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Anesthesia Principles II > Liver Renal Burns > Flashcards

Liver Renal Burns Flashcards

1
Q

Renal pain

A

T10-L1 sympathetic

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2
Q

parasympathetic renal inervation

A

vagus nerve

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3
Q

renal sympathetic innervation

A

T8-L1 preganglionic

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4
Q

ureters innervation

A

S2-S4

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5
Q

Innervation of bladder

A

sympathetic T11-L2
parasympathetic S2-S4

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6
Q

another name for aterial pressure

A

glomerular capillary pressure

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7
Q

another name for renal blood flow

A

glomerular oncotic pressure

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8
Q

major determinents of GFR?

A

aterial pressure and renal blood floqw

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9
Q

intense SNS stimulation does what?

A

consctrict afferent and decreae RBF

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10
Q

mild SNS does what?

A

constricts efferent to increase RBF

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11
Q

what do NO and prostaglandins do?

A

dilate afferent to increase GFR

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12
Q

what does angiotensin activity do?

A

constrict efferent

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13
Q

myogenic reflex

A

pressure

increase in arterial pressure = constriction by reflex
decrase in pressure = dilation by reflex

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14
Q

where is 2/3 of Na and H2O reabsorbed?

A

PCT
Na is active transport
H2O is passive reabsorption

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15
Q

ANP does waht?

A

diuresis, systemic vasodilation

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16
Q

name three renal vasodilators

A

NO prostaglandins ANP

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17
Q

where are prostaglandins produced?

A

kidneys

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18
Q

what does renal vasodilation cause?

A

increae in Na and H20 excretion. Thus the reason ANP wants to cause vasodilation

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19
Q

when do you see symptoms for hypnatremia?

A

<125

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20
Q

most common cause of AKI in surgical patients?

A

actue tubular necrosis

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21
Q

how does AKI cause excess nitrogenous substances adn waste?

A

cant excrete them. accumulation of creatinine and urea in the blood

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22
Q

name some nephrotoxins

A

aminoglycosides, chemo drugs, NSAIDS, contrast dye

may take 24-48 hours to develop and peaks in 3-5 days

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23
Q

endogenous nephrotoxins?

A

calcium
uric acid
myoglobin (rhabdo)
hemoglboin (hemolysis)
bilirubin
paraproteins

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24
Q

when is renal azotemia irreversible?

A

if ischemia is severe or prolonged

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25
Q

what causes actue intersitital nephriits?

A

acute druge rxn

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26
Q

increase interval of waht two meds?

A

APAP and ASA

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27
Q

intervel stays the same for what meds?

A

al/remi/sufentanil

28
Q

decrease dose of?

A

codeine
fentanyl
torodol
meperidine
methadone
morphine

29
Q

is chronic renal failure irreversible?

A

yes

30
Q

electrolyte imbalances in CKD?

A

hyp kalmemia mag and calcemia

hyperphosphatemia

31
Q

how does urea affect platle function?

A

makes them dysfunctional

32
Q

what is renal osteodystrophy?

A

join issues from the hyperphos and hypocalcemia

33
Q

what causes pruritius?

A

uremia and waste build up

34
Q

how do kidney patiens respond to induction?

A

as if hypovolemic

35
Q

Anes meds in kindey patients?

A

N2O is okay, ISO is most hemodynamically stable

36
Q

when do you get uremic syndrome?

A

when GFR drops to < 10%

37
Q

what is nephrolithiasis?

A

kidney stones

most and calcium oxalate
flank pain can be a sign of ureteral stone

38
Q

you can get what with glycine solution?

A

hyperammonemia

39
Q

when might you see a wide QRS and elevated ST?

A

TURP syndrome

40
Q

can you get DIC in TURP?

A

yes. from hyponatremia??

41
Q

what to do to prevent TURP

A

resesction time < 1hour
bag no >30cm from bed to start and 15 during end of resection

avoidi hypotonic solution

42
Q

are spinals good during turp?

A

yes they say awake so they can talk to you, ensure they dont get TURP syndrome

43
Q

TURP tx

A

oxygenation and ciruclatory support
tell surgeon to stop ASAP
invasive monitors
send labs

44
Q

how to tx mld TURP?

A

fluid restriction and loop diurectics

45
Q

how to tx severe turp?

A

3% NS at <100ml/hr

DC when NA>120

46
Q

is extra or intra peritoneal more common?

A

extra peritoneal this also heals itself
intraperitoneal needs surgery

47
Q

bladder rupture

A

more common in peds than adults

48
Q

what would cause chemical peritonitis?

A

intraperitoneal bladder rupture

49
Q

intraperitoneal symptoms are more like what?

A

MI.

extraperiotneal symptoms are more generalized pain

50
Q

which volatiles directly cause renal dysfunction?

A

methoxyflurane and enflurane

51
Q

is thiopenal good in renal patients?

A

no

52
Q

ketamine?

A

okay

53
Q

etomidate

A

okay, incrased free fraction decrease dose?

54
Q

benzos

A

decraes dose

55
Q

propofol

A

go slow

56
Q

dex

A

okay

57
Q

can you use codeine or meperidine?

A

no

58
Q

morphine?

A

single dose okay, nothing more

59
Q

order of NMB agents

A

cis, atracurium, then ROC
Vec is prolonged

60
Q

what NMB have minimal renal excretion?

A

succ, atracurium, cis, micacurium

61
Q

short acting NMB?

A

micacron. eliminated by plasma cholinesterase at rate slower than succ

62
Q

what meds undergoe hoffman elimination>

A

cis-attracurium and attracuriuym

63
Q

where does acetezoalmide work?

A

PCT

64
Q

where does mannitol work?

A

descending tuble

65
Q

where do thiazide diurecgics work?

A

DCT

66
Q

where does spiro work?

A

Collecting duct

67
Q

where do loop diuretics work?

A

ascending loop

Anesthesia Principles II (14 decks)

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