GU surgery Flashcards
1
Q
kidneys lie retroperitoneally in the abd at what 2 levels?
A
T12 and L4
2
Q
renal arteries originate from what artery?
A
aorta
3
Q
renal veins cross anteriorly or posteriorly before joining the IVC?
A
anteriorly
4
Q
renal innervation is primarily sympathetic and afferent fibers that arise from what range of spinal levels?
A
T10-L1
5
Q
surgical anesthesia of the kidneys requires what range of levels?
A
T8-L3
6
Q
kidney pain may be perceived by afferent fibers that travel in what nerve? (V)
A
vagus nerve
7
Q
what level of sensory block is needed to produce anesthesia for the ureters?
A
T10
8
Q
The long what of ureters makes them vulnerable to injury/transection during retroperitoneal surgery? (P)
A
path
9
Q
should LA containing epi be given for injections around the penis?
A
no
10
Q
what response may occur with testicular manipulation? (V)
A
vagal response
11
Q
what 5 things make up the urinary system? (K,BS,U,B,U)
A
kidneys, blood supply, ureter, bladder, urethra
12
Q
what % range of the CO goes to the kidneys?
A
20-25%
13
Q
what is the renal BF equation?
A
RBF=(MAP-VP)xVR
14
Q
what 2 things determine renal BF? (NA, NR)
A
natural autoregulation, neural regulation
15
Q
what is the MAP range to maintain renal filtration?
A
50-180 mmHg
16
Q
MAP less that what stops filtration?
A
<50 mmHg
17
Q
renal BF to both kidneys is how many mLs per minute?
A
1200 mL
18
Q
glomerular filtration is the filtering the blood into tubule forming what? (PU)
A
primitive urine
19
Q
tubular reabsorption is absorption of substances needed by the body from what to what?
A
from the tubule to the blood
20
Q
tubular secretion is the secretion of substances to be eliminated from where to where?
A
blood to the tubule
21
Q
AKI is up to what % of critically ill pts?
A
8%
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
23
Q
Prerenal, intrinsic or postrenal AKI:
- impaired renal autoregulation
- decrease effective circulating volume
- acute glomerulonephritis
- vasculitis
- bladder outlet obstruction
A
- prerenal
- prerenal
- intrinsic
- intrinsic
- postrenal
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
25
what procedures can significantly alter renal function? (L, CB, ACC, RAD, NP)
laparoscopy, CPB, aorta cross clamping, renal artery dissection, neurosurgical procedures
26
are anesthesia effects on the kidneys more or less during regional anesthesia?
less
27
what are the 3 reversible anesthesia effects on normal RBF? (H, SA, EE)
hypotension, sympathetic activation, endocrine effects
28
light anesthesia and intense surgical stimulation causes what reversible anesthesia effect on normal RBF? (SA)
sympathetic activation
29
hypotension limits what that ends up reducing renal function? (A)
autoregulation
30
Response to what causes the endocrine effects that causes an increase in catecholamines and a decrease in renal BF? (S)
stress
31
ADH and angiotensin 2 decrease RBF by causing constriction where? (RA)
renal artery
32
what VA that is not used anymore has high nephrotoxicity? (M)
methoxyflurane
33
do isoflurane and desflurane produce nephrotoxicity?
no
34
sevoflurane has the potential for nephrotoxicity from having what as its byproduct? (CA)
compound A
35
what electrolyte are we worried about with renal pts?
potassium
36
what is the GFR equation?
urine cr x serum cr x urine volume
37
normal range of lab values:
1. BUN (mg/dL)
2. serum Cr (mg/dL)
3. creatinine clearance (mL/min)
1. 10-20 mg/dL
2. 0.7-1.5 mg/dL
3. 95-150 mL/min
38
what lab test is the main product of protein metabolism?
BUN
39
what lab test is a key indicator for GFR function?
serum Cr
40
what test is considered the specific test for GFR?
Cr clearance
41
what test measures the ability of the glomeruli to excrete creatinine given a specific plasma creatinine concentration?
Cr clearance
42
what 3 lab tests measure renal tubular function? (USG, UO, USC)
1. urine specific gravity
2. urine osmolality
3. urine sodium concentration
43
Is urine specific gravity or urine osmolality more specific of renal tubular function?
urine osmolality
44
normal range of lab values:
1. urine specific gravity
2. urine osmolality (mOsm/L)
3. urine sodium concentration (mEq/day)
1. 1.003-1.030
2. 65-1400 mOsm/L
3. 130-260 mEq/day
45
urine specific gravity and urine osmolality measure waht in urine? (S)
solutes
46
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
1. >90
2. 60-89
3. 30-59
4. 15-29
5. <15
47
Qualitatively describe the CKD stages:
1. stage 1
2. stage 2
3. stage 3
4. stage 4
5. stage 5
1. normal
2. mild
3. moderate
4. severe
5. ESRD
48
Risk criteria:
1. Cr increased how many times?
2. GFR decreased greater than what %?
3. UO less than what for how many hrs?
1. 1.5 times
2. 25%
3. .5 mL/kg/hr for 6 hrs
49
Injury criteria:
1. Cr increased how many times?
2. GFR decreased greater than what %?
3. UO less than what for how many hrs?
1. 2 times
2. 50%
3. .5 mL/kg/hr for 12 hrs
50
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?
1. 3 times
2. 75%
3. 4 mg/dL
4. .3 mL/kg/hr for 24 hrs (or anuric for 12 hrs)
51
Loss criteria is complete loss of renal function greater than how many weeks?
4 weeks
52
Renal failure system abnormalities:
1. hyper or hypokalemia?
2. hyperparathyroidism or hypoparathyroidism?
3. hypernatremia or hyponatremia?
4. hypercalcemia or hypocalcemia?
1. hyperkalemia
2. hyperparathyroidism
3. hypernatremia
4. hypocalcemia
53
what are 5 causes of chronic renal failure? (DN, H, G, PKD, KI/O)
1. diabetic neuropathy
2. HTN
3. glomerulonephritis
4. polycystic kidney disease
5. kidney infection/obstructions
54
Chronic renal failure:
1. what is the mortality %?
2. what % will need dialysis?
1. 20%
| 2. 50%
55
do pts with renal disease have delayed gastric emptying?
yes
56
since renal disease pts have delayed gastric emptying, what 2 meds should you consider? (HB, MFA)
1. H2 blockers
| 2. magnesium free antacids
57
what med that can promote gastric emptying is party excreted by the kidneys? (R)
reglan
58
opioid and other drugs have an increased effect in renal disease pts because of reduced what? (PB)
protein binding
59
what opioid should be used with caution?
morphine
60
why should morphine be used with caution in renal disease pts?
because active metabolites are excrete by the kidney
61
what opioid should be avoided in pts with renal disease? (M)
mepiridine
62
can meperidine be removed by dialysis?
no
63
meperidine metabolite accumulation can lead to what neuro symptom? (C)
convulsions
64
can renal disease pts receive toradol?
no
65
can hydromorphone be removed by dialysis?
yes
66
what 2 muscle relaxants should you avoid? (S, P)
succinylcholine and pancuronium
67
what 2 muscle relaxants should be given to renal disease pts because they are eliminated independent of renal function? (A, C)
atracurium and cisatracurium
68
what are 3 EKG changes of hyperkalemia?
1. peaked T wave
2. widened QRS
3. prolonged PR
69
Nephrotoxicity with VAs is least with which one?
Desflurane
70
what 4 things should you be prepared to treat for renal disease pts undergoing GA? (H, DCO, A, PDE)
1. hypotension
2. decreased CO
3. arrhythmias
4. prolonged drug effects
71
AV grafts are for pts with small what? (V)
veins
72
what is an AV graft?
a tube that connects a vein and an artery
73
what is an AV fistula?
a connection between the vein and and artery
74
what are 6 long term complications of AV fistulas and grafts? (I, I, A, T, H, VH)
1. infection
2. ischemia
3. aneurysm
4. thrombosis
5. hematoma
6. venous HTN
75
what regional anesthesia is required for these procedures?
1. lithotripsy
2. cystoscopy
3. transurethral resection of the prostate (TURP)
1. T4
2. T9
3. T10
76
what is the most common GU procedure? (C)
cystoscopy
77
Methylene blue causes a temporary decrease in what measurement?
SpO2
78
Cystometrogram is performed for diagnosing what 4 things? (OB, DU, UR, I)
1. overactive bladder
2. difficulty urinating
3. urinary retention
4. incontinence
79
What position for cystoscopy?
lithotomy
80
What is a cystoscopy?
instrumentation to examine the urinary tract
81
what may be performed along with a cystoscopy?
insertion of urethral stents
82
Cystometrogram is inserting a catheter into the bladder to measure what? (BP)
bladder pressure
83
do pts receiving a cystometrogram receiving sedation?
no
84
why don't we want pts having a cystometrogram to be sedated?
so they can provide the best results of trying to empty their bladder
85
what position for cystometrogram?
lithotomy
86
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)
1. vital capacity, lung volume, lung compliance
2. increase
3. hypotension
87
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)
1. 4 hr
2. <20
3. smoking
88
what 5 nerves can be damaged in the lithotomy position? (FOPSS)
1. femoral
2. obturator
3. peroneal
4. sciatic
5. saphenous
89
what nerve damage results in loss of dorsiflexion of the foot?
common peroneal
90
damage to the peroneal nerve results in what sign? (FD)
foot drop
91
damage to what nerve results in numbness along the medial calf?
saphenous
92
what is the most common procedure for urinary incontinence?
sling procedure
93
sling procedure takes a piece of human tissue or synthetic tape to support what 2 things? (BN, U)
bladder neck, urethra
94
what are 2 serious complications of sling procedures? (PP, I)
pelvic pain, infections
95
Lithotripsy is used to disrupt renal calculi by focusing what at them? (HESW)
high energy shock waves
96
pts with what 2 cardiac histories have an increased risk of developing arrhythmias? (CA, P)
cardiac arrhythmias, pacemaker
97
to decrease the incidence of arrhythmias, lithotripsy shock waves are synchronized with what EKG wave?
R wave
98
what position for lithotripsy?
supine
99
what can be placed and what can be given before lithotripsy to help pass the stone?
stent, IV fluids
100
what 2 drugs can be given to increase the HR and thus the shock frequency? (G, A)
glycopyrrolate, atropine
101
what regional anesthesia level is recommended for lithotripsy?
T4
102
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)
lungs, intestine
103
what are 4 other absolute CI to lithotripsy? (OBS, UI, BD, P)
1. obstruction below stone
2. untreated infection
3. bleeding disorder
4. pregnancy
104
postpone TURP if Na is less than what? (mEq/L)
128
105
Describe the TURP procedure
inserting a scope into the urethra and electrically cutting away the prostate
106
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)
1. venous sinuses
2. cytal, glycine, saline
3. 10-30 mLs
4. 6-8
5. irrigation fluid
107
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?
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
what is the metabolite of glycine?
ammonia
109
what are the 6 clinical manifestations of TURP syndrome? (FO, WI, H, G/AT, H, C)
1. fluid overload
2. water intoxication
3. hyponatremia
4. glycine/ammonia toxicity
5. hemolysis
6. coagulopathy
110
what are the 2 EKG changes of hyponatremia?
1. wide QRS
| 2. t wave inversion
111
what are 5 s/s of glycine/ammonia toxicity? (N, V, H, H, C)
1. nausea
2. vomiting
3. HA
4. hyperglycemia
5. confusion
112
what are 3 interventions to manage TURP syndrome? (SS, AD, DL)
1. stop surgery
2. administer diuretics (lasix)
3. draw labs
113
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)
1. hypertonic saline (3% or 5%)
2. 0.5 mEq/L per hour
3. osmotic demyelination syndrome
114
is testicular torsion an emergent procedure?
yes
115
what 2 things are given to visualize the ureters? (IC, MB)
indigo carmine, methylene blue
116
what med can be given in low doses to maintain UO?
dopamine
117
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?
1. dependent
2. dependent
3. IVC
4. legs
118
what are the 2 absolute CIs to kidney transplant? (AI, C)
acute infection, cancer
119
potassium should be what before kidney transplant? (mEq/L)
5.5 mEq/L
120
kidney transplant anastomosis:
1. renal artery to what artery? (IIA)
2. renal vein to either what 2 veins? (E/CIV)
1. internal iliac artery
| 2. external or common iliac vein
121
cadaveric kidney can be preserved for up to how many hours?
48
122
what happens post arterial anastomosis that indicates good graft function? (BUF)
brisk urine flow
123
what 5 things to be prepared to treat post reperfusion? (B, H, H, A, DPC)
bleeding, hypoxemia, hyperkalemia, arrhythmias, decrease pulmonary compliance
124
the da vinci robotic prostatectomy allows the surgeons to robotically remove the prostate using what? (SI)
small incisions
125
is the da vinci robotic prostatectomy performed laparoscopically?
yes
126
what position for da vinci robotic prostatectomy?
steep trendenlenburg
127
what are 4 major complications from da vinci robotic prostatectomy? (MI, CC, T, N)
MI, cardiac collapse, thromboembolism, neuropathies
128
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?
1. limit
2. decreases
3. carina
4. brachial plexus
129
brachial plexus injuries happen when the arms are in what 2 positions? (H, H)
hyperabducted, hyperextended
130
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
1. increase
2. increase
3. increase
4. increase
5. increase
6. decrease
131
where does venous congestion occur in steep trendelenburg? (E, T, L)
eyes, tongue, larynx
132
what is there a significant risk of with peritoneal insufflation? (CDE)
carbon dioxide emoblism
133
da vinci robotic prostatectomy has potential damage to what nerve?
common peroneal nerve
134
does peritoneal insufflation increase or decrease these:
1. compliance
2. V/Q mismatch
3. peak airway pressure
4. CO2 in blood
1. decrease
2. increase
3. increase
4. increase
135
does age >55 put you at a risk for AKI?
yes
136
what does a Cystometrogram measure?
bladder pressure
137
do neurosurgical procedures alter kidney function?
yes
138
what 3 things multiplied together gets you the GFR?
serum Cr, urine Cr, urine volume
