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CV Perf Tech III > Splanchnic Viscera- Exam 1 > Flashcards

Splanchnic Viscera- Exam 1 Flashcards

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1
Q

What is viscera?

A

Pertaining to the internal organs located within the ventral body cavity

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2
Q

Where is the thoracic cavity?

A

Above the diphragm

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3
Q

What cavities are contained within the thoracic cavity?

A

Left pleural cavity
Right pleural cavity
Mediastinal cavity (includes pericardial)

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4
Q

What are the two cavities within the abdominopelvic cavity?

A

Abdominal cavity

Pelvic cavity

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5
Q

Abdominal cavity

A

stomach, liver, spleen, GI Pancreas, kidneys

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6
Q

Pelvic cavity

A

Last part of the large intestines and reproductive organs

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7
Q

What do body cavities do?

A

Body cavities protect organs and allow space for organ movement like inflation of lungs or contraction of heart

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8
Q

Splanchnic Circulation

A

Refer to the vasculature within the abdominopelvic cavity priot to the iliac bifurcation of renal vessels

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9
Q

What is not considered part of the splanchnic system due to positioning function?

A

Independent autoregulation
Direct aortic and IVC drainage
Kidneys

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10
Q

What are the limitations of research?

A

Small sample size
Difficulty in monitoring abdominal viscera and correlating to outcomes
Conflicting data
Controlling for other variables

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11
Q

Updated Research: Incidence of GI Complication

A

4.1%

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12
Q

Updated Research: LOS

A

19.3 vs 8.8

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13
Q

Updated Research: Inpatient Mortality

A

12.0% vs 2.5%

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14
Q

Risk Factors for Mortality of CPB and Splanchnic Circulation

A 
Age > 65
Dialysis
IABP 
\+Valve procedure
urgency
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15
Q

Stomach

A

Stores and breaks down ingested food via acids and enzymes (chyme); release into the small intestine controlled by pyloric sphincter

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16
Q

Chyme

A

pulpy acidic fluid that passes from the stomach to the small intestine, consisting of gastric juices and partly digested food

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17
Q

What percent of nutrient absorption occurs in the small intestine?

A

90%

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18
Q

How long is the small intestine?

A

20ft

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19
Q

Duodenum

A

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

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20
Q

Jejunum

A

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

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21
Q

Ileum

A

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

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22
Q

How long is the large intestine?

A

5’

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23
Q

What happens in the large intestine?

A

Small amount of nutrient absorption, primarily vitamins from bacterial byproducts, fluid, and bicarb reabsorption; compaction and storage of chyme into fecal matter

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24
Q

CPB and GI Effects

A

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

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25
Extensive use of what during CPB exacerbates the risk of inadequate mesenteric perfusion?
Vasoconstrictors
26
What's the incidence of GI complications in cardiac surgery?
Low
27
What's the level of mortality in the GI instances in cardiac surgery?
High
28
Risk equation
Risk = probability x severity
29
Pancreas Function
Production of digestive enzymes and buffers (NaHCO3) to neutralize acidic chyme
30
What are the arterial blood sources of the pancreas?
Splenic, hepatic, sup. Mesenteric
31
The pancreas is primarily an _________ organ, but endocrine function is vital.
Exocrine (99%)
32
What percent of pancreas are islets of langerhans/pancreatic islets?
1%
33
What cells are in the islets of langerhands/pancreatic islets?
Alpha cells Beta cells Delta cells F cells
34
Alpha Cells
produce glucagon
35
Beta cells
Produce insulin
36
Delta cells
produce somatostatin/tropin to suppress insulin and glucagon release
37
F cells
Pancreatic polypeptide; inhibits gall bladder contraction and some regulation of enzyme production
38
What cells comprise 99% of the pancreas?
Acinar Cells
39
Amylase
breaks down starch/carbs
40
Lipase
breaks down lipids
41
Nuclease
breaks down nucleic acids
42
Proteolytic enzymes
proteases attack large proteins | peptidases break small peptides into amino acids
43
What is a common indicator for pancreatic injury? Does it correlate with negative post op symptoms
Elevate [amylase], did not correlate
44
Is amylase or lipase more sensitive?
Amylase more sensitive
45
Is amylase or lipase more specific?
Lipase more specific
46
How often does pancreatitis occur?
0.1-0.8 %, but carries increase mortality
47
What are the risk factors for pancreatitis?
CPB time hypotension Secondary to low cardiac output syndrome
48
What percent mortality does mild pancreatitis carry?
50% mortality
49
What percent mortality does severe pancreatitis carry?
67-100%
50
Incidence of pancreatic injury post-CPB in peds?
4-8%
51
What are the lab tests for pancreatitis in peds?
Trypsinogen-2 | Trypsin-2-alpha-1- antitrypsin
52
Red pulp in the Spleen
Big honking filter and storage
53
White pulp
lymphoid tissues
54
Post-splenectomry patients have what risk of infection and a _____% greater risk of future MIs
33%
55
What is the largest visceral organ and multifunctional?
Liver
56
Blood flow supplied by hepatic artery at what rate?
400 cc/min
57
Blood flow supplied by the portal vein at what rate?
1000 cc/min
58
What does the liver drain to?
Drains to IVC just below the diaphragm
59
Why should you use caution in placing venous cannula?
To avid obstruction and portal HTN
60
What does the liver also serve as?
Large blood reservoir
61
All blood leaving the absorptive sections of the GI tract flows where?
Into the liver via the hepatic portal vein
62
Blood leaving the liver allows nutrients and toxins to do what?
Be removed, stored, or allowed into the systemic circulation
63
Intrinsic regulation determines what?
Nutrient storage and release
64
Removal of damaged formed elements or pathogens is via what cells? (Livers)
Kupfer cells
65
Hematological Regulation of the Liver
Plasma protein synthesis Antibody, toxin, hormone removal occur by various mechanisms Carboxylation of Vit K dependent coagulation factors
66
How much bile is produced each day?
1L
67
What is necessary for lipid digestion?
Bile production
68
Where is bile stored?
Stored in gall bladder and release upon lipid detection in the duodenum (cholecystokinin stimulation bile production and gallbladder contraction)
69
What leads to "gall stones"?
Over concentrated bile leads
70
What blood flow increases slightly during CPB?
Hepatic blood flow
71
What is a primary factor in decreased clearance of drugs?
Hypothermia (although not all drugs illustrate decreased C)
72
What is an example of a hepatic function lab?
Albumin
73
What is an example of hepatocellular leakage enzymes?
SGOT (AST) | SGPT (ALT)
74
Types of total bilirubin
Unconjugated | Direct
75
Unconjugated
relative water insoluble
76
Direct
Water soluble
77
Alkaline Phosphatase (ALP)
Hepatic test; specific to the liver's biliary tree and represents biliary damage or cholestasis
78
What are some other hepatic tests?
INR PT LDH 5' Nucleotidase (5' NTD)
79
Splanchnic Flow Drugs
``` Dopaminergic (dopamine & dobutamine) Fenoldopam mesylate (corlopam) ```
80
Dopaminergic (dopamine and dobutamine)
drugs help dilate splanchnic vessels during massive pressor administration for sepsis
81
Fenolopam mesylate (corlopam)
selective D1 agonist with no B effects, therefore the best choice for splanchnic perfusion
82
Describe the autoregulatory response to splanchnic circulation.
Muted autoregulatory response
83
Higher pressures do not seem to aid in splanchnic perfusion except to which organ?
Liver; overcome portal and IVC P
84
What pre-existing conditions predispose patients to a higher incidence risk of injury?
Advanced age, athersclerosis, redo procedures, combined procedures predispose patients to a higher incidence risk of injury

CV Perf Tech III (16 decks)

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