Liver Renal Burns Flashcards
Renal pain
T10-L1 sympathetic
parasympathetic renal inervation
vagus nerve
renal sympathetic innervation
T8-L1 preganglionic
ureters innervation
S2-S4
Innervation of bladder
sympathetic T11-L2
parasympathetic S2-S4
another name for aterial pressure
glomerular capillary pressure
another name for renal blood flow
glomerular oncotic pressure
major determinents of GFR?
aterial pressure and renal blood floqw
intense SNS stimulation does what?
consctrict afferent and decreae RBF
mild SNS does what?
constricts efferent to increase RBF
what do NO and prostaglandins do?
dilate afferent to increase GFR
what does angiotensin activity do?
constrict efferent
myogenic reflex
pressure
increase in arterial pressure = constriction by reflex
decrase in pressure = dilation by reflex
where is 2/3 of Na and H2O reabsorbed?
PCT
Na is active transport
H2O is passive reabsorption
ANP does waht?
diuresis, systemic vasodilation
name three renal vasodilators
NO prostaglandins ANP
where are prostaglandins produced?
kidneys
what does renal vasodilation cause?
increae in Na and H20 excretion. Thus the reason ANP wants to cause vasodilation
when do you see symptoms for hypnatremia?
<125
most common cause of AKI in surgical patients?
actue tubular necrosis
how does AKI cause excess nitrogenous substances adn waste?
cant excrete them. accumulation of creatinine and urea in the blood
name some nephrotoxins
aminoglycosides, chemo drugs, NSAIDS, contrast dye
may take 24-48 hours to develop and peaks in 3-5 days
endogenous nephrotoxins?
calcium
uric acid
myoglobin (rhabdo)
hemoglboin (hemolysis)
bilirubin
paraproteins
when is renal azotemia irreversible?
if ischemia is severe or prolonged
what causes actue intersitital nephriits?
acute druge rxn
increase interval of waht two meds?
APAP and ASA
intervel stays the same for what meds?
al/remi/sufentanil
decrease dose of?
codeine
fentanyl
torodol
meperidine
methadone
morphine
is chronic renal failure irreversible?
yes
electrolyte imbalances in CKD?
hyp kalmemia mag and calcemia
hyperphosphatemia
how does urea affect platle function?
makes them dysfunctional
what is renal osteodystrophy?
join issues from the hyperphos and hypocalcemia
what causes pruritius?
uremia and waste build up
how do kidney patiens respond to induction?
as if hypovolemic
Anes meds in kindey patients?
N2O is okay, ISO is most hemodynamically stable
when do you get uremic syndrome?
when GFR drops to < 10%
what is nephrolithiasis?
kidney stones
most and calcium oxalate
flank pain can be a sign of ureteral stone
you can get what with glycine solution?
hyperammonemia
when might you see a wide QRS and elevated ST?
TURP syndrome
can you get DIC in TURP?
yes. from hyponatremia??
what to do to prevent TURP
resesction time < 1hour
bag no >30cm from bed to start and 15 during end of resection
avoidi hypotonic solution
are spinals good during turp?
yes they say awake so they can talk to you, ensure they dont get TURP syndrome
TURP tx
oxygenation and ciruclatory support
tell surgeon to stop ASAP
invasive monitors
send labs
how to tx mld TURP?
fluid restriction and loop diurectics
how to tx severe turp?
3% NS at <100ml/hr
DC when NA>120
is extra or intra peritoneal more common?
extra peritoneal this also heals itself
intraperitoneal needs surgery
bladder rupture
more common in peds than adults
what would cause chemical peritonitis?
intraperitoneal bladder rupture
intraperitoneal symptoms are more like what?
MI.
extraperiotneal symptoms are more generalized pain
which volatiles directly cause renal dysfunction?
methoxyflurane and enflurane
is thiopenal good in renal patients?
no
ketamine?
okay
etomidate
okay, incrased free fraction decrease dose?
benzos
decraes dose
propofol
go slow
dex
okay
can you use codeine or meperidine?
no
morphine?
single dose okay, nothing more
order of NMB agents
cis, atracurium, then ROC
Vec is prolonged
what NMB have minimal renal excretion?
succ, atracurium, cis, micacurium
short acting NMB?
micacron. eliminated by plasma cholinesterase at rate slower than succ
what meds undergoe hoffman elimination>
cis-attracurium and attracuriuym
where does acetezoalmide work?
PCT
where does mannitol work?
descending tuble
where do thiazide diurecgics work?
DCT
where does spiro work?
Collecting duct
where do loop diuretics work?
ascending loop
