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UPR- RCM Advanced Anesthesia I > Final Exam Deck > Flashcards

Final Exam Deck Flashcards

1
Q

Mention the three paired Larynx cartilages

A
  1. Arytenoid
  2. Corniculate
  3. Cuneiform
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2
Q

Mention the three unpaired cartilages of the Larynx

A
  1. Epiglottis
  2. Thyroid
  3. Cricoid
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3
Q

Which nerve supplies Sensory innervation to the Larynx?

A
  1. SLN (internal branch-Vagus)
  2. RLN
  3. Glossopharyngeal
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4
Q

Which nerve supplies Motor innervation to the Larynx?

A
  1. RLN
  2. SLN (external branch)
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5
Q

Which structures of the Larynx are innervated by the SLN-internal branch (Vagus)?

A
  • Laryngeal mucosa above the vocal cords
  • Inferior to the epiglottis
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6
Q

Which structures of the Larynx are innervated by the RLN?

A
  • Laryngeal mucosa below vocal cords
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7
Q

Which structures of the Larynx are innervated by the Glossopharyngeal nerve?

A
  • Superior aspect of epiglottis
  • Base of the tongue
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8
Q

Which muscle group of the Larynx are innervated by the RLN-Motor?

A
  • ALL intrinsic muscles
  • Except Cricothyroid muscle
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9
Q

Which muscle of the Larynx is innervated by the SLN-external branch Motor?

A

Cricothyroid muscle

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10
Q

Identify the structures of the image below.

A
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11
Q

What are the muscle groups of the Larynx?

A
  1. Intrinsic Muscles
  2. Extrinsic muscles
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12
Q

What is the function of the Cricothyroid muscle of the Larynx?

A
  • Tension vocal cords
  • Elongates vocal cords
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13
Q

What is the function of the Thyoarytenoid and Vocalis muscle of the Larynx?

A
  • Relax the vocal cord
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14
Q

What is the function of the Posterior Cricoarytenoid muscle of the Larynx?

A
  • ABduts vocal cords
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15
Q

What is the function of the Lateral Cricothyroid and Transverse Arytenoid muscle of the Larynx?

A
  • ADducts vocal cords
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16
Q

What is the function of the Aryepiglottic muscle of the Larynx?

A
  • Closes glottis
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17
Q

Identify the function of each of the Intrinsic muscles of the larynx in the image below.

A
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18
Q

Mention the Extrinsic Muscles of the Larynx.

A
  1. Sternohyoid
  2. Sternothyroid
  3. Thyrohyiod
  4. Thyroepiglottic
  5. Stylopharyngeus
  6. Inferior pharyngeal constrictor
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19
Q

Which Extrinsic muscles of the larynx are innervated by the Cervical plexus and C1, C2, and C3?

A
  • Sternohyoid (draws hyoid bone inferiorly)
  • Sternothyroid ( draws thyroid cartilage caudad)
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20
Q

Which Extrinsic muscles of the larynx are innervated by the Cervical plexus, Hypoglossal nerve, and C1, C2?

A

Thyrohyoid muscle

Pulls Hyoid Bone Inferiorly

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21
Q

What’s the function of the Thyrohyoid muscle?

A
  • Pulls hyoid bone inferiorly
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22
Q

What’s the function of the Thyroepiglottic muscle?

A
  • Inversion of aryepiglottic fold
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23
Q

What’s the function of the Stylopharyngeous muscle?

A
  • Folds thyroid cartilage
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24
Q

What’s the function of the Inferior pharyngeal constrictor muscle of the larynx?

A

Aids swallowing

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25
Q

Which Extrinsic muscle of the larynx is innervated by the Glossopharyngeal nerve?

A

Stylopharyngeus muscle

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26
Q

The Thyroepiglottic muscle is innervated by:

A

The Recurrent Laryngeal Nerve (RLN)

Only extrinsic muscle innervated by the RLN
Fx: Inversion of Aryepiglottic fold

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27
Q

The Thyrohyoid is innervated by:

A
  • Cervical plexus
  • Hypoglossal nerve
  • C1 and C2
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28
Q

Which topical anesthetic has the vasoconstrictive ability and blocks the reuptake of NE and EPI at adrenergic nerve endings?

A
  • Cocaine 4% Sln
  • Dose 3 mg/kg
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29
Q

What are the doses of Lidocaine as a topical anesthetic?

A
  • 4 mg/kg plain
  • 7 mg/kg with EPI 200-300mg
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30
Q

What are some notable features of Lidocaine?

A
  • Rapid onset
  • Suitable for all areas of the tracheobronchial tree
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31
Q

What are some notable features of Benzocaine?

A
  • Short duration of action (10min)
  • Produce methemoglobinemia
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32
Q

What is the dose of Bupivacaine and what are some notable features?

A
  • Dose 2.5 mg/kg plain
  • Slow hepatic clearance
  • Long duration of action
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33
Q

What are the dose and notable features of Mepivacaine?

A
  • 4 mg/kg
  • Intermediate potency
  • Rapid onset
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34
Q

What are the dose and notable features of Dyclonine?

A
  • 300 mg maximum
  • Topical spray or gargle
  • Frequent use for laryngoscopy
  • Absorbed through skin and mucous membranes
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35
Q

What are some Ester Local anesthetics drugs for ENT procedures?

A
  • Procaine
  • Chloroprocaine
  • Tetracaine
  • Cocaine
  • Benzocaine
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36
Q

What are some Amide Local anesthetics drugs for ENT procedures?

A
  • Lidocaine
  • Mepivacaine
  • Prilocaine
  • Bupivacaine
  • Ropivacaine
  • Articaine
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37
Q

What are the characteristics of Anticholinergic drugs used during ENT procedures?

A
  • Produce antisialogogue effects
  • Useful in certain intraoral procedures requiring a dryer field.
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38
Q

Which Anticholinergic drug, Glycopyrrolate or Atropine, is better during ENT procedures?

A
  • Glycopyrrolate
  • Produces less tachycardia
  • Does not cross the BBB
  • Lacks sedative effects
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39
Q

What are the common agents used for Hypotensive techniques?

A
  • Sodium nitroprusside
  • Dexmedetomidine
  • Esmolol
  • Nitroglycerine
  • Nicardipine
  • Remifentanil with Propofol
  • Propofol
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40
Q

What are the does, advantages, and disadvantages of Sodium Nitroprusside for Hypotensive techniques?

A
  • Young adults 1-5 mcg/kg/min
  • Children 6-8 mcg/kg/min

Advantages:
- Potent
- Reliable
- Rapid onset and recovery
- CO well-preserved

Disadvantages:
- Reflex tachycardia
- Rebound HTN
- Pulmonary shunting
- Cyanide toxicity

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41
Q

What are the doses, advantages, and disadvantages of Dexmedetomidine for Hypotensive techniques?

A
  • 1 mcg/kg/ over 10 min
  • Then 0.2-0.7 mcg/kg/min

Advantages:
- Dose-dependent sedation and analgesia.
- Hypotension
- Decreases IV and inhaled anesthetic requirements
- Smooth emergence

Disadvantages:
- Bradycardia
- Hypotension
- Heart block

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42
Q

What needs to be determined before the controlled hypotension technique?

A
  • A safe MAP
  • MAP not < 50-60 mmHg
  • No more > a 20% decrease in baseline MAP
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43
Q

What must be monitored regardless of the chosen technique during permissive hypotension?

A
  • UOP
  • MAP
  • CPP
  • Cardiac perfusion pressure
  • ABG’s
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44
Q

What are the two most common lasers used during an ENT procedure?

A
  1. CO2 ( 10,600nm)
  2. Nd: YAG (1064nm)
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45
Q

What are the characteristics of the CO2 laser?

A
  • Produces beam with long wavelengths
  • Absorb almost entirely the tissue-vaporizing cell water
  • Burn the cornea
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46
Q

What are the characteristics of the Nd: YAG laser?

A
  • A shorter beam passes through the garnet
  • shorter wavelength less absorption by water and tissue
  • beam light passes through the cornea
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47
Q

What are the appropriate color eye-protection glasses for the Nd: YAG laser?

A
  • Green-lensed protection
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48
Q

What are the appropriate color protection glasses for the CO2 laser?

A
  • Any clear glass or plastic that surrounds the face.
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49
Q

What are the appropriate color protection glasses for the Potassium titanyl-phosphate (KTP) laser?

A

Orange-red

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50
Q

What are the appropriate color eye-protection glasses for the Argon laser?

A

Orange glasses

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51
Q

What is the general safety protocol for Surgical lasers?

A
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52
Q

Thyroid Gland?

A
  • Butterfly-shaped
  • Composed of two lobes
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53
Q

The two lobes of the Thyroid gland are connected by a tissue mass named:

A

Thyroid Isthmus

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54
Q

Where is the Thyroid located?

A
  • Anterior and Anterolateral aspect of the trachea
  • inferior to the larynx
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55
Q

What is the largest endocrine gland in the body?

A
  • Thyroid gland
  • weights 20g in healthy adults
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56
Q

What is the blood supply of the thyroid gland?

A

Superior and inferior thyroid arteries.

branches of common carotid artery

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57
Q

Which nerve is associated with the motor function of the larynx that abducts, adducts, and tenses the vocal cords?

A
  • RLN
  • SLN- external branch
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58
Q

What is the primary PreOp goal for Thyroid surgery?

A
  • Ensure Pt is Euthyroid
  • Assess the degree of organ complication
  • Determine the extent of airway involvement
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59
Q

Which medication regimen should be continued until the morning of surgery for a patient undergoing a thyroid procedure?

A
  • Antithyroid medications
  • Beta-blockers
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60
Q

Which lab values are increased or decreased in a patient with Hypothyroidism?

A
  • T3 and T4 increased
  • TSH decrease or normal
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61
Q

What are the oral drugs used to treat Hyperthyroidism?

A
  • Methimazole (Tapazole)
  • Propylthiouracil (TPU)
  • Iodine
  • SSKI
  • Lugol solution
  • Propranolol (Inderal)
  • Atenolol (Tenormin)
  • Metoprolol
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62
Q

Which is the drug of choice to treat Hyperthyroidism?

A
  • Methimazole (Topazole)
  • Easy dosing
  • Better side effect
  • 10-40mg start QD
  • 5-15mg maintenance
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63
Q

How long in advance is Iodide added to a patient undergoing thyroid surgery?

A
  • 1 week prior to surgery
  • Continue through the day of surgery.
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64
Q

Which drug is used in emergency thyroid surgery for adrenergic suppression?

A
  • Beta Blockers without intrinsic sympathomimetic activity
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65
Q

What is the adjunct Gold standard of visual nerve identification during thyroid and parathyroid surgery?

A

Intraoperative nueral monitoring (IONM)

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66
Q

Which monitors are used to assess RLN and Vocal cord function during thyroidectomy?

A
  • A special ETT, Medtronic nerve integrity monitor (NIM)
  • EMG endotracheal tube (NIM 3.0 ETT)
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67
Q

What’s the anesthesia technique of choice for thyroidectomy?

A
  • General endotracheal anesthesia
  • Standard induction and maintenance drugs are used.
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68
Q

What is the NMBD of choice for paralysis during thyroidectomy?

A

Succinylcholine because of short duration and spontaneous degradation.

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69
Q

The PreOp airway assessment for a patient undergoing thyroidectomy involves:

A
  • Full visualization and palpation of the neck for thyroid goiter.
  • Airway should be assessed in the supine position.
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70
Q

A patient with Hyperthyroidism is at higher incidence for:

A
  • Myasthenia gravis
  • Skeletal muscle weakness
  • Increased sensitivity to muscle relaxants
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71
Q

What are the three types of Le Fort fractures?

A
  • Le Fort I fracture
  • Le Fort II fracture
  • Le Fort III fracture
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72
Q

Le Fort I Fracture characteristics

A
  • Horizontal fracture of the maxilla
  • Extend from the floor of the nose and hard palate
  • Nasal septum to pterygoid plates posteriorly
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73
Q

Which structures are mobilized in a patient with Le Fort I?

A
  • Palate
  • Maxyllary alveolar bone
  • Lower Pterygoid plate
  • Part of palatine bone
74
Q

Le Fort II Fracture characteristics

A
  • Triangular fracture running from the bridge of the nose
75
Q

Le Fort III Fracture characteristics

A
  • Fracture totally separates the midfacial skeleton from the cranial base
76
Q

Which Le Fort fracture causes little difficulty for the anesthesia provider?

A
  • Le Fort, I fracture
  • Patient may be intubated orally or nasally.
  • Airway is secure without a problem
77
Q

Which Le Fort fractures are a concern when contemplating nasal intubation?

A
  • Le Fort II
  • Le Fort III
  • Disruption of the cribriform plate may occur and an opening of the underside of the cranial cavity
78
Q

Please Mark the extraocular(recta medial) muscle responsible for eye adduction. In the image below.

A
79
Q

The Oculocardiac reflex is generated by pressuring the following structures:

A
  • Pressure on the globe
  • Orbital structures (optic nerve)
  • Conjunctiva
  • Traction of the extraocular muscles(particularly the medial rectus muscle)
80
Q

What is the afferent pathway for the Oculocardiac reflex?

A
  • Via long and short ciliary nerves
  • Ciliary ganglion
  • Gasserian ganglion
  • Ophthalmic division of CN V
  • Ends at trigeminal sensory nucleus in the fourth ventricle.
81
Q

The Efferent pathway of the Oculocardiac reflex consists of the following:

A
  • Vagus nerve to the cardioinhibitory center.
82
Q

The oculocardiac reflex often results in the following:

A
  • Sinus bradycardia
  • Nodal rhythms
  • AV block
  • Ventricular ectopy
  • Idioventricular rhythm
  • Asystole
83
Q

What should you do if an oculocardiac reflex occurs?

A
  • Cease all pressure or traction by the surgeon
  • Assess Pt for adequate oxygenation and ventilation
  • Anesthetic depth
  • Atropine 2-3 mg for complete vagal blockade (careful use - causes dysrhythmias)
  • Glycopyrrolate for less severe bradycardia
84
Q

Ocular medications

A
85
Q

Which ocular Carbonic Anhydrase inhibitor drug Reduces Aqueous Humor Production?

A

Acetazolimide (Diamox)

86
Q

Which ocular B-blocker drugs Reduce Aqueous Humor production?

A

Timolol (Timoptic)

87
Q

Risk factors of Glaucoma

A
  • Chronic Increase in IOP
  • Leads to retinal artery compression
  • IOP is reduced by drugs that reduce aqueous humor production or facilitate aqueous humor drainage
88
Q

Which drugs decrease Aqueous Humor production?

A
  • Acetazolimide
  • Timolol
89
Q

Which drugs facilitate Aqueous Humor Drainage?

A
  • Echothiophate

Prolongs Succinylcholine duration

90
Q

What’s the goal of strabismus surgery?

A
  • Correct misaligment of the extraoular muscles
  • Reestablishes the visual axis
91
Q

Patients undergoing Strabismus surgery are at risk for the following:

A
  • Increase PONV
  • Increase the risk of activating the oculocardiac reflex (afferent CN 5 + efferent CN 10)
92
Q

Which gas bubble is placed over the retina during retinal detachment, vitrectomy, and macular hole repair?

A

Sulfur Hexafluoride (SF6)

93
Q

What are the effects of Nitrous oxide with SF6 bubble placement?

A
  • Expand SF6 bubble
  • Compromise retinal perfusion
  • Cause permanent blindness
94
Q

How long in advance is N2O discontinued before the SF6 bubble placement?

A

15 minutes

95
Q

How long is N2O avoided after SF6 bubble placement?

A

7 to 10 days after SF6 placement

96
Q

What are the alternative gases to SF6, and how long is the N2O avoid?

A
  • Silicone oil = 0 days
  • Air bubble = 5 days
  • Perfluoropropane (C3F8) = 30 days
97
Q

What is the most common injury occurring after general anesthesia for eye surgeries?

A

Corneal abrasion

98
Q

What are the risk factors of Corneal Abrasion?

A
  • Drying of the exposed cornea
  • Direct trauma
  • Chemical injury
  • Central retinal artery occlusion
99
Q

What patient positions increase the risk for Corneal abrasion?

A

Prone position

100
Q

How long in advance is Cefazolin given for orthopedic surgeries?

A

Within 1 hour of incision time

101
Q

How long in advance is Vancomycin given for orthopedic surgeries?

A

Within 2 hours of incision time

102
Q

What are the organisms commonly associated with orthopedic procedures?

A
  • Staph Aureus
  • Gram-neg bacilli
  • Coagulase- neg staph
  • B-hemolytic Strep
103
Q

In which surgical procedures are prophylactic antibiotics not indicated?

A
  • Clean procedures
  • Diagnostic arthroscopic
  • Procedures not involving implantations.
104
Q

Spinal surgery with or without instrumentation should be covered with:

A

Antimicrobial agents

105
Q

Why are Tourniquets used in orthopedic surgeries?

A
  • Minimize blood loss
  • Provide a bloodless operating field
106
Q

Why is important to use the proper cuff size and inflation pressure of tourniquets?

A
  • Reduce risk of neuromuscular injury
107
Q

What is the inflation pressure of tourniquets for upper and lower extremities?

A
  • Upper: 70-90 mmHg > SBP
  • Lower: 2 times > SBP
108
Q

For how long can a tourniquet be safely placed?

A

2 hours

109
Q

How long after placement of the tourniquet can the patient start complaining of pain?

A
  • 45-60 mins after inflation
  • Transmitted by C fibers (slow pain)
110
Q

What transient physiologic changes are produced by the release of the tourniquet?

A
  • Increase ETCO2
  • Decrease body Temp
  • Decrease BP
  • Decrease SVO2
  • Metabolic acidosis
111
Q

Safety measures for preventing Tourniquet complications

A
112
Q

Physiologic changes caused by Tourniquets

A
113
Q

What are the clinical features of Bone Cement Implantation (BCIS)?

A
  • Hypoxia
  • Hypotension
  • Cardiac arrhythmias
  • Cardiac arrest
  • Increased pulmonary vascular resistance
  • Unexpected loss of consciousness when regional anesthesia is given
114
Q

What is the first indication of BCIS under general anesthesia?

A

Decrease ETCO2

115
Q

What are the early signs of BCIS in the awake patient undergoing regional anesthesia?

A
  • Dyspnea
  • Altered Sensorium
116
Q

What is the treatment if BCIS is suspected in a patient?

A
  • Increase Inspired O2 concentration to 100%
  • Supplemental O2 PostOP
  • Cardiovascular collapse Tx: Right-sided HF
  • Hypotension Tx: alpha-agonist
117
Q

What are the actions that should be taken before cementing a patient?

A
  • BP optimized
  • 100% fraction inspired O2 (FiO2)
  • Pressure bags - available
  • IV fluid bags
  • Document cement time on the anesthesia record (important)
118
Q

Position-related complications during shoulder arthroscopy

A
119
Q

Prevention of Position-related complications during shoulder arthroscopy

A
120
Q

What is the drug used for patients undergoing total joint hip replacement?

A

Tranexemic acid (TXA)

121
Q

The use of TXA has been shown to decrease the following:

A
  • Periopertive blood loss
  • Transfusion requirements
  • Minimal risk of complications
122
Q

How is TXA administered?

A

1-2 g PeriOp IV or Topically at the surgical site

123
Q

What are the preferred regional anesthesia techniques used for breast surgery?

A
  • Thoracic paravertebral
  • Pectoral nerve blocks (PECS) I and II
  • Serratus anterior (SA) plane block
124
Q

What are the advantages of Regional anesthesia during extrathoracic surgery?

A
  • Excellent PostOp analgesia
  • Opioid sparing
  • Reduce PONV
125
Q

What are some factors that reduce Liver blood flow?

A
  • Increased splanchnic vascular resistance (SNS stimulation, pain, hypoxia)
  • Things that increase CVP ( positive-pressure ventilation, excessive hydration, and CHF)
  • Some beta-blockers (propranolol reduces CO and increases splanchnic vascular resistance)
  • Intraabdominal surgical procedures
  • Laparoscopic surgery
126
Q

What percentage of CO does the liver receive?

A
  • 25 %
  • 1,500 mL via a dual blood supply
127
Q

How much blood does the Portal vein provide to the liver?

A
  • 75% of total liver blood flow
  • 50% of the liver’s oxygen supply
128
Q

How much blood does the Hepatic artery provide?

A
  • 25% total liver blood flow
  • 50% of liver oxygen supply
129
Q

What reduces portal vein flow?

A
  • Increased splanchnic vascular resistance
130
Q

What are the effects of General and Neuraxial anesthesia?

A
  • Reduce MAP
  • Reduce CO

This can reduce liver blood flow in a dose-dependent fashion.

131
Q

Liver function

A
132
Q

The liver plays an essential role in

A
  • Protein synthesis
  • Vital role in carbohydrate, protein, and lipid metabolism
133
Q

The liver produces all the clotting factors except:

A
  • Factor 3 & 4
  • Von Willebrand factor
134
Q

Vitamin K-dependent clotting factors include:

A
  • Factors 2, 7,9, & 10
  • Protein C, S, and Z (anticoagulants)
135
Q

How is Factor 8 produced in the liver?

A
  • Liver sinusoidal cells
  • Endothelial cells
  • Not hepatocytes
136
Q

What stimulates Platelet production?

A
  • Synthesis of fibrinolytic like plasminogen and thrombopoietin
137
Q

The liver is an important regulator of

A
  • Serum glucose
  • Clears insulin from circulation
  • Patients with liver failure are at risk of hypoglycemia.
138
Q

The liver produces all the plasma proteins except for

A

Immunoglobulins

139
Q

What is the most abundant protein?

A
  • Albumin
  • Serves as a blood reservoir for acid drugs
  • Also binds with basic drugs
140
Q

What is the blood reservoir for basic drugs?

A

Alpha-1 acid glycoprotein

141
Q

What are the effects of reduced Pseudocholinesterase production in patients with severe liver disease?

A
  • Increase Succinylcholine duration
  • Increase the duration of Ester-type local anesthetic
142
Q

What is the byproduct of protein metabolism?

A
  • Ammonia
  • Lead to hepatic encephalopathy
143
Q

What is the byproduct of hemoglobin metabolism?

A
  • Bilirubin
  • Unconjugated Bilirubin is neurotoxic
144
Q

Drug Metabolism in the Liver

A
145
Q

Which labwork provides information of the Liver synthetic function?

A
  • PT
  • Albumin
146
Q

Which labwork provides information on Hepatocellular injury?

A
  • AST (10-40 Units/L)
  • ATL (10-50 Units/L)
147
Q

Which labwork provides information on Hepatic clearance?

A

Bilirubin (0-11 units/L)

148
Q

Which labwork provides information on Biliary duct obstruction?

A
  • Alkaline phosphate
  • Y glutamyl transpeptidase
  • 5-nucleotidase
149
Q

Which labwork is sensitive for acute hepatic injury?

A
  • Prothrombin time (PT)
  • Factor 7 has a half-life of only 4-6 hr
150
Q

Which labwork is NOT sensitive for acute hepatic injury?

A
  • Albumin
  • Has a half-life of 21 days
151
Q

Clinicopathologic Features of Halothane Hepatitis

A
152
Q

Hepatitis?

A
  • Liver inflammation
  • Associated hepatocellular injury with variable degrees of necrosis
  • Can be acute or chronic
153
Q

What is the most common cause of Liver cancer?

A

Hepatitis

154
Q

A common indication of liver transplant?

A

Hepatitis

155
Q

What is the etiology of Hepatitis?

A
  • Viruses
  • Hepatotoxins
  • Autoimmune response
156
Q

In the U.S. viral Hepatitis is most caused by:

A
  • By one of the four hepatitis viruses: A, B, C, D
157
Q

What is the most common hepatitis type in the US?

A

Hepatitis E

158
Q

What are other viral etiologies of Hepatitis?

A
  • Herpes simplex
  • CMV
  • Epstein-Barr
159
Q

What are the routes of transmission of Hepatitis A and Hepatitis E

A

Fecal-oral

160
Q

Which hepatitis virus is transmitted via the parental route?

A
  • Hepatitis C
161
Q

Which hepatitis virus is transmitted via the parental-sexual route?

A
  • Hepatitis B
  • Hepatitis D
162
Q

What are the Antibodies of acute viral hepatitis?

A
163
Q

What is the most common cause of drug-induced hepatitis?

A

Alcohol

164
Q

What is the most common cause of acute liver failure in the U.S.?

A
  • Acetaminophen overdose
  • Max dose 4g/day
  • Tx: Oral N-acetylcysteine within 8 hours of intake
165
Q

What is the effect of impaired fatty Acid Metabolism?

A
  • Fat accumulation in the liver
  • Leads to hepatomegaly
166
Q

Chronic hepatitis

A
  • Hepatic inflammation > 6 mons
  • Leads to progressive destruction of hepatic parenchyma
  • cirrhosis
  • Liver failure
167
Q

What is the most common cause of chronic hepatitis?

A
  • Alcoholism
  • Hep C ( 2nd most common)
168
Q

How is Chronic Hepatitis diagnosed?

A
  • Liver enzymes
  • Bilirubin + Histologic evidence of liver inflammation
169
Q

Chronic Hepatitis Signs and Symptoms?

A
  • Jaundice
  • Fatigue
  • Thrombocytopenia
  • Glomerulonephritis
  • Neuropathy
  • Arthritis
  • Myocarditis
170
Q

How are PT and albumin affected by chronic hepatitis?

A
  • PT is prolonged
  • Albumin is decreased
171
Q

Anesthetic management with Acute Hepatitis

A
172
Q

What are the anesthesia considerations for Hepatitis?

A

Acute hepatitis:

  • non-emergent sx should be postponed until symptoms have resolved and the liver function test returns to normal

Chronic hepatitis:

  • PT may proceed to sx. as long as the condition is stable
173
Q

Anesthetic considerations for Acute hepatitis include:

A
  • Maintaining liver blood flow
  • Avoid PEEP
  • Avoid hepatotoxic drug
  • Avoid drug that inhibits hepatic enzyme
  • Monitor neuromuscular junction
174
Q

Most common places to find carcinoid tumors (70%)

A
  • Appendix 45%
  • Jejunoileum 28%
  • Rectum 16%
  • Duodenum 4%
175
Q

How is Carcinoid syndrome diagnosed?

A
  • Elevated level of 5-hydroxyindoleacetic acid (5-HIAA) >30mg in 24hr in urine
  • Normal levels are from 3-15 mg/24 hr
176
Q

Carcinoid syndrome

A
177
Q

Signs and symptoms of Carcinoid syndrome

A
178
Q

Carcinoid Crisis

A
179
Q

Carcinoid treatment

A
180
Q

Anesthetic considerations for Carcinoid syndrome

A

UPR- RCM Advanced Anesthesia I (5 decks)

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