormone (ACTH)
-released by anterior pituitary -targets adrenal cortex -increases glucocorticoid hormone secretion
181
Luteinizing hormone
-released by anterior pituitary -targets ovaries and testes -ovulation and progesterone production in ovaries, testosterone synthesis
182
Follicle stimulating hormone (FSH)
-released by anterior pituitary -targets follicles in ovaries, seminiferous tubules -follicle maturation and estrogen secretion, sperm cell production
183
prolactin
-released by anterior pituitary -targets ovaries and mammary glands -milk production, increased response of follicle to LH and FSH
184
epinephrine
-released by adrenal medulla -targets heart, BV, liver, adipose -increases CO, blood flow to muscles, constriction of BV, increased release of glucose and FA
185
Mineralcorticoids (aldosterone)
-released by cortex (glomerulosa) -targets kidney -increased Na reabsorption and K/H excretion; enhanced water reabsorption
186
Glucocorticoids (cortisol)
-released by cortex (fasciculata) -15-30 mg/day (up to 100 in stress) -targets most tissues -increased protein and fat breakdown, increased glucose production, inhibition of immune response and decreased inflammation
187
Androgens
-released by cortex (reticularis) -targets many tissues -development of secondary sex characteristics
188
thyroxine (T4) and triidothyronine (T3)
-stimulates oxygen and energy consumption, increases basal metabolic rate -stimulate protein synthesis -t4 is more abundant, T3 is active
189
calcitonin
-released by thyroid -stimulates osteoblasts, inhibits Ca release from bone -"tones" down calcium
190
Parathyroid hormone (PTH)
regulates serum calcium, phosphate, and vitamin D synthesis
191
Glucagon
-released by alpha cells -breakdown of glycogen in liver and muscles -increases glucose level in blood
192
insulin
-released by beta cells -increases membrane permeability for glucose, lowers glucose level, stimulates synthesis of glycogen in liver and muscles
193
somatostatin
-released by delta cells -inhibits release of GI hormones
194
pancreatic polypeptide
self regulate the pancreas secretion activities and affect glycogen levels
195
What are hormones?
chemical messengers- either proteins, amino acid derivatives, steroids
196
How are hormones stimulated to be released?
-low blood concentrations -SNS fibers stimulate -hypothalamus secrete stimulating hormones
197
4 main stimulants for aldosterone release
-hyperkalemia -angiotensin II -hyponatremia -ACTH
198
Where is cortisol metabolized?
liver
199
metabolism of epi and NE
metabolized by COMT in the liver and kidney
200
Metabolism of insulin
can be metabolized by almost all tissues but mostly by liver and kidneys
