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Anesthesia Basics > Ch. 28 Renal, Liver, and Biliary Tract Disease > Flashcards

Ch. 28 Renal, Liver, and Biliary Tract Disease Flashcards

1
Q

What does AKI stand for?

A

Acute Kidney Injury

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2
Q

The kidneys account for about ___% of total body weight and account for about ___% of cardiac output.

A

0.5%; 20%

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3
Q

(autoregulation) Renal blood flow and GFR remain relatively constant at renal arterial pressures of ___-___mmHg.

A

80-180mmHg

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4
Q

When might the renal autoregulation range be different?

A

chronic HTN

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5
Q

Any decrease in renal blood flow will initiate the release of _____.

A

renin

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6
Q

Roughly what percent of fluid that flows through glomeruli is reabsorbed?

A

~90%

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7
Q

What is normal GFR?

A

125cc/min

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8
Q

Renin may be released in response to any of three conditions - name them

A

SNS stimulation, decreased renal perfusion pressure, decreased sodium delivery to distal convoluted tubule

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9
Q

Prostaglandins may be released in response to any of three conditions - name them

A

sympathetic stimulation, HoTN, increased levels of angiotensin II

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10
Q

What is arginine vasopressin (AVP)?

A

ADH

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11
Q

Where does AVP bind?

A

V2 receptors in collecting duct

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12
Q

AVP has what effect on serum and urine osmolality?

A

decreases serum osmolality; increases urine osmolality

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13
Q

Which are more efficiently filtered at the glomerulus - drugs that are highly protein-bound drugs or those that are not?

A

drugs that are not highly protein-bound

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14
Q

What kind of drugs undergo passive reabsorption in the proximal and distal tubules?

A

un-ionized acidic drugs and basic drugs

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15
Q

What are the flaws in using serum Cr concentration as a measure of GFR?

A

concentration is dependent upon muscle mass

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16
Q

What are the flaws in using BUN as a measure of GFR?

A

influenced by protein metabolism and flow through renal tubules

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17
Q

Formula for determining GFR from serum Cr?

A

GFR = (140 - age) x kg wt/serum Cr x 72

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18
Q

Which method for determining GFR requires urinalysis and blood gas analysis?

A

creatinine clearance testing

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19
Q

Can proteins travel through the glomerulus?

A

yes, small ones can

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20
Q

What is proteinurea?

A

high levels of protein in the urine

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21
Q

Proteinurea is caused by what?

A

abnormally high filtration of protein, exercise, fever, or CHF

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22
Q

Which diuretics cause hypokalemic, hypochloremic metabolic alkalosis?

A

thiazides and loop diuretics

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23
Q

Which diuretics cause hyperglycemia?

A

loop diuretics (somewhat) and thiazides

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24
Q

What are side effects associated with diuretic-induced hypokalemia?

A

skeletal muscle weakness, risk of digitalis toxicity, enhancement of non-depolarizing NMBD

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25
Q

What is the most commonly administered osmotic diuretic?

A

mannitol (a six-carbon sugar)

26
Q

Fluid overload secondary to cirrhosis is often treated with what diuretic?

A

spironolactone

27
Q

What is the predominant cause of death in patients with ESRD?

A

cardiovascular disease

28
Q

What are two of the most common reasons for systemic HTN in ESRD pts?

A

hypervolemia and excess activation of the renin-angiotensin-aldosterone system

29
Q

Patients with prerenal oliguria have decreased/increased levels of Na+ in the urine? Why?

A

decreased. Low kidney perfusion due to hypovolemia or poor cardiac output - kidneys trying to conserve volume.

30
Q

Patients with intrinsic renal disease have decreased/increased levels of Na+ in the urine? Why?

A

increased. Tubules ineffective at reabsorbing Na+.

31
Q

The liver receives what percent of CO?

A

~25%

32
Q

Most of the blood to the liver comes via the _____ with the rest supplied by the ______.

A

portal vein; hepatic artery

33
Q

How is hepatic blood flow determined?

A

MAP or (portal vein P - hepatic vein pressure) and splanchnic vascular resistance

34
Q

What is the main organ for the storage and release of glucose?

A

liver

35
Q

In what form is glucose stored? What hormone releases glucose from its stored form back into the bloodstream? What is the process called?

A

glycogen; glucagon; gluconeogenesis

36
Q

Hepatocytes are responsible for the synthesis of the majority of procoagulent proteins as well as regulators except for which factor?

A

factor VIII

37
Q

Hepatic metabolism of drugs is characterized by the conversion of _____-soluble drugs to _____-soluble drugs.

A

lipid; water

38
Q

What are the three phases of hepatic metabolism of drugs?

A

polarization, conjugation, excretion

39
Q

What percentage of erythrocyte production occurs in the liver (in adults)?

A

~20%

40
Q

Heme degradation results in what end product?

A

bilirubin

41
Q

In the liver, bilirubin is turned into what?

A

bile

42
Q

Does the liver store dietary fat as triglycerides, cholesterol and phospholipids?

A

yes it does!

43
Q

What is hepatic encephalopathy?

A

worsening brain function when the liver is no longer able to get rid of toxic substances (i.e. ammonia)

44
Q

What is physiologic shunting?

A

passage of blood from the arterial to venous side of circulation without effectively traversing a capillary bed (i.e. spider veins)

45
Q

Gastric varices can develop as a result of what?

A

high resistance of blood flow through liver (characteristic of ESLD)

46
Q

What drug has been shown to decrease symptoms of hepatic encephalopathy?

A

flumazenil

47
Q

With severe liver disease, highly protein bound drugs are more likely to be found in the _____ form.

A

unbound

48
Q

What is ascites?

A

buildup of fluid between lining of abdomen and abdominal organs

49
Q

Inhaled anesthetics and regional anesthesia both _____ hepatic bloodflow __-__% in the absence of surgical stimulation.

A

decrease; 20-30%

50
Q

What is a pre-operative test the can be used to assess liver function?

A

a liver function test

51
Q

The Child-Pugh score is used to assess what?

A

severity of liver dysfunction

52
Q

The MELD score is used to assess what?

A

severity of liver dysfunction

53
Q

Why might liver disease be exposed during surgery?

A

The liver has large reserves, so when part of it is damaged, it won’t necessarily show up on a liver function test. The decrease in liver function during anesthesia exposes it.

54
Q

Patients with what condition may bleed when a TEE probe is placed?

A

esophageal varices

55
Q

IV anesthetics have what effect on hepatic blood flow?

A

minimal

56
Q

Sympathetic stimulation has what effect on hepatic blood flow?

A

decreases

57
Q

Which volatile anesthetic can cause hepatotoxicity?

A

halothane

58
Q

Alcohol has what effect on gastric emptying?

A

slows

59
Q

What is the treatment for alcohol withdrawal?

A

benzos

60
Q

How common are gallstones in men and women between ages of 55-65?

A

men ~10%, women ~20%

61
Q

What are the reasons for using an OG or NG tube during laparoscopic surgery?

A

decompression of stomach decreases risk for visceral puncture at time of needle insertion; also improves visualization

Anesthesia Basics (13 decks)

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