Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles I* > E3- GU Procedures > Flashcards

E3- GU Procedures Flashcards

1
Q

6 Indications for Urological Surgery

A

Direct visualization of urethra, bladder, ureter, kidney
* Biopsies/evaluate bleeding
* Retrograde pyelography
* Laser/retrieve stones
* Remove/treat stricture
* Resect masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

%%%

List the structures of the genitourinary system from the top to bottom.

A
  • Kidney
  • Ureter
  • Bladder
  • Urethra
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What position will the patient be in for Urological Surgery?

A
  • Lithotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In the Lithotomy position, the stirrups can cause what type of nerve injury?

A
  • Peroneal Nerve Injury
  • Femoral Nerve Injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What other problems can occur besides nerve injuries in the Lithotomy position?

A
  • Skin breakdown d/t stirrup pressure
  • Hip dislocation
  • Back strains
  • Vessel compression (DVT, Compartment Syndrome)

Remember to move both legs simultaneously to prevent torsion and injury to lower spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What lab is the best measure of glomerular function?

A
  • GFR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is normal GFR?
When will patients become symptomatic?

A
  • 125 mL/min
  • Asymptomatic until a 50% drop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What will be the result of moderate GFR insufficiency?

A
  • ↑ BUN/Creat
  • Anemia
  • Decreased energy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What will be the result of severe GFR insufficiency?

A
  • Profound uremia (high levels of waste product in the blood)
  • Acidemia
  • Volume overload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

%%%

What is BUN?

A
  • Blood Urea Nitrogen
  • BUN measures the amount of nitrogen in the blood that comes from the waste product urea.
  • Urea is produced when the body breaks down proteins from the food we eat.
  • The liver then processes this nitrogen into urea, which is eventually eliminated from the body through urine.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a Normal BUN?

A
  • 8-18 mg/ dL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What will influence the BUN level?

A
  • Exercise
  • Steroids
  • Dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

BUN will not be elevated in the kidney disease until GFR is ________% of normal.

A
  • 75%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

%%%

What is Creatinine?

A
  • Creatinine is a waste product that comes from muscle metabolism.
  • It is produced at a relatively constant rate and is filtered out of the blood by the kidneys, then excreted through urine.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is normal Creatinine? Varies with?

A
  • 0.8 - 1.2 mg/dL
  • Varies with age and gender
  • Higher in men d/t more muscle mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are 6 considerations during the preoperative evaluations of patients with Chronic Renal Failure?

A
  • Hypervolemia = ↑Na, ↑H2O
  • Acidosis = ↓ production of ammonia, ↑ Anion Gap
  • Hyperkalemia = normally managed … precipitated by hemorrhage, met acidosis
  • HTN d/t RAAS
  • Cardiac/Pulmonary Symptoms = arthersclerosis, pulm edema, vent hypertrophy
  • Hematologic Symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of anemia with CRF pts have? what is abnormal?

A
  • normochromic (color) , normocytic (size) , iron defecient anemia
  • abnormal :: plt aggregation + prothrombin consumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Because most anesthetic drugs are lipid soluble in a non-ionized state, termination doesn’t depend on _________.

A
  • Renal Excretion

Metabolite of these drugs are excreted as water-soluble compounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 7 drugs of concern for patients with Renal Insufficiency?

A
  • Drugs that are highly ionized and eliminated unchanged in urine
  • Muscle relaxants (pancuronium)
  • H2 antagonists
  • Cholinesterase inhibitors (neostigmine)
  • Thiazide diuretics
  • Digoxin
  • Many antibiotics
  • Active metabolites of opioids (morphine/meperidine/ketamine/midazolam)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

%%%

What is the active metabolite of morphine?

A
  • Morphine-6-glucuronide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Renal Protection strategies

A

Pts w/ moderate RI - cardiac sx + AKI (sepsis, crush, burn, nsaids)
* hydration
* adequate RBF
* NOT helpful = mannitol, low dose dopamine , fenoldopam , loop d, bicacrb gtt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Only renal protection strategy proven to work

A

N-Acetylcysteine (dye injuries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Mortality rate of AKI?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are examples of endoscopic evaluations (scope procedures) of the lower urinary tract?

A
  • Through urethra = urethroscopy
  • Through bladder = cystoscopy
  • Through ureteral orifice = ureteroscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the two types of scopes used for urological procedures?

A
  • Flexible
  • Rigid (this scope NOT into ureter, it will stop in the bladder)

Scope hooked to irrigation system
Guid Wire is inserted through scope for catheter and instruments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Purpose of a urethroscopy/cystoscope.

A
  • Visualize the urethra and/or bladder d/t urinary symptoms (Pain, burning, hematuria, difficult urination.)
  • Diagnose and Treat a lesion or stricture (dilate stricture, treat cystitis, stent placement, resect tumors).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

The procedure of choice for mid/distal ureter or bilateral stones.

A
  • Ureteroscopy (flexible scope)

Can incorporate laser technology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What percentage of men and women lifetime will experience ureter stones?

What is the recurrence percentage?

Stones contain ______ and are _____.

A
  • Men: 10%
  • Women: 5%
  • Recurrence: 50%
  • Calcium ,, radiopaque
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Ureter stones are diagnosed using _______, _______, and ________.

A
  • CT
  • KUB X-RAY
  • IVP (Intravenous Pyelogram)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Complications of ureteroscopy are low.
What is the percentage for perforation?
What is the percentage of stricture formation?

A
  • Perforation: 5%
  • Stricture formation: <2%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some medical therapy for ureter stones?

A
  • MET (Medical Expulsive Therapy)
  • NSAIDs
  • Aggressive Fluid intake
  • CCB and alpha blockers to vasodilate - relax ureter
  • Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are 3 choices for surgery for ureter stones?

A
  • Stone basket vs. Laser (preferred) - uteroscopy
  • Shock Wave Lithotripsy
  • Percutaneous nephrolithotomy (least preferable)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Shock wave Lithotripsy is best suited for __________ intranephric stones.

A
  • small/medium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the risk for Shock Wave Lithotripsy (SWL)?

A
  • kidney injury (trauma from pressure)
  • sub-capsular hematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Compare the Old SWL vs New SWL.

A
  • Old SWL: Water baths, hypothermia, painful
  • New SWL: Water-filled coupler device, focus beam, decrease pressure pulse, less painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are ABSOLUTE contraindications to SWL?

A
  • Bleeding disorder/ anticoagulants
  • Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

5 RELATIVE contraindications to lithotripsy

A
  • Large calcified aortic/renal aneurysms
  • Untreated UTI
  • Obstruction distal to the renal calculi
  • Pacemaker, ICD, neuro-stimulate
  • Morbid obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Preoperative anesthetic considerations for SWL, stone basket, or laser therapy.

A
  • Single PIV
  • Consider anxiolytics
  • Appropriate ABX within 1 hour “cut time”
  • Iodine Allergy - pretreat with benadryl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Intraoperative anesthetic considerations for SWL, stone basket, or laser therapy.

A
  • Local vs. General (most people will be general)
  • LMA vs ETT
  • Minimal narcotics
  • Consider antiemeticc
  • **Eye covering for laser **
  • Lead for providers

PACU postop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What procedure will be indicated for large intranephric stone removal?

A
  • Percutaneous Nephrolithotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Describe a percutaneous nephrolithotomy.

A
  • Minimally-invasive procedure to remove stones from the kidney by a small puncture wound through the skin.
  • The procedure will** require initial stent placement** of ureteral stents to prevent obstruction as the fragment passes
  • Uses lg amt fluoroscopy
  • Transurethral Resection syndrome possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Preoperative anesthetic considerations for percutaneous nephrolithotomy.

A
  • Single PIV
  • Consider anxiolytics
  • Appropriate ABX within 1 hour “cut time”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Intraoperative anesthetic considerations for percutaneous nephrolithotomy.
Position? NMBD?

A
  • General ETT
  • Short NMBD’s
  • Lateral position (bean bag, pillows)
  • Lead apron for provider
  • Eye covering for laser (document!)
44
Q

What is an orchiectomy?

A
  • one or both testicles are removed.
  • Almost always bilateral
  • Spermatic cord is clamped, cut, and sutured
  • metastatic prostate cancer
45
Q

What is a Hydrocelectomy?

A
  • remove a hydrocele.
  • A hydrocele is a fluid-filled sac inside the scrotum.
  • Wall of hydrocele excised and edges sutured to prevent recurrence.
46
Q

Testicular torsion must be performed within ____ hours to prevent irreversible ischemia.

A
  • 6 hours
47
Q

What are the reasons for circumcision in older males?

A
  • Phimosis (tight foreskin)
  • Penile/ prostate cancer risk
48
Q

What is hypospadias?

A
  • Birth defect in boys
    opening of the urethra is not located at the tip of the penis.
49
Q

What is a Penectomy?

A
  • Removal of squamous cell carcinoma on the penis or inguinal lymph node.
50
Q

What population group would seek a penile prosthesis discussed in the lecture?
Special considerations?

A
  • Diabetic patients
  • Spinal cord injury patients
  • Infection risk !!
51
Q

Anesthetic considerations for scrotal and penile operations.

A
  • Preop anxiolytics
  • General: ETT vs LMA
  • Supine
  • Penile Block :: (S2-S4) = pudendal nerve
  • SCIP (take care with prosthesis touching skin before insertion)
  • Manipulation of genitals —vagal bradycardia, have glycopyrrolate ready
52
Q

What is a Cystectomy?

A
  • Surgical removal of all or part of the urinary bladder.
53
Q

What are the indications for cystectomy?

A
  • Simple-benign conditions (hemorrhagic cystitis, radiation cystitis)
  • Radical - malignant conditions (bladder cancer, includes removal of ureters, prostate, uterus, ovaries)
  • Requires ileal conduit or bladder substitution
54
Q

Preoperative anesthetic considerations for cystectomy.

A
  • Risk factors for CAD or pulmonary disease, CXR? (older patients)
  • Anticoagulant use. EKG?
  • Bowel prep
55
Q

Intraoperative anesthetic considerations for cystectomy.

A
  • GETA, SAB, epidural
  • Supine
  • SCIP
56
Q

What are 3 common complications of cystectomy?

A
  • Blood loss: up to 3L — 1-2 PIV, type and crossmatch blood
  • 3rd space losses d/t open belly
  • Hypothermia — prepping lg area
57
Q

What is a TURP?

A
  • Transurethral Resection of Prostate
  • Surgical procedure that involves cutting away a section of the prostate using a laser or electrocautery.
  • Usually done on elderly patients to treat BPH, the gold standard
58
Q

What is the estimated blood loss of a TURP?

A
  • 100-200 mL
59
Q

What comorbidities will patients receiving a TURP procedure have?

A
  • Patients are generally in their 30-50’s
  • Obesity
  • HTN
  • Hyperparathyroidism
  • Chronic Renal Insufficiency
  • DM
  • Paraplegia
60
Q

Preoperative anesthetic considerations for TURP?

A
  • Consider comorbidities
  • Consider if the patient is on anticoagulants
  • Large bore IV (18G or 16G)
61
Q

Intraoperative anesthetic considerations for TURP?

A
  • General/ SAB (textbook: perform a SAB)
  • Lithotomy
  • Possible transfusion
  • TUR syndrome

The reason why you want to perform a SAB for a TURP is to assess for TUR Syndrome. You can assess when a patient begins to become confused versus being under general anesthesia.

62
Q

What are anesthetic considerations to take into account for robotic prostatectomy?

A
  • Insertion of an arterial line (we want to watch the blood pressure d/t to lack of fluid).
  • Phenylephrine drip
  • LIMIT IV fluids
63
Q

What is TUR syndrome?

A
  • Symptoms r/t hypervolemic water intoxication
  • Excessive volume expansion through venous sinuses
  • > > Hyponatremia

D/t Irrigating fluid!

64
Q

What are CNS and EKG changes with a serum Na+ level of 120 mEq/L?

A

CNS changes: Confusion, Restlessness
EKG changes: Widening of QRS

65
Q

What are CNS and EKG changes with a serum Na+ level of 115 mEq/L?

A

CNS changes: Somnolence, Sleepy, Nausea
EKG changes: Elevated ST segments, Widened QRS

66
Q

What are CNS and EKG changes with a serum Na+ level of 110 mEq/L?

A

CNS changes: Seizure, Coma, Death
EKG changes: V-tach, V-fib

67
Q

What are the types of irrigants used in TURP?

A
  • Saline- volume overload, current dispersion with monopolar cautery
  • Glycine- metabolized in liver to ammonia
  • Water- intravascular hemolysis
  • Sorbitol- metabolized to CO2 and fructose, volume overload
68
Q

What is the irrigation rate for a TURP?
What is the absorption rate of irrigation fluid for a TURP?

A
  • Irrigation rate: 300 ml/min
  • Absorption rate: 20 to 200 ml/min
69
Q

Greater than _______ (volume) of irrigation fluid absorption is usually required for TUR syndrome.

A
  • 2 Liters
70
Q

How do you prevent TUR syndrome? 3

A
  • Limit resection time to 1 hour
  • Suspend the irrigation fluid less than 30 cm above the table
  • Treat hypotension for SAB with vasopressors NOT IVF
71
Q

Treatment of TUR Syndrome (Mild vs Severe)

A
  • ABC’s
  • Stop the procedure
  • Consider invasive lines…for cardiovascular instability
  • For Mild symptoms (Na > 120): Fluid restriction and Loop diuretics
  • Severe symptoms (Na < 120): 3% IV saline
72
Q

What is a nephrectomy?

A
  • Surgical removal of a kidney, performed to treat several kidney diseases.
73
Q

How many nephrectomies are performed each year?
Complication rate?

A
  • 50,000 nephrectomies/yr
  • 20% post-op compilation rate: mortality, peritonitis, acute renal failure, etc.
74
Q

What are the types of nephrectomy procedures?

A
  • Simple: Irreversible non-malignant disease (autoimmune), trauma, congenital disease (Polycystic Kidney disease)
  • Radical: Renal cell carcinoma, kidneys and adrenal glands removed
  • Donor
75
Q

Nephrectomies are commonly associated with these conditions.

A
  • CAD
  • CKD / ESRD
  • HTN
76
Q

Preoperative anesthetic considerations for nephrectomy.

A
  • Anxiolytics
  • SCIP
  • Type/Screen or Type/Cross
  • 2 large bore IV
77
Q

Intraoperative anesthetic considerations for nephrectomy.

A
  • GETA: avoid nitrous
  • Consider an arterial line
  • Consider a central line: Ipsilateral to the surgical site
  • Consider regional anesthesia for postop pain
  • Have these items available: Colloids, Blood, Rapid transfusion set up, mannitol, furosemide
78
Q

Which kidney has a long ureter and longer vascular supply?

A
  • Left Kidney
79
Q

What arteries and veins do transplanted kidneys attach to?

A
  • Transplanted kidneys are attached to the common iliac vein and artery
80
Q

Do you re-anastomose the vein, artery, or ureter first in a kidney transplant?

A
  • Re-anastomose :: Vein&raquo_space; artery&raquo_space; ureter
81
Q

What fraction of all nephrectomies are living donor nephrectomies?

A
  • 1/3
82
Q

What are the benefits of receiving a kidney from a living donor?

A
  • No physiological alterations compared to Donations after brain death or cardiac death donor.
  • Waiting times avoided
  • Decreases cold ischemic times
83
Q

What are the parameters of being a living donor?

A
  • Healthy
  • Two Kidneys
  • No DM, HIV, Liver Disease, Cancer
84
Q

Anesthesia Considerations for the Living Kidney Transplantation.

A
  • Similar to simple nephrectomy (anesthesia-wise)
  • Starts a couple of hours before recipient
  • Left kidney preferred
  • Aggressive isotonic hydration (10-20 ml/kg/hr)
  • Kidney needs low-level anticoagulation (5000 U of heparin)
  • Furosemide, mannitol to maintain 2 ml/kg/hr
  • Protamine reversal (50 mg)
85
Q

What neurological instability will occur with brain death? 2

A
  • Cushing’s sign: HTN, bradycardia, wide pulse pressure
  • Catastrophic ICP elevation
86
Q

What cardiac instability will occur with brain death? 3

A
  • Massive release of catecholamines
  • Acute MI
  • Cardiovascular collapse (catecholamines run out, massive dilation)
87
Q

What pulmonary instability will occur with brain death? 2

A
  • Neurogenic pulmonary edema
  • SIRS
88
Q

What metabolic instability will occur with brain death?

A
  • Dysfunction of the hypothalamus and pituitary systems
  • Thermoregulation, hormones, insulin, electrolytes, DIC
89
Q

Anesthesia Considerations for the Cadaver Donors.

A
  • Don’t need anesthetic….need stabilization until retrieval
  • Maintain hemodynamics with short-acting agents (cardene, esmolol, volatiles)
  • Significant bradycardia not responsive to anticholinergics…use isuprel
  • Fluid resuscitation with crystalloids and PRBC’s
  • Avoid glucose-containing solutions, can metabolize and become a hypotonic solution
  • PEEP/lung protective ventilation: 6-8 ml/kg of ideal body weight and 5-10cm PEEP
  • Steroids to attenuate immune response (in recipient)
90
Q

Donor Management Goals:
CVP

A
  • 4-10 mmHg
  • 6-8 mmHg for lung transplant
91
Q

Donor Management Goals:
MAP

A
  • 60-120 mmHg
92
Q

Donor Management Goals:
PaO2

A
  • > 300 mmHg on 5cm PEEP on 100% O2
93
Q

Donor Management Goals:
PaCO2

A
  • 35-45 mmHg
94
Q

Donor Management Goals:
ABG pH

A
  • 7.35-7.45
95
Q

Donor Management Goals:
Urine Output

A
  • Greater than 1 mL/kg/hr
96
Q

Donor Management Goals:
Sodium

A
  • 135-160 mEq/L
97
Q

Donor Management Goals:
Glucose

A
  • < 150
98
Q

Donor Management Goals:
Ejection Fraction

A
  • > 50%
99
Q

Donor Management Goals:
Hemoglobin

A
  • > 9
100
Q

Ischemic time for kidney

A
  • 48-72 hours
101
Q

What happens to the donor kidney during ischemia?

A
  • Lack of O2
  • Depletion of ATP/glycogen
  • Failure of Na/K Pump
  • Increase intracellular sodium….edema
102
Q

What are preop evaluations for the kidney recipient?

A
  • Need to know last dialysis and K+ level
  • Diabetic (blood sugar, insulin)
  • 40% have CAD, and most have HTN (EKG, Heart Cath)
  • If PCKD, is nephrectomy concurrent? (Consider positioning)
103
Q

Intraoperative consideration for kidney transplantation.

A
  • GETA, may use Anectine if K+ appropriate
  • Consider cisatracurium
  • Supine; watch AV access
  • CVP/art line…..STERILE
  • Donor anastomoses to recipient (vein, artery, ureter)
  • Steroids, mannitol, lasix, bumex, antithymocyte, albumin
  • Extubate on table…to ICU (D/C next day)
104
Q

What is an anti-thymocyte?

A
  • Infusion of rabbit-derived antibodies against human T cells to prevent/treat acute rejection
105
Q

What is the side effect of an anti-thymocyte?
Treatment?

A
  • Cytokine release syndrome: high-grade fevers (over 39C), chills, and possibly rigors.
  • Treatment: steroids (normally methylprednisolone), diphenhydramine 25–50 mg, acetaminophen 650 mg
106
Q
A

Principles I* (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions