Hepatic Gi Flashcards
(29 cards)
The smooth muscle that surrounds the end of the common bile duct & pancreatic duct and into the duodenum
sphincter of Oddi distal to Vallii
What meds relax the sphincter of Oddi
Glucagon 0.5-1mg per surgeon’s request
Glucagon reduces intraluminal pressure of the gallbladder
If you have to convert to open and are anticipating blood loss converting to open, what do you do to your vent?
100% FiO2
What does cholangiography look for?
choledocholithiasis
anatomy
pathology abnormal
steps of cholangiography
cystic duct opened
a catheter was placed and secured
dye injected into the biliary tree
x-ray taken
What do they do if stones are found during cholangiography?
common duct exploration
ERCP post-op
Common bile duct exploration
anatomy of duct
numner of stones
what is the least invasive way to enter bile duct?
ERCP
ercp may be intravascularly dry…
give albumin
give fluids even if they edemedous
ERCP where is catheter advanced
mouth to duodenum
Papilla of Vader
position for ERCP
Prone, arms tucked, head turned
anesthesia for ERCP
the endoscope may move the ETT
ERCP stomach decompression
may be decompressed before extubation
ERCP perls
have glucagon available
CV & ERCP
Hypotension and ECG changes are common
What is the most important predictor of short-term survival in liver resection?
Blood loss
Mostly from intrahepatic branches of the portal and hepatic veins.
premed for liver resection
midazolam unless encephalopathic
decrease blood loss in liver resection?
nitroprusside
narcotics
increase gas
Lr is not compatable with
blood
NSS
pringle maneuvar
Temporary occlusion (20m) of hepatoduodenal ligament to minimize blood loss
what vessles are within hepatoduodenal ligament?
Within the ligament are
Hepatic artery
Portal vein
Common bile duct
how to minimize blood loss
nitroprusside
CVP <5mmHg
(7-10 = bleeding)
CO2 pneumoperi 10-14mmHg
decreased venous return
acute pancreatitis may cause
volume depletion –> renal insufficiency
Why could serum k be elevated in pancreatitis
acidosis
renal failure
