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Principles2 > GU surgery > Flashcards

GU surgery Flashcards

1
Q

kidneys lie retroperitoneally in the abd at what 2 levels?

A

T12 and L4

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2
Q

renal arteries originate from what artery?

A

aorta

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3
Q

renal veins cross anteriorly or posteriorly before joining the IVC?

A

anteriorly

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4
Q

renal innervation is primarily sympathetic and afferent fibers that arise from what range of spinal levels?

A

T10-L1

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5
Q

surgical anesthesia of the kidneys requires what range of levels?

A

T8-L3

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6
Q

kidney pain may be perceived by afferent fibers that travel in what nerve? (V)

A

vagus nerve

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7
Q

what level of sensory block is needed to produce anesthesia for the ureters?

A

T10

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8
Q

The long what of ureters makes them vulnerable to injury/transection during retroperitoneal surgery? (P)

A

path

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9
Q

should LA containing epi be given for injections around the penis?

A

no

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10
Q

what response may occur with testicular manipulation? (V)

A

vagal response

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11
Q

what 5 things make up the urinary system? (K,BS,U,B,U)

A

kidneys, blood supply, ureter, bladder, urethra

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12
Q

what % range of the CO goes to the kidneys?

A

20-25%

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13
Q

what is the renal BF equation?

A

RBF=(MAP-VP)xVR

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14
Q

what 2 things determine renal BF? (NA, NR)

A

natural autoregulation, neural regulation

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15
Q

what is the MAP range to maintain renal filtration?

A

50-180 mmHg

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16
Q

MAP less that what stops filtration?

A

<50 mmHg

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17
Q

renal BF to both kidneys is how many mLs per minute?

A

1200 mL

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18
Q

glomerular filtration is the filtering the blood into tubule forming what? (PU)

A

primitive urine

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19
Q

tubular reabsorption is absorption of substances needed by the body from what to what?

A

from the tubule to the blood

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20
Q

tubular secretion is the secretion of substances to be eliminated from where to where?

A

blood to the tubule

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21
Q

AKI is up to what % of critically ill pts?

A

8%

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22
Q

what are 10 preop risk for AKI? (EKD,D,H,H,LD,I,T,M,A,NAE)

A

existing kidney disease, DM, HTN, hypovolemia, liver disease, infection, trama, MM, age (>55), nephrotoxic agent exposure

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23
Q

Prerenal, intrinsic or postrenal AKI:

  1. impaired renal autoregulation
  2. decrease effective circulating volume
  3. acute glomerulonephritis
  4. vasculitis
  5. bladder outlet obstruction
A
  1. prerenal
  2. prerenal
  3. intrinsic
  4. intrinsic
  5. postrenal
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24
Q

what are the 3 most important prophylactic measures to avoid AKI? (MNRP, AN, APH)

A

maintain normal renal perfusion, avoid nephrotoxins, avoid prolonged hypoperfusion

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25
Q

what procedures can significantly alter renal function? (L, CB, ACC, RAD, NP)

A

laparoscopy, CPB, aorta cross clamping, renal artery dissection, neurosurgical procedures

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26
Q

are anesthesia effects on the kidneys more or less during regional anesthesia?

A

less

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27
Q

what are the 3 reversible anesthesia effects on normal RBF? (H, SA, EE)

A

hypotension, sympathetic activation, endocrine effects

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28
Q

light anesthesia and intense surgical stimulation causes what reversible anesthesia effect on normal RBF? (SA)

A

sympathetic activation

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29
Q

hypotension limits what that ends up reducing renal function? (A)

A

autoregulation

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30
Q

Response to what causes the endocrine effects that causes an increase in catecholamines and a decrease in renal BF? (S)

A

stress

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31
Q

ADH and angiotensin 2 decrease RBF by causing constriction where? (RA)

A

renal artery

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32
Q

what VA that is not used anymore has high nephrotoxicity? (M)

A

methoxyflurane

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33
Q

do isoflurane and desflurane produce nephrotoxicity?

A

no

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34
Q

sevoflurane has the potential for nephrotoxicity from having what as its byproduct? (CA)

A

compound A

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35
Q

what electrolyte are we worried about with renal pts?

A

potassium

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36
Q

what is the GFR equation?

A

urine cr x serum cr x urine volume

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37
Q

normal range of lab values:

  1. BUN (mg/dL)
  2. serum Cr (mg/dL)
  3. creatinine clearance (mL/min)
A
  1. 10-20 mg/dL
  2. 0.7-1.5 mg/dL
  3. 95-150 mL/min
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38
Q

what lab test is the main product of protein metabolism?

A

BUN

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39
Q

what lab test is a key indicator for GFR function?

A

serum Cr

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40
Q

what test is considered the specific test for GFR?

A

Cr clearance

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41
Q

what test measures the ability of the glomeruli to excrete creatinine given a specific plasma creatinine concentration?

A

Cr clearance

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42
Q

what 3 lab tests measure renal tubular function? (USG, UO, USC)

A
  1. urine specific gravity
  2. urine osmolality
  3. urine sodium concentration
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43
Q

Is urine specific gravity or urine osmolality more specific of renal tubular function?

A

urine osmolality

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44
Q

normal range of lab values:

  1. urine specific gravity
  2. urine osmolality (mOsm/L)
  3. urine sodium concentration (mEq/day)
A
  1. 1.003-1.030
  2. 65-1400 mOsm/L
  3. 130-260 mEq/day
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45
Q

urine specific gravity and urine osmolality measure waht in urine? (S)

A

solutes

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46
Q

What GFR range for these CKD stages? (mL/min/1.73 m^2)

  1. stage 1
  2. stage 2
  3. stage 3
  4. stage 4
  5. stage 5
A
  1. > 90
  2. 60-89
  3. 30-59
  4. 15-29
  5. <15
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47
Q

Qualitatively describe the CKD stages:

  1. stage 1
  2. stage 2
  3. stage 3
  4. stage 4
  5. stage 5
A
  1. normal
  2. mild
  3. moderate
  4. severe
  5. ESRD
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48
Q

Risk criteria:

  1. Cr increased how many times?
  2. GFR decreased greater than what %?
  3. UO less than what for how many hrs?
A
  1. 1.5 times
  2. 25%
  3. .5 mL/kg/hr for 6 hrs
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49
Q

Injury criteria:

  1. Cr increased how many times?
  2. GFR decreased greater than what %?
  3. UO less than what for how many hrs?
A
  1. 2 times
  2. 50%
  3. .5 mL/kg/hr for 12 hrs
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50
Q

Failure criteria:

  1. Cr increased how many times?
  2. GFR decreased greater than what %?
  3. Cr greater than what? (mg/dL
  4. UO less than what for how many hrs?
A
  1. 3 times
  2. 75%
  3. 4 mg/dL
  4. .3 mL/kg/hr for 24 hrs (or anuric for 12 hrs)
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51
Q

Loss criteria is complete loss of renal function greater than how many weeks?

A

4 weeks

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52
Q

Renal failure system abnormalities:

  1. hyper or hypokalemia?
  2. hyperparathyroidism or hypoparathyroidism?
  3. hypernatremia or hyponatremia?
  4. hypercalcemia or hypocalcemia?
A
  1. hyperkalemia
  2. hyperparathyroidism
  3. hypernatremia
  4. hypocalcemia
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53
Q

what are 5 causes of chronic renal failure? (DN, H, G, PKD, KI/O)

A
  1. diabetic neuropathy
  2. HTN
  3. glomerulonephritis
  4. polycystic kidney disease
  5. kidney infection/obstructions
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54
Q

Chronic renal failure:

  1. what is the mortality %?
  2. what % will need dialysis?
A
  1. 20%

2. 50%

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55
Q

do pts with renal disease have delayed gastric emptying?

A

yes

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56
Q

since renal disease pts have delayed gastric emptying, what 2 meds should you consider? (HB, MFA)

A
  1. H2 blockers

2. magnesium free antacids

57
Q

what med that can promote gastric emptying is party excreted by the kidneys? (R)

A

reglan

58
Q

opioid and other drugs have an increased effect in renal disease pts because of reduced what? (PB)

A

protein binding

59
Q

what opioid should be used with caution?

A

morphine

60
Q

why should morphine be used with caution in renal disease pts?

A

because active metabolites are excrete by the kidney

61
Q

what opioid should be avoided in pts with renal disease? (M)

A

mepiridine

62
Q

can meperidine be removed by dialysis?

A

no

63
Q

meperidine metabolite accumulation can lead to what neuro symptom? (C)

A

convulsions

64
Q

can renal disease pts receive toradol?

A

no

65
Q

can hydromorphone be removed by dialysis?

A

yes

66
Q

what 2 muscle relaxants should you avoid? (S, P)

A

succinylcholine and pancuronium

67
Q

what 2 muscle relaxants should be given to renal disease pts because they are eliminated independent of renal function? (A, C)

A

atracurium and cisatracurium

68
Q

what are 3 EKG changes of hyperkalemia?

A
  1. peaked T wave
  2. widened QRS
  3. prolonged PR
69
Q

Nephrotoxicity with VAs is least with which one?

A

Desflurane

70
Q

what 4 things should you be prepared to treat for renal disease pts undergoing GA? (H, DCO, A, PDE)

A
  1. hypotension
  2. decreased CO
  3. arrhythmias
  4. prolonged drug effects
71
Q

AV grafts are for pts with small what? (V)

A

veins

72
Q

what is an AV graft?

A

a tube that connects a vein and an artery

73
Q

what is an AV fistula?

A

a connection between the vein and and artery

74
Q

what are 6 long term complications of AV fistulas and grafts? (I, I, A, T, H, VH)

A
  1. infection
  2. ischemia
  3. aneurysm
  4. thrombosis
  5. hematoma
  6. venous HTN
75
Q

what regional anesthesia is required for these procedures?

  1. lithotripsy
  2. cystoscopy
  3. transurethral resection of the prostate (TURP)
A
  1. T4
  2. T9
  3. T10
76
Q

what is the most common GU procedure? (C)

A

cystoscopy

77
Q

Methylene blue causes a temporary decrease in what measurement?

A

SpO2

78
Q

Cystometrogram is performed for diagnosing what 4 things? (OB, DU, UR, I)

A
  1. overactive bladder
  2. difficulty urinating
  3. urinary retention
  4. incontinence
79
Q

What position for cystoscopy?

A

lithotomy

80
Q

What is a cystoscopy?

A

instrumentation to examine the urinary tract

81
Q

what may be performed along with a cystoscopy?

A

insertion of urethral stents

82
Q

Cystometrogram is inserting a catheter into the bladder to measure what? (BP)

A

bladder pressure

83
Q

do pts receiving a cystometrogram receiving sedation?

A

no

84
Q

why don’t we want pts having a cystometrogram to be sedated?

A

so they can provide the best results of trying to empty their bladder

85
Q

what position for cystometrogram?

A

lithotomy

86
Q

Lithotomy position:

  1. decreases what 3 lung measurements? (VC, LV, LC)
  2. does passive elevation increase or decrease venous return?
  3. rapid lowering of the legs can produce what? (H)
A
  1. vital capacity, lung volume, lung compliance
  2. increase
  3. hypotension
87
Q

lithotomy position has an increased risk postop motor neuropathy in:

  1. staying in the position for greater than how many hrs?
  2. pts with BMI less than what?
  3. pts with a recent history of what? (S)
A
  1. 4 hr
  2. <20
  3. smoking
88
Q

what 5 nerves can be damaged in the lithotomy position? (FOPSS)

A
  1. femoral
  2. obturator
  3. peroneal
  4. sciatic
  5. saphenous
89
Q

what nerve damage results in loss of dorsiflexion of the foot?

A

common peroneal

90
Q

damage to the peroneal nerve results in what sign? (FD)

A

foot drop

91
Q

damage to what nerve results in numbness along the medial calf?

A

saphenous

92
Q

what is the most common procedure for urinary incontinence?

A

sling procedure

93
Q

sling procedure takes a piece of human tissue or synthetic tape to support what 2 things? (BN, U)

A

bladder neck, urethra

94
Q

what are 2 serious complications of sling procedures? (PP, I)

A

pelvic pain, infections

95
Q

Lithotripsy is used to disrupt renal calculi by focusing what at them? (HESW)

A

high energy shock waves

96
Q

pts with what 2 cardiac histories have an increased risk of developing arrhythmias? (CA, P)

A

cardiac arrhythmias, pacemaker

97
Q

to decrease the incidence of arrhythmias, lithotripsy shock waves are synchronized with what EKG wave?

A

R wave

98
Q

what position for lithotripsy?

A

supine

99
Q

what can be placed and what can be given before lithotripsy to help pass the stone?

A

stent, IV fluids

100
Q

what 2 drugs can be given to increase the HR and thus the shock frequency? (G, A)

A

glycopyrrolate, atropine

101
Q

what regional anesthesia level is recommended for lithotripsy?

A

T4

102
Q

an absolute CI to lithotripsy is the inability to position the pt so what 2 things are out of the way of the shock waves? (L, I)

A

lungs, intestine

103
Q

what are 4 other absolute CI to lithotripsy? (OBS, UI, BD, P)

A
  1. obstruction below stone
  2. untreated infection
  3. bleeding disorder
  4. pregnancy
104
Q

postpone TURP if Na is less than what? (mEq/L)

A

128

105
Q

Describe the TURP procedure

A

inserting a scope into the urethra and electrically cutting away the prostate

106
Q

TURP:

  1. fluid absorption is via what? (VS)
  2. what are the 3 irrigation solutions? (CGS)
  3. what range of mLs can be absorbed per minute?
  4. what range of liters can be absorbed in 2 hours?
  5. what makes the blood loss difficult to assess? (IF)
A
  1. venous sinuses
  2. cytal, glycine, saline
  3. 10-30 mLs
  4. 6-8
  5. irrigation fluid
107
Q

TURP bladder perforation:

  1. when to suspect bladder perforation?
  2. how do vitals start and then change?
  3. awake pts complain of what 2 things? (AF, SP)
  4. absorption of which irrigation solution can cause CNS symptoms?
  5. do you stop the surgery?
  6. what does the surgery convert to?
A
  1. when fluid fails to return
  2. HTN & tachy then hypotensive & brady
  3. abd fullness, shoulder pain
  4. glycine
  5. yes
  6. ex lap
108
Q

what is the metabolite of glycine?

A

ammonia

109
Q

what are the 6 clinical manifestations of TURP syndrome? (FO, WI, H, G/AT, H, C)

A
  1. fluid overload
  2. water intoxication
  3. hyponatremia
  4. glycine/ammonia toxicity
  5. hemolysis
  6. coagulopathy
110
Q

what are the 2 EKG changes of hyponatremia?

A
  1. wide QRS

2. t wave inversion

111
Q

what are 5 s/s of glycine/ammonia toxicity? (N, V, H, H, C)

A
  1. nausea
  2. vomiting
  3. HA
  4. hyperglycemia
  5. confusion
112
Q

what are 3 interventions to manage TURP syndrome? (SS, AD, DL)

A
  1. stop surgery
  2. administer diuretics (lasix)
  3. draw labs
113
Q

TURP syndrome:

  1. if Na is less than 120, what do you give?
  2. correct Na how many mEq/L per hour?
  3. rapid correction of hyponatremia can lead to what? (ODS)
A
  1. hypertonic saline (3% or 5%)
  2. 0.5 mEq/L per hour
  3. osmotic demyelination syndrome
114
Q

is testicular torsion an emergent procedure?

A

yes

115
Q

what 2 things are given to visualize the ureters? (IC, MB)

A

indigo carmine, methylene blue

116
Q

what med can be given in low doses to maintain UO?

A

dopamine

117
Q

lateral flexed position:

  1. increased or decreased FRC in dependent lung?
  2. atelectasis in independent or dependent lung?
  3. what is compressed causing a decreased venous return?
  4. what part of the body has venous pooling?
A
  1. dependent
  2. dependent
  3. IVC
  4. legs
118
Q

what are the 2 absolute CIs to kidney transplant? (AI, C)

A

acute infection, cancer

119
Q

potassium should be what before kidney transplant? (mEq/L)

A

5.5 mEq/L

120
Q

kidney transplant anastomosis:

  1. renal artery to what artery? (IIA)
  2. renal vein to either what 2 veins? (E/CIV)
A
  1. internal iliac artery

2. external or common iliac vein

121
Q

cadaveric kidney can be preserved for up to how many hours?

A

48

122
Q

what happens post arterial anastomosis that indicates good graft function? (BUF)

A

brisk urine flow

123
Q

what 5 things to be prepared to treat post reperfusion? (B, H, H, A, DPC)

A

bleeding, hypoxemia, hyperkalemia, arrhythmias, decrease pulmonary compliance

124
Q

the da vinci robotic prostatectomy allows the surgeons to robotically remove the prostate using what? (SI)

A

small incisions

125
Q

is the da vinci robotic prostatectomy performed laparoscopically?

A

yes

126
Q

what position for da vinci robotic prostatectomy?

A

steep trendenlenburg

127
Q

what are 4 major complications from da vinci robotic prostatectomy? (MI, CC, T, N)

A

MI, cardiac collapse, thromboembolism, neuropathies

128
Q

trendelenburg position:

  1. limits or enhances diaphragm movement?
  2. increases or decreases lung volume and FRC?
  3. the ETT end up R mainstem because of the upward shift of what? (C)
  4. what nerve injury is most common in this position?
A
  1. limit
  2. decreases
  3. carina
  4. brachial plexus
129
Q

brachial plexus injuries happen when the arms are in what 2 positions? (H, H)

A

hyperabducted, hyperextended

130
Q

in steep trendelenburg, do these things increase or decrease?

  1. SVR
  2. MAP in the brain
  3. cerebral blood volume
  4. BP
  5. filling pressures
  6. CO to LEs
A
  1. increase
  2. increase
  3. increase
  4. increase
  5. increase
  6. decrease
131
Q

where does venous congestion occur in steep trendelenburg? (E, T, L)

A

eyes, tongue, larynx

132
Q

what is there a significant risk of with peritoneal insufflation? (CDE)

A

carbon dioxide emoblism

133
Q

da vinci robotic prostatectomy has potential damage to what nerve?

A

common peroneal nerve

134
Q

does peritoneal insufflation increase or decrease these:

  1. compliance
  2. V/Q mismatch
  3. peak airway pressure
  4. CO2 in blood
A
  1. decrease
  2. increase
  3. increase
  4. increase
135
Q

does age >55 put you at a risk for AKI?

A

yes

136
Q

what does a Cystometrogram measure?

A

bladder pressure

137
Q

do neurosurgical procedures alter kidney function?

A

yes

138
Q

what 3 things multiplied together gets you the GFR?

A

serum Cr, urine Cr, urine volume

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