FU(6): Metabolism, Obesity, Malnutrition, & Endocrine Flashcards
A 32-year-old female with a known history of acute intermittent porphyria is scheduled for elective surgery. She reports a history of mild abdominal pain and neurological symptoms that have been well controlled. Which of the following anesthetic plans is MOST appropriate for this patient?
Use of benzos for predmedication and propofol for induction, avoid barbiturates and sulfonamide antibiotics
A patient with hereditary coproporphyria presents with acute abdominal pain and neurological symptoms suggestive of an acute porphyric crisis. Which of the following treatment strategies is MOST appropriate?
Immediate administration of IV glucose followed by heme therapy if no improvement is seen
A 40-year-old female with a history of acute intermittent porphyria (AIP) presents for an emergency laparotomy due to suspected intestinal obstruction. She is currently symptomatic, reporting severe abdominal pain, and her medical record indicates a history of psychiatric disturbances during acute porphyric attacks. Laboratory tests reveal hyponatremia and elevated urinary porphobilinogen. Given her condition and the emergent nature of the surgery, which of the following anesthesia management plans is MOST appropriate to mitigate the risk of exacerbating her porphyria and managing her symptoms effectively?
Preop carb loading with glucose infusion, use of propofol for induction, and maintenance with a non-triggering volatile anesthetic like sevo, ensuring avoidance of barbiturates sulfonamide abx, and any drugs known to induce ALA synthase. Post op pain management with opioids and careful correction of hyponatremia.
A 52-year-old male with a long-standing history of primary hemochromatosis, managed with routine phlebotomy, presents for elective abdominal surgery. His preoperative workup reveals a serum ferritin level of 1500 μg/L and a fasting transferrin saturation of 55%. He has a history of diabetes and is on oral hypoglycemics, with recent echocardiography showing mild left ventricular hypertrophy but preserved ejection fraction. Given his condition, which of the following anesthesia management strategies is MOST appropriate?
Utilization of low dose prop and avoidance of volatile anesthetics d/t potential for worsening liver damage, monitor for cardiac arrhythmias given the left ventricle hypertrophy, and careful glucose monitoring
A 27-year-old female with Wilson disease, presenting with acute neurologic deterioration including dysarthria and tremors, requires emergency decompressive neurosurgery. Her current medications include zinc and trientine. Preoperative evaluation reveals elevated liver enzymes, indicative of ongoing liver involvement, and Kayser-Fleischer rings are noted. In planning her anesthetic care, which of the following considerations is MOST critical?
Preference for TIVA with agents such as prop and remifentanil to minimize hepatic metabolism burden, along with careful monitoring for neuro changes postop
A 58-year-old male with metabolic syndrome (MetS) is scheduled for elective abdominal aortic aneurysm repair. He has a BMI of 34 kg/m^2, blood pressure of 150/95 mmHg, fasting blood glucose of 110 mg/dL, and dyslipidemia. Given the increased risk of cardiovascular events associated with MetS, which of the following anesthetic management strategies would be MOST appropriate for this patient?
Utilize a balance anesthesia technique with careful titration of volatile anesthetics and vasopressors to maintain hemodynamic stability, intraoperative glucose monitoring and consideration of post-op pain management to reduce stress response
A rare case involves a 35-year-old male diagnosed with both hemochromatosis and Wilson disease, scheduled for elective laparoscopic cholecystectomy due to symptomatic gallstones. His hemochromatosis is managed with phlebotomy, maintaining serum ferritin levels below 1000 μg/L, while Wilson disease is controlled with trientine and dietary modifications. He has mild hepatomegaly but no signs of cirrhosis or acute liver failure. His cardiac function is normal, but he has a history of mild neuropsychiatric symptoms including anxiety and depression. In planning his anesthetic management, which of the following strategies is MOST appropriate?
Implement balanced anesthesia technique with careful use of low-dose volatile and TIVA avoiding narcotics that may exacerbate neuropsych symptoms, and close monitoring of liver function tests pre and post op
A 60-year-old patient with metabolic syndrome, nonalcoholic steatohepatitis (NASH), and compensated cirrhosis is scheduled for partial hepatic resection due to a hepatic adenoma. The patient’s preoperative evaluation indicates well-controlled hypertension and diabetes, mild portal hypertension, and preserved liver function with a Child-Pugh score of A. In the context of this patient’s complex condition, which of the following perioperative management strategies aligns best with optimizing surgical outcomes and maintaining hemodynamic stability?
Tailor anesthetic management to ensure minimal changes in portal venous pressure, utilizing a combo of low-dose vasopressors and careful fluid administration to maintain normovolemia and avoid exacerbating portal HTN
A 55-year-old patient with metabolic syndrome, nonalcoholic steatohepatitis (NASH), and poorly controlled diabetes (HbA1c 8.5%) is undergoing major colorectal surgery. Considering the intricate pathophysiological interactions between insulin resistance inherent in metabolic syndrome, hepatic dysfunction due to NASH, and the surgical stress response, which of the following strategies most effectively aligns anesthetic management with optimal glycemic control?
Implement comprehensive intraop management that integrates continuous insulin infusion based on real time glucose monitoring with anesthetic technique adjusted for hepatic function. This approach should be supported by rigorous hemodynamic monitoring
In managing anesthesia for a patient with clinically severe obesity, understanding the impact of obesity on the pharmacokinetics of anesthetic drugs is crucial. Which of the following statements BEST explains the pathophysiological alterations in drug metabolism in obese patients?
Increased adipose tissue leads to altered drug distribution, requiring adjustments in dosing based on lean body weight.
During laparoscopic surgery in obese patients, the creation of pneumoperitoneum and patient positioning have significant effects on physiological parameters. Which of the following BEST describes a pathophysiological effect of pneumoperitoneum on cardiovascular function in these patients?
Pneumoperitoneum decreases venous return, increasing the risk of thromboembolic events due to decreased cardiac output
Considering the pathophysiological changes in obese patients, which of the following is a PRIMARY concern for airway management during anesthesia?
Decreased FRC in obese patients leads to rapid desaturation during apnea, necessitating preoxygenation and careful airway management.
Which of the following best describes the primary pathophysiological mechanism by which malnutrition increases the risk of perioperative infection?
Malnutrition induced mitochondrial malfunction and proinflammatory cytokine release impair leukocyte mobilization and function
What is the primary pathophysiological defect that characterizes the early stage of type 2 diabetes mellitus?
Insulin resistance in skeletal muscle, adipose tissue, and the liver with relative B-cell insufficiency
How does the coexistence of obesity and malnutrition (malnourished obesity) uniquely affect perioperative risk management?
Hypoalbuminemia in obese patients signifies a compounded risk for complications, necessitating targeting nutritional interventions.
Which mechanism is primarily responsible for insulin resistance in type 2 diabetes, particularly affecting skeletal muscle glucose uptake?
Impaired insulin receptor substrate phosphorylation leading to dysfunctional insulin signaling pathways
Which counter-regulatory hormone exacerbates hyperglycemia by increasing glucose production during insulin deficiency?
Glucagon through its actions on gluconeogenesis and glycogenolysis in the liver
What differentiates the pathophysiological mechanism of hyperglycemic hyperosmolar syndrome (HHS) from diabetic ketoacidosis (DKA)?
Severe dehydration and hyperosmolarity due to sustained hyperglycemia without significant ketoacidosis
Which of the following best explains the primary pathophysiological process leading to the development of diabetic ketoacidosis (DKA)?
Increased counter-regulatory hormones promote gluconeogenesis and ketogenesis exacerbating hyperglycemia and acidosis
Which treatment strategy is essential in managing Hyperglycemic Hyperosmolar Syndrome (HHS) due to the risk of severe dehydration and hyperosmolarity?
Aggressive fluid resuscitation with hypotonic saline
Which counter-regulatory hormone exacerbation primarily contributes to the onset of diabetic ketoacidosis (DKA) by enhancing lipolysis and providing substrates for ketone body production?
Glucagon
In the management of DKA, what is the primary mechanism through which insulin administration resolves metabolic acidosis?
Insulin inhibits ketogenesis and promotes the shift of potassium into cells
In diabetic nephropathy, why are ACE inhibitors particularly beneficial for slowing disease progression?
They directly reduce glomerular hypertension, slowing the decline in renal function