Pathophys final review Flashcards
Describe eosinophilic esophagitis.
reaction due to T cell mediated response that causes strictures & patient may present with difficulty swallowing
eosinophils build up in lining of esophagus
Extrinsic asthma is when
reaction is triggered by an allergen; response by IgE
intrinsic asthma is triggered by non-allergic factors such as stress, cold air, infection, & airway manipulation.
Treatment of acute angioedema include
FFP (replace the deficient enzyme)
A type I allergic reaction is an
IgE anaphylaxis reaction of mast cells & basophils
The epinephrine dose for anaphylaxis is
1-10 mcg/kg IV bolus
Common allergens in the OR include:
latex, antibiotics, & rocuronium & succinylcholine (paralytics)
Latex allergies present
in ~30 minutes (can take up to this long) because it has to cross through the skin
The following antibiotics are cross-reactive
penicillin & cephalosporin
Treatments for anaphylaxis include:
beta 2 agonists
corticosteroids
epinephrine
antihistamines
Can you give propofol for patients who have anaphylaxis reaction to eggs?
yes
True or false, the FDA requires all latex products to be marked.
True
How does cricoarytenoid joint arthritis affect our anesthetic and what is it?
cricoarytenoid joint arthritis is when the cricoarytenoid joint is malpositioned and stiff
might need to downsize our tube
can occur in rheumatoid arthritis & lupus
may present without clinical symptoms
Graft versus host disease may develop
1 month after bone marrow transplants
and conditions seen may include diarrhea, elevated liver enzymes & skin conditions
A HMEF filter should be used with patients who have
an infectious disease such as
SARS or active TB
Anesthetic considerations for scleroderma include
pHTN, difficult IV access, difficult intubation due to limited mouth opening, systemic HTN, at risk for aspiration because off hypotonia of LES, renal dysfunction
Lupus is an
autoimmune disease of T & B lymphocyte hyperreactivity
The four types of lupus include:
systemic lupus- affects the whole body, autoimmune disease
drug-induced lupus- goes away when trigger is stopped
cutaneous lupus- reactive to UV light, cutaneous changes, pigment changes, & loss of hair
neonatal lupus- from moms antibodies attacking baby- most serious result for neonates is heart block
Antiphospholipid syndrome is
acquired hypercoagulability leading to embolism
symptoms may include blood clots PE, MI, CVA
related to SLE
Rheumatoid arthritis is an
autoimmune, morning stiffness lasting more than 30 minutes
symmetrical & involves inflamed synovium
Describe atlantoaxial instability.
involves C1 & C2- need inline stabilization to prevent severance of the spinal-cord
may occur in RA
Sinusoids are where
the portal vein & hepatic artery come together to feed hepatocytes
If you have a clot in the celiac artery, then you have
poor perfusion to the hepatic artery, stomach, spleen, & pancreas
Arterial blood flow is dependent on
metabolic demand & autoregulation
The portal vein supplies
50% of the livers O2 requirement
Blood flow to the liver has
low resistance & high flow
Kuppfer cells are responsible for
absorbing bacteria & cleaning the blood
Bridging fibrosis leads to
decreased portal vein blood flow
The following may decrease hepatic artery blood flow
alpha 1 adrenergic
beta blockers
hypotension
When high pressure in the right atrium exists, the liver is affected because
it produces back pressure in the liver so it expands to 0.5 to 1 L and acts as a blood reservoir
Pores in the sinusoids are
very permeable & allow easy pass of fluid & protein so lymph is similar to plasma
Glucose is stored as
glycogen
Increased hepatic vascular pressure can cause
fluid transudation into the abdominal cavity “liver sweating”–> ascites
_____ is indicated in hepatic encephalopathy
ammonia
Glycogen is a
readily available source of glucose that does not contribute to intracellular osmolality
Phase 1 reactions include
oxidation & halothanation
Phase 2 reactions include
glucuronidation & conjugation
Conjugation works by
making products more water soluble so they can be excreted
How does the liver store iron?
apoferritin + iron–> ferritin
Describe the formation of bilirubin.
hemoglobin–> globin + heme–> Fe + pyrrole rings–> biliverdin–> free bilirubin–> bilirubin + albumin
_____ bilirubin is toxic to the liver
Conjugated
Obstructive jaundice can be due to
gallstone, malignancy or damage to hepatic cells
Tests that measure the livers synthetic function include
serum albumin, PT, cholesterol, pseudocholinesterase
The liver has a large functional reserve
therefore lab tests may be normal in the presence of cirrhosis
The serum transaminase measurement reflects
hepatocellular integrity as opposed to liver function
- tests are not sensitive or specific
_______ is a more specific liver function test than AST
alanine aminotransferase
_______ is the NMBD of choice for patients with liver disease
Cisatricurium
The most common cause of cholestasis is
extrahepatic obstruction & can be due to gallstones, stricture, & tumor in the bile duct
intrahepatic obstruction is from liver damage
Mechanisms responsible for ascites include
portal hypertension
“sweating”
sodium retention
hypoalbuminemia
Hepatorenal syndrome is characterized by
progressive oliguria avid Na+ retention azotemia intractable ascites high mortality
With chronic hepatitis, the lab tests may
show only mild elevation of serum aminotransferases & these correlate poorly with severity of disease
The most common cause of acute drug induced hepatitis is
alcohol
In acute hepatitis, elevated _____ do not correlated well with the degree of cellular necrosis
transaminases
Classify chronic persistent hepatitis, chronic lobular hepatitis, and chronic active hepatitis
chronic persistent hepatitis- eventually resolves and does not progress to cirrhosis; inflammation & preservation of normal cellular architecture
chronic lobular hepatitis- resolves with acute exacerbations, does not progress to cirrhosis; characterized by foci of inflammation & cellular necrosis in the lobules
chronic active hepatitis- chronic hepatic inflammation with destruction of cellular architecture; evidence of cirrhosis
The sphincter of Oddi is affected by
opioids & can cause false positive cholangiograms
fentanyl is the worst offender
can give glucagon or naloxone to fix it
The most common cause of postoperative jaundice is
over-production of bilirubin due to reabsorption of a large hematoma or RBC breakdown following transfusion
Hepatic blood flow is decreased by
PEEP, high mean airway pressures, & hypoxemia- best if patient breathes spontaneously
All volatile agents decrease
portal blood flow- greatest with halothane, least with isoflurane
With intrahepatic or parenchymal dysfunction, we see increased
conjugated bilirubin, increased aminotransferases, no change in alk phosph, prolonged PT, decreased albumin
IgE mediated type 1 hypersensitivity involve
mast & basophil degranulation
_____ & ______ are not effective treatments in acute episodes of bradykinin mediated/hereditary angioedema
catecholamines & antihistamines
Conjugated bilirubin is not conjugated by _____ but it is conjugated by ______ & ______
oxidation
glucuronide & sulfate
