GI Flashcards
Is a small bowel obstruction or large bowel obstruction more emergent?
SBOs have a greater propensity to strangulate
How much fluid is normally secreted into the upper GI tract?
7-9 L daily
Describe usual recovery from a post-operative ileus.
small bowel: 24 hours
gastric motility: 24-48 hours
colon: 3-5 days
What are the risks of cricoid pressure?
lateral displacement of the esophagus in >50% of cases
reflex relaxation of the LES
obscured view of larynx
What are the down sides to leaving an NG tube in place during induction?
no assurance of an empty stomach
mechanical incompetence of the LES
What electrolyte abnormalities contribute to a prolonged post-op ileus?
hyponatremia
hypokalemia
What are the hemodynamics associated with ESLD?
tachycardia
elevated CO
low SVR
low MAP
Why do patients with ESLD have hyponatremia?
increased secretion of ADH
What causes hepatic encephalopathy?
Possibly ammonia, but levels do not correlate with severity
What coagulation abnormalities in ESLD promote bleeding?
reduced synthesis of coagulation factors
thrombocytopenia
elevated tPA
What coagulation abnormalities in ESLD promote clotting?
increased vWF and factor VIII
decreased proteins C and S
decreased ADAMTS-13
How is fibrinogen affected by ESLD?
higher levels but dysfunctional
Why are pateints with ESLD thrombocytopenic?
sequestration in the spleen
impaired hepatic synthesis of thrombopoietin
consumption during DIC
Apart from primary pulmonary disease, what causes hypoxia with ESLD?
atelectasis from compressive ascites
hepatic hydrothorax
hepatopulmonary syndrome
What are the consideration during induction for liver transplant?
RSI due to delayed gastric emptying
reduced FRC due to ascites
What is the pre-anhepatic phase of liver transplant? What happens during this phase?
induction to hepatic artery clamping
mobilization of the liver, isolation of the vasculature, division of the bile duct
What is the anhepatic phase of liver transplant? What happens?
from removal of the diseased liver to reperfusion of the donor liver
anastomoses in this order: vena cava, portal vein, hepatic artery, bile duct
What physiologic derangements occur during the anhepatic phase?
acidosis: no clearance of lactic acid
hypocalcemia: no clearance of citrate
hyperkalemia: no hepatic uptake and acidosis
hypoglycemia: no gluconeogenesis
What are the benefits of venovenous bypass during liver transplant?
decrease portal circulation and gut congestion (better surgical visualization)
maintain preload during IVC clamping
maintain normothermia
What is the major benefit of a cavo-caval “piggy back” anastomosis during liver transplant?
better hemodynamic stability as IVC flow and preload can be maintained
Unclamping of which vessel is associated with hemodynamic instability during liver transplant?
portal vein
What is the neohepatic phase of liver transplant? What happens?
following reperfusion of the donor liver
biliary reconstruction
What is the lethal triad of massive transfusion?
acidosis
coagulopathy
hypothermia
What are the indications for CRRT during liver transplant?
pre-operative dialysis
AKI
What are early signs of good graft function during liver transplant?
resolution of hypocalcemia
resolution of hyperkalemia
hyperglycemia resistant to insulin
