Kidney, Liver, Endo Flashcards
1
Q
What is in renal cortex
A
Glomerulus, Bowman’s capsule, proximal tubules, distal tubules
2
Q
What is in renal medulla
A
Loops of henle and collecting ducts
3
Q
What Aldosterone v adh does
A
Aldosterone- na and water absorbed (extracellular vol). ADH absorbs water (osmolarity).
4
Q
Hormones made by the kidney
A
Renin, EPO, d3
5
Q
Kidneys receive what % of CO. Of that what is filtered by glomerulus, what happens to other part
A
20-25. 20. Circulates through peritubular capillaries
6
Q
Renal blood flow calc
A
(Map - renal venous pressure) / renal vascular resistance
7
Q
Renal cortex v medulla blood flow and p50. Which area more sensitive to ischemia
A
Cortex= 90%, 50. Medulla= 10%, 10. Medulla more sensitive
8
Q
RBF in neonate, when it achieves adult level
A
Doubles first 2 weeks of life. Adult level at 2 years old
9
Q
How kidney autoregulates to maintain renal perfusion
A
When perf too low, bf inc by reducing vascular resistance. Vice versa is true
10
Q
Renal blood flow autoreg range
A
Map 50-180
11
Q
Most important methods of autoreg in kidney
A
Myogenic mechanism and tuboglomerular feedback
12
Q
What increases renin release
A
Reduced renal perf, b1 activation, dec na and cl delivery to distal tubule
13
Q
What things increase aldosterone release
A
High k, low na, RAAS stim
14
Q
What controls adh release
A
Inc osmolarity of ECF and decreased blood vol
15
Q
How adh restores bp
A
Stim v2 in CD, inc cAMP, aquaporin channels inserted into cd and stim water reabsorption. Stim v1 which vasoconstricts in periph vessels (IP3), inc SVR
16
Q
Which anesthesia related things impact adh homeostasis
A
Inc by peep, pos pressure vent, hypotension, bleeding
17
Q
How ANP acts
A
Produced in myocardium in resp to atrial distension. Stim na and h20 excretion in collecting ducts. Neg feedback to RAAS, inhib renin release
18
Q
DA1 v DA2
A
1= in renal vasc and tubules, r/t inc cAMP, vasodilation/inc RBF+GFR/diuresis/na exc. 2= pre sns, dec cAMP, dec NE release
19
Q
Calc: net filtration pressure in kidney
A
Glom hydrostatic p - Bowman’s capsule hydrostatic p - glomerular oncotic p
20
Q
What conditions inc gfr and filtration fraction
A
Constriction of efferent arteriole and dec plasma protein
21
Q
Most important determinant of gfr
A
Glomerular hydrostatic pressure
22
Q
What determines glomerular hydrostatic pressure
A
Arterial bp, afferrent arteriolar res, efferent arteriolar res
23
Q
Reabsorption
A
From tubule to peritubular capillaries
24
Q
Secretion
A
From peritubular capillaries to tubule
25
Excretion
Removal from body in urine
26
Urinary excretion rate=
Filtration - reabsorption + secretion
27
Where is most of filtered na reabsorbed
Proximal tubule
28
Func of proximal tubule, what happens here
Bulk reabsorption of solutes and h20. 65% of h20, na, k, cl, and bicarb
29
Func of desc loop of henle
Water reabsorption, countercurrent inc osmolarity of peritubular fluid to achieve this
30
Ascending loop of henle function
K, na, and cl pumped into interstitium. Impermeable to h20. UF hypotonic. H excreted. Still countercurrent
31
Distal tubule func
Fine tunes solute conc. Na, k, cl, hco3 reabsorbed. Where aldosterone and adh act, only ways h20 is let in. Parathyroid hormone inc ca. Where juxtaglomerular apparatus is, adjusts urea conc
32
Collecting duct func
Regulates conc of urine. ADH inc h20 reabs, anp inhib h20/na reabs. Aldosterone works here. Adjusts h conc
33
How CAI diuretics work
Inhib carbonic anyhydrase, reduces reabsorption of hco3, na, and water in proximal tubule
34
Uses of CAIs
Open angle glaucoma, high altitude sickness, central sleep apnea
35
Complic of CAIs
Metabolic acidosis, hypokalemia, in COPD loss of hco3 may exac cns dep from hypercarbia
36
How osmotic diuretics work
Inhib h20 reabsorption in proximal tubule and loop of henle. They pull ECF into IV space. Good for brain bad for heart
37
Uses of osmotic diuretics
Prevent AKI, ic htn, dx acute oliguria (inc UOP if prerenal)
38
Complic of osmotic diuretics
CHF, pulm edema, if bbb disrupted will enter brain and cause cerebral edema
39
How loop diuretics work
Poisons na k 2cl transporter, lose dilute urine, k, ca, mg, and cl
40
Complic of loop diuretics
Hypochloremic metab alkalosis, pot nmbs, weakness, ototoxic, reduced lithium clearance
41
How thiazide diuretics work
Inhib na cl transporter in distal tubule. Inc serum ca and can inc bg
42
Complic of thiazide diuretics
High bg/ca/uric acid, low k, metab alkalosis, HLD
43
K sparing diuretics moa
Amigo ride and triad inhib k sec and na reabs in CD. Spironolactone = aldosterone antag, inhib k sec and na reabs in CD
44
Complic of k sparing diuretics
High k (inc if using nsaids/bb/ace inhib), metab acid, gynecomastia, libido changes, nephrolithiasis
45
Best tests of tubular func
Frac exc of na and urine osmolality
46
Tests of GFR
BUN and creatinine clearance
47
Bun <8 means what
Overhydration, dec urea produc (malnutrition or liver dis)
48
Bun 20-40 means what
Dehyd, inc protein input (diet, GIB, hematoma breakdown), catabolism (sepsis or trauma), dec gfr
49
100% inc in creatinine means what
50% reduction in gfr
50
Nml bun to creat ratio. If >20:1= what
10:1. If >= azotemia.
51
GFR calc
((140-age) x (kg)/(72 x creat)
52
Fe(na) <1% means what
More na conserved than creat cleared. = prerenal azotemia
53
If Fe na >3% means what
More na excreted than creat cleared. Means tubular func impaired
54
Prerenal oliguria looks like what w tests
Fe na <1, urinary na <20, osmolality of urine >500, ratio >20:1, nml sediment or maybe hyaline casts
55
Acute tubular necrosis looks like what in tests
Fe na >3, urinary na >20, urine osmolality <400, bun cr ratio normal. Tubular epithelial casts or granular casts
56
Uremic bleeding: cause, what is normal, tx
Dysfunctional platelets. Normal pt, ptt, and plt count. Tx is desmopressin, dialysis preop
57
Prop in renal pts dose and why
Inc dose, hyperdynamic circ and bbb disrup d/t uremia
58
Precedex use in renal pts
Liver metab, safe to use. Doa may be prolonged
59
Preventative strategies for contrast media induced AKI
Nacl, low/isoosmolar contrast, sodium bicarb
60
SE and use of calcineurin inhib in renal pts
Immunosuppression for transplants. SE: htn, renal vasoconstriction
61
Turp: level required for spinal. Resec time limit and solution height above table
T10. 1 hr or less. <30 cm above table
62
Turp solution pro and SE: distilled water
Good for surgeon. Inc risk turp syndrome, dec, na, hemolysis, hemoglobinuria
63
Turp solution pro and SE: glycine
Dec risk turp syndrome. Inc ammonia, dec loc, postop blindness
64
Turp solution pro and SE: sorbitol
Dec risk turp syndrome. Hyperglycemia, lactic acidosis
65
Turp solution pro and SE: mannitol
Osmolarity similar to plasma, no renal metab. Transient plasma expansion —> risk if lv fail
66
Turp solution pro and SE: NACL
Absent of many se. Can only be used if bipolar cautery, cant use unipolar (current)
67
Turp syndrome: triad, na level <120, na level <110
Hypertension (inc PP), bradycardia (reflex), alt LOC. <120= inc risk complic. <110 sz, coma, lethal ventric dysrhythmias
68
Absolute contraindications to ESWL
Pregnancy, bleeding disorders, anticoagulation
69
What removes bacteria from liver
Kuppfer cells
70
Liver version: arterioles, capillaries, venule s
Term branches of hepatic a and portal v. Sinusoids. Central vein
71
In liver, which zone best oxygenated, which worst oxygenated, which has highest conc of cp450 enzymes
Best= zone 1 (periphery). Worst= zone 3 (near central vein)). Highest cp450, zone 3
72
Liver: % of CO, blood flow to liver
30. Aorta to sphlanchnic to portal v to liver. Or aorta to hep artery to liver
73
Portal vein: ___% of liver bf, ____% of o2 content
75% bf, 50% constant (lower o2 sat)
74
Hep artery: __% bf to liver, ___% 02 content
25, 50 (higher constant)
75
Portal htn dx: portal vein p, sinusoidal p
>20, >5
76
Hepatic artery perf p calc
MAP - hepatic vein pressure
77
Hepatic arterial buffer response. What happens, what mediates it, what impairs it
Reduc in portal v flow compens by inc hepatic artery flow. Mediated by adenosine, impaired by severe liver disease
78
Effect of anesthesia on hepatic BF
Dec MAP, can reduce hepatic bf 30-50%
79
Procoagulants made by liver
Thrombopoietin, alpha 1 glycoprotein, factor 7
80
Factor VIII is made in the _____ but not made by the _____
Made in liver. Not made by hepatocytes
81
Albumin= reservoir for ____ drugs
| A1 glycoprotein= reservoir for ____ drugs
Acidic. Basic
82
AST/ALT ratio > ___ suggests cirrhosis or etoh liver disease
2
83
most sensitive indicator of biliary duct obstruction
5 nucleotidase
84
Bilirubin levels if damage: before liver, in liver, after live (cholestatic)
Before= inc unconjugated. In or after= inc conjugated
85
Markers of hepatitis a
IgM early, IgG late
86
IA that makes most trifluoroacetic acid, IA doesnt make any
Halothane. Sevo makes none
87
RF for IA induced TFA/hepatitis
>40 years old, female, >2 exposures, genetics, obesity, CYP2EI induction (etoh, isoniazid, phenobarb)
88
Hepatitis: most common cause, 2nd most common. Dx of it
Etoh. Hep c. Inc liver enzymes, bilirubin, cell changes
89
S/sx and lab changes w hepatitis
Jaundice, fatigue, low plt, glomerulonephritis, neuropathy, arthritis, myocarditis. Pt prolonged, dec albumin
90
Anes consid to maintain hepatic bf
Use iso (preserves it), avoid peep (inc resistance to drainage), normocapnia, liberal IVF, regional ok if no coag alt
91
Hepatotoxic drugs that inhib cyp 450
Tye, amio, halothane, abx (pcn, tetracycline, sulfonamides)
92
Etoh withdrawal syndrome: when s/s appear, peak. Early and late s/s
Appear 6-8 hr. Peak 24-36 hr. Early: tremor, halluc, nightmares. Late: inc sns (hi hr and bp, dysrhythmias), Nv, insomnia, agit
93
Tx etoh withdrawal
Etoh, BB, A2 agonists
94
When DTs occur. S/s. Tx
2-4 days after no etoh. Grand mal sz, hi hr, hi or low bp, combative. Valium or benzos, BBs
95
Tx drug for alcoholics in recovery. SE of it
Disulfiram. Hepatotoxic. Inhib dopa beta hydrozylase —> hypotension
96
MELD: what it assesses. Low risk, high risk
Bilirubin, INR, and serum creatinine. <10. >15
97
Child Pugh score: what it assesses, classes
Albumin, PT, bilirubin, ascites, encephalopathy. A= 10% risk periop morbid. B= 30. C= 80
98
Child Pugh score: how class scoring impacts proceeding to surgery
A or B ok to surgery if optimized. C should be medically managed until function improves (hepatic)
99
Drugs that relax sphincter of oddi
Glucagon, glyco, atropine, narcan, ntg
100
Ant pituitary hormones
Fsh, lh, acth, tsh, prolactin, growth hormone
101
T3 compared to T4
T3 has higher potency and shorter half life
102
T3 is a ____hormone, T4 is a ____hormone
T3= prohormone. T4= active hormone
103
Hypothyroid: lab alt, what causes goiter
Tsh chronically high. Thyroglobulin colloid causes gland to inc since tsh high
104
How thyroid hormones effects heart
Inc contractility/rate/rate of relaxation, dec SVR
105
How thyroid hormone effects resp and mac
Inc co2 produc __> inc vt and rr. No effect on mac. Dec rate of induc
106
Effect of k iodide on hyperthyroidism
Reduces thyroid hormone synthesis and release, given 10d preop
107
Drugs that inhib conversion of t4 to T3
Propranolol, esmolol, ptu, methimazole, carbimazole
108
If emergent thyroid sx give what rx
Bb, k iodide, glucocorticoid, ptu
109
Avoid what in thyroid surgery
Sympathomimetics, anticholinergics, ketamine, panc
110
What thyroid storm can mimic under GA
MH, pheo, neuroleptic malignant syndrome, light anesthesia
111
What Block’s thyroid synthesis
Methimazole, ptu, k iodide
112
What Block’s thyroid release
Iodine/iodide
113
Why aspirin bad in thyroid pt
Dislodges t4 from plasma proteins and inc free frac of t4
114
Signs of hypocalcemia
Spasms, tetany, laryngospasm, mental status alt, low bp, prolonged qt, parasthesias, chvosteks and trousseaus
115
Hypothyroid: rx given and initial response
T4, natiuresis and dec tsh
116
Induction (inhalation) is ____ w hypothyroid
Faster
117
Hormones made in: zona glomerulosa, fasciculata, reticularis
Mineralcorticoids, glucocorticoids, androgens
118
How to remember what adrenal cortex zones release
Salt, sugar, sex
119
Aldosterone causes what shifts
Na and h20 reabsorption. K and h excretion
120
Aldosterone release is inc by what 3 things
RAAS activ, high k, low na
121
Aldosterone regulates what, does not regulate what. Causes metabolic ___
Reg iv vol not osmolarity or na conc. Alkalosis
122
What doesnt have glucocorticoid effects
Aldosterone
123
What doesnt have mineralcorticoid effects
Decadron, betamethasone, triamcinolone
124
Conns disease: excess ____. Features, anes implic, tx
Aldosterone. Htn, low k, metab alk. Give k, restrict na, give spironolactone. Sensitive to NDMR, u wave on ekg, avoid hypervent and vol overload (hypertensive)
125
Cushings: k shift, metabolic ___, anes implic
Low k, alkalosis. Post op give steroid. May have DI after resection
126
Signs of adrenal insuff
Low k, hi na, metab acid, low bg and bp, nv
127
When pt should get stress dose of steroids preop
>20 mg/day prednisone (80 hydrocortisone) for over 3 weeks
128
Hydrocortisone if minor, moderate, or major sx
Minor: 25 mg. Moderate: 50-75 mg. Major: 100-150
129
Hormone released by pancreatic cells: alpha, beta, delta
Glucagon, insulin, somatostatin
130
Drugs that inc or dec blood glucose
Inc by beta agonists. Dec by BB or VAs
131
What stim v inhib glucagon release
Stim: decreased glucose, stress, sepsis, trauma, b agonist. Inhib: inc glucose, insulin, somatostatin
132
What somatostatin does
Inhibits insulin and glucagon. Dec sphlanchnic bf and dec motility
133
Biguanides (metformin): key facts/risks
Doesn’t cause hypoglycemia, risk of lactic acidosis, dc >48h preop
134
Sulfonylureas key facts
Avoid if hypoglycemia, avoid if sulfa allergy, dc 24-48h preop
135
Oral dm med that inc risk CHF
Thiazolinediones, end in -azone
136
Which receptor stim inc v decrease insulin sec
Beta 2 and pns inc insulin sec. A2 stim dec insulin sec
137
Very rapid acting insulin: onset, peak, duration
5-15 min, 45-75 min, 2-4h
138
Rapid acting insulin: onset, peak, duration
30 min, 2-4h, 6-8h
139
Intermediate acting insulin: onset, peak, duration
2h, 4-12h, 18-28 h
140
Long acting insulin: onset, peak, duration
2h. 3-9h. 6-24 h
141
Drugs that counter hypoglycemic effect of insulin
Epi, glucagon, estrogen, acth
142
Drugs that extend hypoglycemic effect of insulin
MAOIs, salicylates, tetracycline
143
Drugs to give in carcinoid crisis
Somatostatin (octreotide), antihistamines, 5ht3 antagonists, steroids, neo or vaso for low bp
144
Drugs to avoid in carcinoid pts
Histamine releasers, sux, exogenous catecholamines, ephedrine, ketamine
145
Levels that are inc in renal osteodystrophy
2 ps: phosphate and PTH
146
Where each is made: angiotensinogen, ang I, ace, ang II
Liver, systemic circ, lung, adrenal gland
