splanchic

Question 1

What is Viscera

Answer 1

Def: pertaining to the internal organs located within the ventral body cavity

Question 2

Thoracic Cavity- above diaphragm

Answer 2

a. left pleural cavity
b. right pleural cavity
c. mediastinal cavity (includes pericardial

Question 3

Abdominopelvic Cavity

Answer 3

a. abdominal cavity- stomach, liver, spleen, GI, pancreas, kidneys…
b. pelvic cavity- last part of large int. and reproductive organs

Question 4

Splanchnic circulation will refer to the

Answer 4

vasculature w/in the abdominopelvic cavity prior to the iliac bifurcation with the exception of renal vessels.

Question 5

kidneys are not considered part of splanchnic system. because

Answer 5

Due to positioning, function, independent autoregulation, and direct aortic and IVC drainage,

Question 6

CPB and Splanchnic Circulation

Limitations of research

Answer 6

1. Small sample size
2. Difficulty in monitoring abdominal viscera and correlating to outcomes
3. Conflicting data
4. Controlling for other variables

Question 7

risk factors for splanchic circulation and bypass

Answer 7

age > 65, dialysis, IABP (2o), +valve procedure, urgency

Question 8

Release into small intestine controlled by

Answer 8

pyloric sphincter

Question 9

how long is small intestine and how much food is absorbed here

Answer 9

20 ft. 90%

Question 10

Duodenum- first

Answer 10

10”, serves as “mixing bowl” for chyme and digestive enzymes from liver and pancreas

Question 11

Jejunum-

Answer 11

approx 8’, primary site of chemical digestion and nutrient absorption

Question 12

Ileum-

Answer 12

approx 12’, last section before large int. Large [ ] of lymphoid nodules to protect SI from bacteria in LI.

Question 13

Large Intestine

Answer 13

(5ft)
•Small amount of nutrient absorption, primarily vitamins from bacterial byproducts, fluid, and bicarb resorption
•Compaction and storage of chyme into fecal matter

Question 14

CPB results in an increase in intestinal blood flow due to

Answer 14

a decrease in resistance

Question 15

increase BF is independent of

Answer 15

T, pH, or pCO2. (autoregulation?)

Question 16

Intestinal BF during CPB seems to be independent of

Answer 16

MAP and dependent on Q

Question 17

Extensive use of vasoconstrictors during CPB exacerbates the risk

Answer 17

inadequate mesenteric perfusion

Question 18

Takeaway: Cardiac surgery is associated with a relatively low incidence of GI complications but those complications cause

Answer 18

a vastly disproportionate level of mortality

Risk = probability X severity

Question 19

Pancreas

•Primary function is

Answer 19

production of digestive enzymes and buffers (NaHCO3) to neutralize acidic chyme.

Question 20

Several arterial blood sources from pancreas

Answer 20

splenic, hepatic, and sup. Mesenteric

Question 21

pancreas is 99%

Answer 21

exocrine

Question 22

Alpha cells

Answer 22

produce glucagon

Question 23

beta cells

Answer 23

produce insulin

Question 24

delta cells

Answer 24

produce somatostatin/tropin to suppress insulin and glucagon release

Question 25

F cells-

Answer 25

pancreatic polypeptide; inhibits gall bladder contraction and some regulation of enzyme production

Question 26

Acinar Cells comprise

Answer 26

99% of pancreas

Question 27

Amylase

Answer 27

break down starch and carbs

Question 28

lipase

Answer 28

breaks down lipids

Question 29

nuclease breaks down

Answer 29

nucleic acids

Question 30

Proteolytic enzymes

Answer 30

Proteases attack large proteins | •Peptidases break small peptides into amino acids

Question 31

Elevated [amylase], a common indicator

Answer 31

for pancreatic injury did not correlate to negative post-op symptoms Amylase more sensitive, Lipase more specific

Question 32

Pancreatitis occurs infrequently

Answer 32

(0.1-0.8%), but carries ↑ mortality

Question 33

risk factors for pancreatitis

Answer 33

CPB time and hypotension secondary to low cardiac output syndrome

Question 34

Mild pancreatitis carries

Answer 34

50% mortality

Question 35

Severe pancreatitis carries

Answer 35

67-100 %

Question 36

Much higher incidence of pancreatic injury post-CPB in

Answer 36

peds (4-8%)

Question 37

Lab tests for pancreatitis in peds are

Answer 37

trypsinogen-2 and trypsin-2-α 1-antitrypsin

Question 38

Red pulp

Answer 38

big honking filter and storage

Question 39

White pulp:

Answer 39

lymphoid tissues

Question 40

Post-splenectomy patients have a substantially greater risk of

Answer 40

infection and a 33% greater risk of future MIs.

Question 41

Blood flow supplied by hepatic artery at

Answer 41

400cc/min and portal vein at 1000cc/min

Question 42

liver Drains to the

Answer 42

IVC just below the diaphragm

Question 43

use caution in placing venous

Answer 43

cannula to avoid obstruction and portal HTN.

Question 44

Liver | 1.Metabolic Regulation

Answer 44

All blood leaving the absorptive sections of the GI tract flows into the liver via the hepatic portal vein. •This allows nutrients and toxins to be removed, stored, or allowed into the systemic circulation •Intrinsic regulation determines nutrient storage or release

Question 45

Liver | 2.Hematological Regulation

Answer 45

Removal of damaged formed elements or pathogens via Kupfer cells •Plasma protein synthesis •Antibody, toxin, and hormone removal occur by various mechanisms •Carboxylation of vit K dependent coagulation factors

Question 46

Liver 3.Bile production •

Answer 46

Approx. 1L produced each day •Necessary for lipid digestion •Stored in gall bladder and released upon lipid detection in the duodenum (cholecystokinin stimulates bile production and gallbladder contraction) •Over concentrated bile leads to “gall stones”

Question 47

Hepatic blood flow increases

Answer 47

slightly during CPB. Perfusion is ↑ with ↑Q.

Question 48

cpb and liver. Hypothermia is primary factor in decreased

Answer 48

clearance of drugs (Although not all drugs illustrate ↓C)

Question 49

may show hepatic markers of injury

Answer 49

Valve procedures, transfusions, and prolonged CPB times

Question 50

Hepatic tests: | –Albumin

Answer 50

a hepatic function lab

Question 51

Serum glutamic and oxaloacetic transaminase (SGOT) / Aspartate aminotransferase (AST) and Serum Glutamic pyruvic transaminase (SGPT) / Alanine aminotransferase (ALT

Answer 51

are fairly specific hepatocellular leakage enzymes

Question 52

Total Bilirubin: | •Unconjugated

Answer 52

water insoluble

Question 53

conjugated or direct bilirubin

Answer 53

water soluble

Question 54

Alkaline phosphatase (ALP) is specific

Answer 54

to the liver’s biliary tree and represents biliary damage or cholestasis –Others (INR, PT, LDH, 5’ Nucleotidase (5’NTD)

Question 55

Dopaminergic (Dopamine & Dobutamine) drugs help

Answer 55

dilate splanchnic vessels during massive pressor administration for sepsis (explain)

Question 56

Fenoldopam mesylate (Corlopam)

Answer 56

is a selective D₁ agonist with no β effects, therefore best choice for splanchnic perfusion

Question 57

Unlike the brain or kidneys during CPB

Answer 57

there appears to be a muted autoregulatory response to the splanchnic circulation

Question 58

Higher pressures do not seem to aid in

Answer 58

splanchnic perfusion except to liver (overcome portal and IVC P).

Question 59

Although there is a low incidence of splanchnic injury,

Answer 59

the consequences carry high mortality rates.

Question 60

The one constant is that longer CPB times have

Answer 60

higher incidence of post-op complications.

Question 61

Pulsatile perfusion may ameliorate some short term dysfunction but

Answer 61

has not been proven to reduce gross injury.

Question 62

In theory, increasing CPB flow during longer pumps times may

Answer 62

reduce complications

Question 63

OPCAB splanchic

Answer 63

No apparent benefit

Question 64

Pre-existing conditions that predispose patients to splanchic injury

Answer 64

(ie ulcer), advanced age, atherosclerosis, redo procedures, and combined procedures