ASSCC 1 Flashcards
6 CT findings in acute pancreatitis:
1) Fat stranding
2) Pseudocyst
3) Oedema
4) Collection
5) Abscess
6) Necrosis
Why does pancreatitis cause hyperglycaemia?
Pancreatic enzymes destroy β cells = increase in serum glucose
5 complications of acute pancreatitis:
1) Hypovolaemic shock
2) ARDS
3) Pseudocyst
4) Haemorrhagic pancreatitis
5) Sepsis
6) Multiorgan failure
6 causes acute pancreatitis:
1) Gallstones
2) Alcohol
3) Abdominal trauma
4) Post-ERCP
5) Thiazide diuretics
6) Steroids
7) Viral infections (mumps)
8) Hyperparathyroidism
3 exocrine secretions of pancreas:
1) Trypsinogen
2) Amylase
3) Lipase
Define pseudocyst:
Collection of amylase rich fluid enclosed in a wall of fibrous or granulation tissue. Takes > 4 weeks to form after onset of acute pancreatitis
4 symptoms of pseudocyst:
1) Vomiting
2) Epigastric swelling
3) Dyspepsia
4) Mild fever
5 complications pancreatitic pseudocyst:
1) Rupture
2) Bleeding from splenic vessels
3) Portal vein thrombosis
4) Infection
5) CBD obstruction
6) Cholangitis
4 line related complications of parenteral feeding?
1) Infection
2) Thrombosis
3) Pneumothorax
4) Haemothorax
2 feed related complications of parenteral feeding?
1) Fluid and electrolyte imbalances
2) Hypo/hyperglycaemia
3) Refeeding syndrome
4) Gut atrophy
6 TPN Indications:
1) Severe malnutrition >10% weight loss
2) Multiple trauma
3) Sepsis with MOF
4) Severe burns
5) Enterocutaneous fistula
6) IBD
7) Radiation enteritis
8) Short bowel
Routes of administration of TPN:
1) Central line
2) PICC
Type of electrolytes in TPN:
1) Sodium chloride
2) Calcium chloride
3) Potassium chloride
4) Magnesium chloride
What are the components of TPN?
Water Carbohydrates 50% Fats 30% Protein Vitamins Nitrogen Trace elements
kcal/g of energy of FAT:
9.3 kcal/g
kcal/g of energy of PROTEIN:
4.1 kcal/g
kcal/g of energy of CARBs:
4.1 kcal/g
4 Disadvantages of using glucose as sole energy source:
1) Critical ill pt unable to utilise due to stress response
2) Fatty liver
3) Deficiency in essential fatty acids
4) Respiratory failure (excess CO2 released on oxidation of glucose)
5 factors affecting epidural efficiency:
1) Level of injection
2) Drugs used
3) Dose of drug
4) Vasoconstrictors
5) Posture
6) Age, height, weight
Causes of gastric outlet obstruction:
Benign: pyloric stenosis due to chronic peptic ulceration
Malignant: Gastric or pancreatic carcinoma
ABG result gastric outlet obstruction:
Metabolic alkalosis
3 Biochemical abnormalities in gastric outlet obstruction:
1) Metabolic alkalosis
2) Hypochloraemia due to vomiting
3) Hypokalaemia due to ^aldosterone
Why is bicarbonate increased in gastric outlet obstruction?
- Increase in reabsorption of bicarb in renal tubules due to loss of Cl- due to vomiting
- Reduced pancreatic secretions = more bicarb rich secretions retained
Why paradoxical acuduria in gastric outlet obstruction?
- Hypovolaemia
- RAAS activation
- Na+ and H20 retained in exchange for H+ + K+
- Aciduria
Clinical presentation of hyponatraemia:
1) Agitation
2) Confusion
3) Reduced GCS
4) Seizure
5 differentials air under diaphragm on CXR:
1) Perforated viscus
2) Perforated DU
3) Perforated diverticulum
4) Ischaemic bowel
5) Necrotising enterocolitis
5 complications of aortic stenosis:
1) Left ventricular failure
2) Myocardial infarction
3) Arrhythmias
4) Infective endocarditis
5) Sudden death
Define perioperative hypothermia:
< 36 degrees
5 Risk factors for perioperative hypothermia:
1) Major surgery
2) Exposed surgery
3) Massive blood transfusion
4) Combined general and regional anaesthesia
5) Preoperative temp < 36 degrees
Causes of perioperative hypothermia:
1) Abolished behavioural responses (shivering)
2) Increased heat loss via radiation
3) Increased heat loss via evaporation from open cavities
4) Cooling effect of cold anaesthetic gases
5) Hypothalamic function altered by anaesthetic gases reducing heat production
6) Reduced metabolic heat production
7) Reduced muscle activity
CVS complications of hypothermia:
Reduced CO Arrhythmias Vasoconstriction ^PR interval Wide QRS
Resp complications of hypothermia:
Reduced resp drive
Increased pulmonary vascular resistance
V/Q mismatch
Renal complications of hypothermia:
Reduced renal blood flow
Reduced GFR
Cold diuresis
Haem complications of hypothermia:
Reduced plt function Reduced coagulation Increased fibrinolysis Increased haematocrit Left shift O2 dissociation curve
Metabolic complications of hypothermia:
Reduced basal metabolic rate
Metabolic acidosis
Insulin resistance
Hyperglycaemia
