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ACU COURSE > RENAL/GI/ENDO > Flashcards

RENAL/GI/ENDO Flashcards

1
Q

Unit of the kidney

A

Nephron

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2
Q

Blood enters via the _____ arteriole, passing through the ______ and leaves via the ______ arteriole

A

Blood enters via the AFFERENT arteriole, passing through the GLOMERULUS and leaves via the EFFERENT arteriole

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3
Q

Aldosterone

A

Reabsorbs Na+ to aid in reabsorption of H2O and increase BP.

Pushes K+ out

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4
Q

RAAS

A

Kidneys sense decrease in BP –> renin –> angiotensin - vasoconstriction + aldosterone –> increase BP

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5
Q

GFR is ____ to ____ ml/min

Healthy urine output: __/__ L/day

To maintain consistent GFR, the kidneys themselves are able to autoregulate despite what systemic BP is as long as MAP stays between __ to __ mmHg

When MAP falls below ___mmHg, autoregulation of GFR is no longer possible

A

GFR is 100 to 125 ml/min

Healthy urine output: 1/2 L/day

To maintain consistent GFR, the kidneys themselves are able to autoregulate despite what systemic BP is as long as MAP stays between 80 to 180 mmHg

When MAP falls below 70mmHg, autoregulation of GFR is no longer possible

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6
Q

Activation of the SNS causes _____ GFR

A

Activation of the SNS causes DECREASED GFR

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7
Q

Capillary permeability _______ GFR

A

Decreases

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8
Q

A decrease in protein concentration ________ GFR

A

Decreases

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9
Q

Kidneys release _______ which stimulates the bone marrow to produce more _____

A

erythropoietin, RBCs

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10
Q

CKD: Decrease in function greater than ___ months

GFR < ___ and irreversible when < ___

HTN: walls of kidneys begin to thicken = narrow lumen = less blood and oxygen to kidneys = ischemic injury to the glomerulus = _______

DM: Affects ____ arteriole. Blood becomes thick and arterioles become stiff. Creates obstruction and difficult for blood to leave glomerulus = _________

Azotemia: ____ builds up in blood

Electrolyte Imbalances:
- K+ ______
- Ca+ _____
- PTH ______

  • Lower GFR = more _____ = HTN
  • Less EPO = _____
A

CKD: Decrease in function greater than 3 months

GFR < 90 and irreversible when < 60

HTN: walls of kidneys begin to thicken = narrow lumen = less blood and oxygen to kidneys = ischemic injury to the glomerulus = GLOMERULARSCLEROSIS

DM: Affects EFFERENT arteriole. Blood becomes thick and arterioles become stiff. Creates obstruction and difficult for blood to leave glomerulus = GLOMERULARSCLEROSIS

Azotemia: UREA builds up in blood

Electrolyte Imbalances:
- K+ HYPER
- Ca+ HYPO
- PTH HYPER

  • Lower GFR = more RENIN = HTN
  • Less EPO = ANEMIA
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11
Q

Dialysis does not treat renal function and does not replace metabolic functions of the kidney (____, _____ control and Vitamin ___) - these are replaced with pharmaceuticals

A

Dialysis does not treat renal function and does not replace metabolic functions of the kidney (EPO, BP control and Vitamin D) - these are replaced with pharmaceuticals

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12
Q

HD Indications:

A
E
I
O
U

PD indications:

A

HD Indications:

Acidosis
Electrolyte imbalance
Ingestion (acute poisoning)
Overload (fluid)
Uremia

PD indications: AEOU

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13
Q

Oliguria vs Anuria

A

Oliguria: < 400cc in 24hrs
Anuria: < 100cc in 24hrs

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14
Q

4 Phases of AKI Recovery:

Onset: time of _____ until S/S are seen

Oliguric: Acute _______, fluid _______, elevated BUN/Creatinine

Diuretic: Risk of complications from fluid and lyte ______

Recovery: Stabilization

A

4 Phases of AKI Recovery:

Onset: time of ONSET until S/S are seen

Oliguric: Acute HYPERK+, fluid OVERLOAD, elevated BUN/Creatinine

Diuretic: Risk of complications from fluid and lyte DEFICITS

Recovery: Stabilization

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15
Q

Enteric NS is a subdivision of the ____

It functions autonomously from the ___

A

ANS; CNS

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16
Q

Degluttition

A

Swallowing

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17
Q

Peristalsis is initiated by _______

A

Swallowing and chewing

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18
Q

Contain a network of capillaries and lymphatic vessels where nutrients are absorbed and transported to liver for further processing

A

Villi

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19
Q

Superior Mesenteric Artery: main supplier of blood to _________

_____ has a high demand for blood/oxygen = high risk of ________

The MA forms collateral circulation

Blood leaves via

A

Superior Mesenteric Artery: main supplier of blood to SMALL INTESTINE

SI has a high demand for blood/oxygen = high risk of ISCHEMIA

The MA forms collateral circulation

Blood leaves via MESENTERIC VEIN

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20
Q

When chyme enters the duodenum, it stimulates the ______ and liver to secrete ____ and the pancreas to release pancreatic enzymes

Bile aids in the breakdown of fats

A

When chyme enters the duodenum, it stimulates the GB and liver to secrete BILE and the pancreas to release pancreatic enzymes

Bile aids in the breakdown of fats

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21
Q

Hepatic artery brings oxygenated blood to the ______

_____ vein drains deoxygenated, but nutrient-rich blood from all other digestive organs and filters it before it returns to the lungs

A

Hepatic artery brings oxygenated blood to the LIVER

PORTAL vein drains deoxygenated, but nutrient-rich blood from all other digestive organs and filters it before it returns to the lungs

22
Q

________ is produced 2* to hypoxia

A

Lactic acid: body tissues are not getting enough oxygen

23
Q

If there is a GI bleed, there will be _________ peristalsis

A

Increased

24
Q

The anatomical division point between upper and lower GI bleed

A

Ligament of Treitz

25
Q

UPPER OR LOWER?

Hematemesis:
Coffee-Ground Emesis:
Melena:
Hematochezia:
Blood-streaked stool:

A

UPPER OR LOWER?

Hematemesis: UPPER
Coffee-Ground Emesis: UPPER
Melena: UPPER
Hematochezia: LOWER
Blood-streaked stool: LOWER

26
Q

Large blood loss = increased likeliness of _____

A

Rebleed

27
Q

_________ can be induced with rapid fluid resuscitation and can interfere with _______ leading to increased blood loss - _______ of fluids

A

_________ can be induced with rapid fluid resuscitation and can interfere with _______ leading to increased blood loss - _______ of fluids

28
Q

Which medication reduces splanchnic blood flow, resulting in the reduced portal and variceal pressures?

A

Octreotide

29
Q

What is the leading cause of GI hemorrhage?

A

Peptic Ulcer Disease

30
Q

What risk does mechanical ventilation for > 48hrs pose?

What can help prevent this?

A

Mucosal stress ulcers

Enteral feeding + PPIs

31
Q

What happens when blood cannot easily flow through the liver and blood flow is diverted?

A

Varices - veins become engorged and can rupture caused by HTN in the portal vein

MEDICAL EMERGENCY

32
Q

What needs to be at bedside after a patient has had a balloon tamponade to treat a variceal bleed?

A

Scissors

33
Q

Functions of the Liver:

  • Breaks down ______ and stores the extra glucose as glycogen
  • _______ the blood
  • Produces ______, _____ factors, vitamin ___, and _____
A

Functions of the Liver:

  • Breaks down CARBS and stores the extra glucose as glycogen
  • FILTERS the blood
  • Produces PROTEINS, CLOTTING factors, vitamin D, and BILE
34
Q

Normal Abdominal Pressure: < ____ mmHg

A

7

35
Q

IAP: 5-7 in critically ill adults

IAH: > ___mmHg

ACS: > _____mmHg

A

12; 20

36
Q

Main signs of worsening ACS:

  • Abdominal ________
  • Difficulty _____
  • Decreased ______ output
A

Main signs of worsening ACS:

  • Abdominal DISTENSION
  • Difficulty BREATHING
  • Decreased URINE output
37
Q

What are the pancreatic enzymes?

A

Amylase, protease, and lipase

38
Q

Two main causes of pancreatitis

A

Alcohol abuse
Gallstones

39
Q

Where may patient’s with pancreatitis experience pain?

What is Cullen’s sign?
What is Grey-Turner’s sign?

A

ULQ - radiate to back

Umbilicus
Flank

40
Q

Which enzyme is more specific to pancreatitis?

A

Lipase

41
Q

Will there be hypo or hypercalcemia in pancreatitis?

A

HYPO - calcium binds with fatty acids during tissue necrosis

42
Q

Three big complications of pancreatitis?

A

Hemorrhage (hypovolemic shock)
DIC (massive inflammation)
ARDS (massive inflammation)

43
Q

PANCREATITIS:

Pain: top priority - worsening pain can increase enzyme release = worsen inflammation (____ to chest position can help alleviate pain)

F/E: _____calcemia, ____magnesemia, ____glycemia, ___kalemia

Nutritional Support: _____ feeding is safe within first 24-48hrs

A

PANCREATITIS:

Pain: top priority - worsening pain can increase enzyme release = worsen inflammation (KNEE to chest position can help alleviate pain)

F/E: HYPOcalcemia, HYPOmagnesemia, HYPERglycemia, HYPOkalemia

Nutritional Support: ENTERAL feeding is safe within first 24-48hrs

44
Q

What is the difference between mechanical and functional bowel obstruction?

A

Functional does not have a physical blockage present

45
Q

What are the 5 mechanical BO?

A

Hernia
Tumour
Intussusception
Volvulus
Adhesions

46
Q

What acid-base balance is present with GI bleed?

A

Metabolic Alkalosis

47
Q

What does neuroglycopenic mean?

A

Results of brain glucose deprivation

48
Q

What medication may make it difficult to detect early signs of hypoglycemia?

A

BB - it suppresses the SNS

49
Q

What BG is considered pre-diabetes?
What BG is considered hyperglycemia?

A

5.6; 7.8

50
Q

Glucose is osmotically active. What is osmosis?

A

Movement of water from low to high concentration gradient (think of salt)

51
Q

What often triggers DKA?

A

Illness/Infection

ACU COURSE (8 decks)

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