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6901 > Liver, Pancreas, Spleen > Flashcards

Liver, Pancreas, Spleen Flashcards

1
Q

2 functions of pancreas

A
  • endocrine

- exocrine

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2
Q

pancreatic exocrine functions

A

-secretion of pancreatic juice (1500-3000 mL daily) from acinar cells that adjusts the pH of duodenal contents to promote optimal activity for pancreatic enzymes

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3
Q

pancreatic exocrine fluid content

A
  • pH = 8.3

- sodium, potassium, bicarbonate, chloride

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4
Q

cholecystokinin-pancreozymin (CCK-PZ)

A
  • released when acidic chyme arrives in small intestine
  • produced by I-cells in duodenum
  • slows stomach emptying, promotes bile and pancreas secretion
  • creates the sensation of fullness during a meal (not between meals)
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5
Q

secretin

A
  • released when acidic chyme arrives in small intestine
  • produced by crypts of Lieberkühn in intestinal wall
  • promotes bile and pancreas secretion
  • plays a role in osmoregulation
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6
Q

pancreas endocrine cells (4)

A
  • alpha: glucagon
  • beta: insulin
  • delta: somatostatin
  • pancreatic polypeptide:
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7
Q

pancreatic polypeptide hormone function

A

-inhibits exocrine pancreatic secretion

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8
Q

somatostatin hormone function

A

-regulates GI function by restraining the rate nutrients are absorbed

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9
Q

glycogenesis

A

-storage of glucose as glycogen, occurs primarily in the liver and muscle

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10
Q

lipogenesis

A

-storage of fat as triglycerides, occurs primarily in the adipose tissue

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11
Q

gluconeogenesis

A

-formation of glucose from lactate, pyruvate, amino acids, glycerol

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12
Q

glycogenolysis

A

-breakdown of glycogen into glucose, occurs primarily in the liver

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13
Q

lipolysis

A
  • the breakdown of stored triglycerides to free fatty acids and glycerol
  • stimulated by lipase
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14
Q

hormones that oppose insulin (4)

A
  • growth hormone
  • cortisol
  • glucagon
  • epinephrine
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15
Q

factors that stimulate insulin release

A
  • glucose, mannose, fructose
  • amino acids
  • gastrointestinal hormones
  • acetylcholine
  • beta-adrenergic stimulation
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16
Q

factors that inhibit insulin release

A
  • hypoglycemia
  • somatostatin
  • alpha-adrenergic stimulation
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17
Q

blood glucose levels for diabetes diagnosis

A
  • FBG > 126

- random glucose > 200

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18
Q

chronic complications of diabetes

A
  • microvascular: retinopathy, nephropathy, neuropathy
  • macrovascular: CAD, PVD, cerebrovascular disease
  • other: infection, cataracts, stiff joint syndrome, glaucoma, poor wound healing
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19
Q

diabetic patient have _____ morbidity and mortality in the perioperative period compared with non-diabetes because _____

A

higher; organ damage associated with long term disease

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20
Q

the most common cause of perioperative mortality in the diabetic patient is?

A

ischemic heart disease

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21
Q

diabetes: preoperative considerations

A
  • EKG
  • medications for delayed gastric emptying
  • assess neck mobility: glycosylation of tissues produces stiffness, ‘prayer sign’
  • kidney function
  • review of insulin medications
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22
Q

blood glucose above _____ may warrant surgery cancellation?

A

-350

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23
Q

diabetes: perioperative considerations

A
  • impaired respiratory response to hypoxia
  • schedule early in the day
  • careful positioning
  • hourly blood sugars
  • denervation hypersensitivity of cardiac acetylcholine receptors place at risk for severe refractory bradycardia: consider with anticholinesterase reversal
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24
Q

hypoglycemia signs/symptoms

A
  • tachycardia
  • diaphoresis
  • anxiety
  • tremors
  • pupillary dilation
  • vasoconstriction
  • piloerection
  • confusion
  • weakness
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25
Q

hypoglycemia treatment

A
  • 25-50 mL of D50% IV

- D5% gtt

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26
Q

DKA

A

-type 1 DM
BG>250
-ketones - fruity breath, low pH, kussmaul respirations
-dehydration, hyperosmolarity

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27
Q

HHS

A
  • type 2 DM
  • BG>600
  • dehydration, hyperosmolarity
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28
Q

mortality DKA versus HHS

A

-higher in HHS, may be due to HHS affecting an older population

29
Q

acute pancreatitis signs/symptoms

A
  • hemorrhage, edema, necrosis of pancreas
  • induced auto-digestion
  • pain
  • n/v
  • fever
  • hypotension
  • hypocalcemia with EKG changes (prolonged QT)
  • acute renal failure
30
Q

enzymes implicated in the syndrome of pancreatitis are activated by?

A
  • trypsin
  • enterokinase
  • bile acids
31
Q

pancreatic inflammation results from (4)

A
  • vascular breakdown
  • coagulation necrosis
  • fat necrosis
  • parenchymal necrosis
32
Q

acute pancreatitis complications

A
  • CV: pleural effusions, alterations in rhythm, thrombophlebitis, cardiac depression, s/s mimicking acute MI
  • ARDS
  • DIC
33
Q

acute pancreatitis: pain control

A
  • fentanyl

- NOT morphine: it causes spams of the Oddi sphincter

34
Q

chronic pancreatitis: diagnosis triad

A
  • steatorrhea
  • pancreatic calcification
  • diabetes mellitus
35
Q

chronic pancreatitis: pseudocyst

A
  • contains proteolytic enzymes
  • best seen through CT
  • not epithelial lined: therefore not true cyst
  • high mortality
36
Q

chronic pancreatitis: S/S

A
  • hepatic disease: jaundice, ascites, esophageal varices, dereangements in coagulation factors
  • cardiac and pleural effusions
  • pancreatic abscesses
  • intraabdominal hemorrhage
37
Q

causes of pancreatitis mnemonic

A
  • ‘I GET SMASHED’
  • idiopathic
  • gallstones
  • ethanol
  • trauma
  • steroids
  • mumps/malignancy
  • autoimmune
  • scorpion sting
  • HLD, hypercalcemia
  • ERCP
  • drugs
38
Q

ERCP: operative considerations

A
  • done lateral or prone

- glucagon is given to relax sphincter of Oddi: 0.4-1 mg IV

39
Q

Zollinger-Ellison Syndrome

A

-gastrinoma: over secretion of gastrin leading to over secretion of gastric acid

40
Q

Whipple

A

-pancreaticoduodenectomy

41
Q

C-peptide

A
  • is a portion of the precursor to insulin

- tells if the body is making insulin

42
Q

pancreatic transplant: anesthetic considerations

A
  • multiple IVs, central line, A-line
  • agents with minimal cardiac depressant effects and not metabolized in kidney
  • high amount of opioids
  • hemodynamics: cannot rapidly cause vascular expansion as this may result in allograft edema
  • consider colloid
  • heparin gtt
43
Q

spleen zones (3)

A
  • red pulp: splenic sinusoids
  • white pulp: end arterial branches of central arteries, contain lymphocytes, macrophages, plasma cells
  • marginal zone: ill defined zone that contains both
44
Q

blood flow to spleen is?

A

300 mL/min

45
Q

spleen physiologic functions

A
  • blood filtering
  • immune processing of blood-borne foreign antigens (IgM)
  • hematopoiesis in fetus
  • minor role in platelet storage
46
Q

carcinoid tumors

A
  • slow growing malignancies of enterochromaffin cells

- usually in the gastrointestinal tract, also lungs, pancreas, thymus, liver

47
Q

factors that enhance carcinoid hormones

A
  • direct stimulation

- beta adrenergic stimulation

48
Q

carcinoid tumors: substances secreted by the enterochromaffin tumors

A
  • serotonin
  • bradykinin
  • tachykinin
  • prostaglandins
  • ACTH
  • histamine
49
Q

carcinoid syndrome: symptoms

A
  • cutaneous flushing
  • bronchospasm
  • labile BP
  • diarrhea
  • abdominal pain
  • hyperglycemia
  • hypoalbuminemia
50
Q

carcinoid syndrome: diagnosis

A

serotonin metabolites in urine

51
Q

carcinoid syndrome: anesthetic considerations

A
  • histamine blockers
  • avoid histamine agents
  • avoid sympathomimetic agents
  • hypotension with alpha not beta
  • keep normothermic,
  • monitor blood glucose
52
Q

carcinoid syndrome: pretreatment

A
  • octreotide: suppresses the release of tumor products, 100 mcg subq 2-3 times daily
  • somatostatin: suppresses the release of tumor products
53
Q

what cells line the hepatic sinusoids? what is each cells function?

A
  • endothelial cells

- Kupffer cells: removes bacteria

54
Q

liver blood flow

A
  • 1500 mL per minute: 25-30% from artery, 70-75% from vein

- 25-30% cardiac output

55
Q

liver as a reservoir - how much blood can the liver deliver in a time of need?

A

350 ml

56
Q

liver: arterial versus venous differences

A
  • arterial: autoregulation, alpha and beta receptors

- venous: flow from vein, alpha receptors

57
Q

functions of the liver

A
  • carbohydrate metabolism
  • protein synthesis
  • amino acid synthesis
  • protein metabolism
  • bile production
  • lipid production
  • coagulation factor synthesis
  • drug metabolism
  • bilirubin metabolism
58
Q

phase 1 drug reactions

A
  • hydrolysis, oxidation, reduction

- add or expose a functional group

59
Q

phase 2 drug reactions

A

-conjugation

60
Q

3 main complications from cirrhosis

A
  • variceal hemorrhage
  • fluid retention (ascites due to decreased plasma oncotic pressure)
  • hepatic encephalopathy
61
Q

muscle relaxation and liver disease

A
  • NDMR: larger volume of distribution, may require more

- plasma cholinesterase may be deficient

62
Q

the most profound etiologic factor that results in decreased hepatic blood bllod is?

A

-abdominal surgery

63
Q

other factors that reduce hepatic blood flow (3)?

A
  • hyptension
  • excessive sympathetic activation
  • high mean airway pressures during controlled ventilation
64
Q

-sphincter of oddi spasm

A
  • narcotic induced: morphine>Demerol>butorphanol>nalbuphine
  • surgical manipulation
  • cold irrigation
65
Q

volatile agent of choice for liver disease?

A

-isoflurane

66
Q

narcotic of choice for liver disease?

A
  • fentanyl

- avoid morphine

67
Q

portal hypertension treatment

A
  • vasopressin 0.1-0.4 units/min

- octreotide: 50 mcg/hr: reduces blood flow to GI

68
Q

fluid choice for liver failure?

A
  • controversial
  • NS: sodium retention
  • LR can exacerbates liver failure secondary to the breakdown of bicarbonate in the liver

6901 (18 decks)

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