Liver Disease, Renal Disease, Endocrine Disease, and Thermoregulation Flashcards Preview

Anesthesiology > Liver Disease, Renal Disease, Endocrine Disease, and Thermoregulation > Flashcards

Flashcards in Liver Disease, Renal Disease, Endocrine Disease, and Thermoregulation Deck (27)

What are alterations in the hemostatic system in patients with liver disease that impair hemostasis?

1- Thrombocytopenia
2- platelet function defects
3- enhanced production of nitric oxide and prostacyclin
4- low levels of factors II, V, VII, IX, X, and XI
5- Vitamin K deficiency
6- dysfibrinogenemia
7- elevated t-PA levels
8- low levels of factor XIII


What alterations in the hemostatic system in patients with liver disease promote hemostasis?

1- Elevated levels of vWF
2- decreased levels of ADAMTS-13
3- elevated levels of factor VIII
4- decreased levels of protein C, protein S, antithrombin
5- low levels of plasminogen


T or F: In a liver transplant case, plasma must be given that is compatible with the recipient's red blood cells but also has no antibodies against the donor liver.



T or F: like the brain and myocardium, the kidney has the capacity to autoregulate blood flow.



T or F: between the range of MAP 60-160, renal blood flow, and consequently the GFR, remains constant.



T or F: developmentally, humans reach the adult stage of RBF as a percent of cardiac output by 3 years of age.



T or F: After reaching adulthood, RBF progressively decreases with age and is only about half that of a younger adult at an age of 90 years.



T or F: the thermoregulatory threshold, below which humans activey regulate body temperature, is decreased during general anesthesia and is less effective under general anesthesia.



T or F: sweating is the best preserved mechanism under general anesthesia.



T or F: under general anestheia, the thresholds for shivering and vasoconstriction are markedly reuced and less effective than normal when activated.



Define convection.

Hat loss by currents, such as from drafts and the infusino of cold blood and fluids.


Define radiation.

The heat exchange from one surface to another. This is the most important mechanism for heat loss.


Define conduction.

Heat exchanged by direct molecular contact, such as from the skin to the cold OR table


Define evaporation.

Heat lost by the movement of molecules from the liquid to the gas phase.


T or F: postoperative hypothermia increases sympathetic nervous system activity.



Describe the mechanism of action of furosemide.

A loop diuretic that acts at the medullary thick ascending loop of Henle and inhibits the Na/K/Cl pump.


Name the pharmacokinetic profiles of insulin and insulin analogues in order from shortest to longest acting.

Aspart, lispro --> regular insulin --> NPH --> glargine (aka Lantus)


Describe diabetic ketoacidosis.

A metabolic abnormality in diabetic patients that is identified by hyperglycemia, ketoacidosis, dehydration, and electrolyte abnormalities. Due to a deficiency in insulin and an excess of counterregulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone.


What can trigger DKA?

infection (UTI, pneumonia), insufficient insulin administration, MI, CVA, acute pancreatitis, trauma, burns, certain drugs


Treatment for DKA

crystalloid resuscitation with isotonic fluids and administration of insulin to reverse the production of ketoacidosis


T or F: despire measured hyperkalemia in DKA, patients are usually suffering from total body potassium depletion. Potassium supplementation is frequently required during tretment as fluids and insulin lower the serum potassium level.

True- monitor K levesl every 2-4 hours to prevent symptomatic hypokalemia.


T orF: in patients with ESRD, there can be prolongation of the clinical effect of rocuronium due to decreased renal clearance of the drug in patients with renal failure.



T or F: hepatic blood flow is derived from the portal venous system and the hepatic artery. The portal vein provides 75% of the total hepatic blood flow, and the hepatic artery only about 25%.



Describe the hepatic arterial buffer response.

A novel intrinsic mechanism in which a decrease or increase in portal venous flow will be compensated by an increase or decrease in hepatic arterial flow. The synthesis and removal of adenosine from periportal regions is involved in the HABR mechonism.


What is the HBV surface antigen (HBsAg)?

an early serologic marker of infection and if present for greater than 6 months identifies chronic infection


What is the HBV e antigen (HBeAg)?

a marker for active viral replication and infectivity and can persist in a chronic infection for years.


Describe propofol infusion syndrome.

Metabolic acidosis, heart failure, hypotension, and hepatomegaly, progressive lactic acidosis, hyperipidemia, rhabdomyolysis, cardiac instability.

- associated with propofol infusion at doses greater than 4 mg/kg/hr for a duration of more than 48 hours

- proposed mechanism is propofol-mediated inhibition of the mitochondrial respiratory chain and an impairment of mitochonidrial fatty acid metabolism.