Splanchnic Viscera- Exam 1 Flashcards Preview

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Flashcards in Splanchnic Viscera- Exam 1 Deck (84):
1

What is viscera?

Pertaining to the internal organs located within the ventral body cavity

2

Where is the thoracic cavity?

Above the diphragm

3

What cavities are contained within the thoracic cavity?

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

4

What are the two cavities within the abdominopelvic cavity?

Abdominal cavity
Pelvic cavity

5

Abdominal cavity

stomach, liver, spleen, GI Pancreas, kidneys

6

Pelvic cavity

Last part of the large intestines and reproductive organs

7

What do body cavities do?

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

8

Splanchnic Circulation

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

9

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

Independent autoregulation
Direct aortic and IVC drainage
Kidneys

10

What are the limitations of research?

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

11

Updated Research: Incidence of GI Complication

4.1%

12

Updated Research: LOS

19.3 vs 8.8

13

Updated Research: Inpatient Mortality

12.0% vs 2.5%

14

Risk Factors for Mortality of CPB and Splanchnic Circulation

Age > 65
Dialysis
IABP
+Valve procedure
urgency

15

Stomach

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

16

Chyme

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

17

What percent of nutrient absorption occurs in the small intestine?

90%

18

How long is the small intestine?

20ft

19

Duodenum

First 10'' serves as "mixing bowl" for chyme and digestive enzymes from liver and pancreas

20

Jejunum

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

21

Ileum

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

22

How long is the large intestine?

5'

23

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

24

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

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