Flashcards in Splanchnic Viscera- Exam 1 Deck (84):
What is viscera?
Pertaining to the internal organs located within the ventral body cavity
Where is the thoracic cavity?
Above the diphragm
What cavities are contained within the thoracic cavity?
Left pleural cavity
Right pleural cavity
Mediastinal cavity (includes pericardial)
What are the two cavities within the abdominopelvic cavity?
stomach, liver, spleen, GI Pancreas, kidneys
Last part of the large intestines and reproductive organs
What do body cavities do?
Body cavities protect organs and allow space for organ movement like inflation of lungs or contraction of heart
Refer to the vasculature within the abdominopelvic cavity priot to the iliac bifurcation of renal vessels
What is not considered part of the splanchnic system due to positioning function?
Direct aortic and IVC drainage
What are the limitations of research?
Small sample size
Difficulty in monitoring abdominal viscera and correlating to outcomes
Controlling for other variables
Updated Research: Incidence of GI Complication
Updated Research: LOS
19.3 vs 8.8
Updated Research: Inpatient Mortality
12.0% vs 2.5%
Risk Factors for Mortality of CPB and Splanchnic Circulation
Age > 65
Stores and breaks down ingested food via acids and enzymes (chyme); release into the small intestine controlled by pyloric sphincter
pulpy acidic fluid that passes from the stomach to the small intestine, consisting of gastric juices and partly digested food
What percent of nutrient absorption occurs in the small intestine?
How long is the small intestine?
First 10'' serves as "mixing bowl" for chyme and digestive enzymes from liver and pancreas
Approx 8'', primary site of chemical digestion and nutrient absorption
Approx 12' last section before large intestine. Large [ ] of lymphoid nodules to protect SI from bacteria in LI
How long is the large intestine?
What happens in the large intestine?
Small amount of nutrient absorption, primarily vitamins from bacterial byproducts, fluid, and bicarb reabsorption; compaction and storage of chyme into fecal matter
CPB and GI Effects
CPB results in an increase in intestinal blood flow due to decrease in R
Increase in BF independent of T, pH, or pCO2. *Autoregulation
Most studies show slight decrease in pH, but did not correlate to negative outcome
Intestinal BF during CPB seems to be independent of MAP and dependent on Q
Extensive use of what during CPB exacerbates the risk of inadequate mesenteric perfusion?
What's the incidence of GI complications in cardiac surgery?
What's the level of mortality in the GI instances in cardiac surgery?
Risk = probability x severity
Production of digestive enzymes and buffers (NaHCO3) to neutralize acidic chyme
What are the arterial blood sources of the pancreas?
Splenic, hepatic, sup. Mesenteric
The pancreas is primarily an _________ organ, but endocrine function is vital.
What percent of pancreas are islets of langerhans/pancreatic islets?
What cells are in the islets of langerhands/pancreatic islets?
produce somatostatin/tropin to suppress insulin and glucagon release
Pancreatic polypeptide; inhibits gall bladder contraction and some regulation of enzyme production
What cells comprise 99% of the pancreas?
breaks down starch/carbs
breaks down lipids
breaks down nucleic acids
proteases attack large proteins
peptidases break small peptides into amino acids
What is a common indicator for pancreatic injury? Does it correlate with negative post op symptoms
Elevate [amylase], did not correlate
Is amylase or lipase more sensitive?
Amylase more sensitive
Is amylase or lipase more specific?
Lipase more specific
How often does pancreatitis occur?
0.1-0.8 %, but carries increase mortality
What are the risk factors for pancreatitis?
Secondary to low cardiac output syndrome
What percent mortality does mild pancreatitis carry?
What percent mortality does severe pancreatitis carry?
Incidence of pancreatic injury post-CPB in peds?
What are the lab tests for pancreatitis in peds?
Red pulp in the Spleen
Big honking filter and storage
Post-splenectomry patients have what risk of infection and a _____% greater risk of future MIs
What is the largest visceral organ and multifunctional?
Blood flow supplied by hepatic artery at what rate?
Blood flow supplied by the portal vein at what rate?
What does the liver drain to?
Drains to IVC just below the diaphragm
Why should you use caution in placing venous cannula?
To avid obstruction and portal HTN
What does the liver also serve as?
Large blood reservoir
All blood leaving the absorptive sections of the GI tract flows where?
Into the liver via the hepatic portal vein
Blood leaving the liver allows nutrients and toxins to do what?
Be removed, stored, or allowed into the systemic circulation
Intrinsic regulation determines what?
Nutrient storage and release
Removal of damaged formed elements or pathogens is via what cells? (Livers)
Hematological Regulation of the Liver
Plasma protein synthesis
Antibody, toxin, hormone removal occur by various mechanisms
Carboxylation of Vit K dependent coagulation factors
How much bile is produced each day?
What is necessary for lipid digestion?
Where is bile stored?
Stored in gall bladder and release upon lipid detection in the duodenum (cholecystokinin stimulation bile production and gallbladder contraction)
What leads to "gall stones"?
Over concentrated bile leads
What blood flow increases slightly during CPB?
Hepatic blood flow
What is a primary factor in decreased clearance of drugs?
Hypothermia (although not all drugs illustrate decreased C)
What is an example of a hepatic function lab?
What is an example of hepatocellular leakage enzymes?
Types of total bilirubin
relative water insoluble
Alkaline Phosphatase (ALP)
Hepatic test; specific to the liver's biliary tree and represents biliary damage or cholestasis
What are some other hepatic tests?
5' Nucleotidase (5' NTD)
Splanchnic Flow Drugs
Dopaminergic (dopamine & dobutamine)
Fenoldopam mesylate (corlopam)
Dopaminergic (dopamine and dobutamine)
drugs help dilate splanchnic vessels during massive pressor administration for sepsis
Fenolopam mesylate (corlopam)
selective D1 agonist with no B effects, therefore the best choice for splanchnic perfusion
Describe the autoregulatory response to splanchnic circulation.
Muted autoregulatory response
Higher pressures do not seem to aid in splanchnic perfusion except to which organ?
Liver; overcome portal and IVC P