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Equine Surgery: QOD > Physiology > Flashcards

Physiology Flashcards

1
Q

list the formulas for cardiac output

A

CO (cardiac output) = HR (heart rate) x SV (stroke volume) CO = blood pressure/peripheral vascular resistance

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2
Q

effects of loss of vascular tone and blood pressure on cardiac output

A

Distributive shock: Decrease in vascular tone leads to decreased blood pressure which initially increases cardiac output but because the venous return will be decreased (due to low blood pressure), the preload and therefore cardiac output will decrease leading to decreased perfusion

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3
Q

describe the clinical signs of uncompensated shock

A

Also called hypodynamic shock. If >15% blood is lost, compensatory mechanisms fail to maintain arterial blood pressure and perfusion of vital organs. Ischemic to brain and myocardium develops. To try to maintain blood pressure, tachycardia, tachypnea, poor peripheral pulses and cool extremities are present. Mild anxiety and sweating may be apparent due to sympathetic activity. Urine output and central venous pressure drop. As further blood is lost, vasoconstriction further reduces blood flow to tissues and ischaemia occurs. Lactate and CO2 build up leading to acidosis and cellular dysfunction.

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4
Q

what marks the onset of hydrodynamic shock

A

This is usually caused by severe blood loss (>15%).

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5
Q

in order to restore intravascualar volume what is the crystalloid replacement volume that must be administered

A

Fluid needed = percent blood volume (Liters/kg bodyweight x 100) x bodyweight Usually 7-9% bodyweight 35-45 L in a 500kg horse

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6
Q

What is maintenance fluid rate for a foal?

A

70-80ml/kg

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7
Q

List the 4 types of shock

A

Hypovolemic

Cardiogenic

Distributive

Obstructive

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8
Q

What is the magic percentage of blood loss, above which, shock becomes gradually uncompensated/clinical signs appear?

A

15%

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9
Q

List the clinical signs with 15-30% blood loss. And what class of shock is this?

A

Class II

Tachycardia

Tachypnea

Bounding pulses

Agitation

Pupil dilation

Sweating

Normal BP but perfusion deficits

Elevated lactate and anion gap metabolic acidosis

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10
Q

Which electrolytes do isotonic crystalloids contain?

A

Sodium

Chloride

Calcium

Potassium

Magnesium

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11
Q

What percentage of isotonic fluids given IV, diffuse into the intracellular/interstitial space?

A

80%

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12
Q

List the pro inflammatory and anti-inflammatory cytokines

A

Pro inflammatory:

TNF:

From neutrophils, NK cells

Coagulation, fibinolysis, complement activation, APR, neutrophil chemotaxis

Pyrogenic activities, augment cytokines production

IL-1:

From endothelial cells, fibroblasts, keratinocytes, lymphocytes

Coagulation, fibinolysis, complement activation, APR, neutrophil chemotaxis

Pyrogenic activities, augment cytokine production

IL-6:

From fibroblasts, keratinocytes, lymphocytes

Coagulation, fibinolysis, complement activation, APR, neutrophil chemotaxis

IL-8:

From endothelial cells

INF-y:

From NK cells

Anti-inflammatory:

IL-4

IL-10

IL-11

IL-13

TGF-B

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13
Q

TxA2, PGE, PGF2a, PGI2, Bradykinin, NO, angiotensin, endothelin, leukotrienes - state which are vasoconstrictors and which are vasodilators

A

Vasoconstrictors:

Angiotensin

Endothelia

TxA2

Leukotrienes

PGF2a

Vasodilators

Bradykinin

NO

PGI2

PGE2

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14
Q

What are the three components of endotoxin

A

O-antigenic region:

Outer polysaccharide

Monosaccharide core region

Lipid A

Toxic moiety

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15
Q

What is the gold standard for measuring endotoxin and what other methods are available

A

Limulus amebocyte lysate (LAL):

Gold standard for measuring endotoxin

Neutropenia with toxic neutrophil morphology(basophilic cytoplasm, vacuolization, Dohle bodies) and left shift:

Neutropenia can occur within 1 hr

Hyperglycemia

Hypovolemia:

Relative polycythemia

Hyperproteinemia

Azotemia

Metabolic acidosis

Increased anion gap

Lactic acidosis

Specific organ admage:

Azotemia

Increased creatine phosphokinase

Liver enzyme

Cardiac troponin

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16
Q

What are the options for treating endotoxemia

A

Diminish source:Treat underlying disease

Remove intestine

Tissue lavage

Caution with ABs, bactericidal actions, esp. B-lactams, may increase release of endotoxin

Smectite PO:

If cause GI

4 ounces orally BID

Absorbs bacteria and bacterial toxins

Bind and neutralize endotoxin:Anti-endotoxin antibiodies:

Endoserum (Hyperimmune sterum from horses vaccinated with Salmonella typhimurium)

Dilute 1:10/1:20 in LRS, administer IV over 1-2 hrs reduces hypersensitivity

Hyperimmune anti-core plasma to E.coli J5 (foals). 20-14ml/kg

Expensive, require freezer/refrigeration/thawing

Polymixin B:

Cationic antibiotic

Bactericidal at higher doses (nephrotoxic and neurotoxic)

Interacts with lipid A

Care in azotemic patients

1000-6000 IU/kg BID-TID

Fluid therapy

Anti-inflammatories:Flunixin:

Prevents endotoxin-induced prostanoid synthesis and associated clinical signs

0.25mg/kg IV q8hrs:

Low dose reduces potential side effects and effective inhibition of prostanoid synthesis without masking clinical signs

1.1mg/kg IV can be used

Ketoprofen - not evaluated

Phenylbutazone - not evaluated

Firocoxib - not evaluated

Inhibition of other mediators:

DMSO IV 0.1-1mg/kg diluted to 10% in isotonic fluid

Pentoxyfilline

Lidocaine

17
Q

As percentages of bodyweight, what % of the body is made up of:

a) blood
b) ECF
c) ICF
d) TBW

A

a) blood 8%
b) ECF 20%
c) ICF 40%
d) TBW 60%

18
Q

What makes up ECF

A

Interstitial fluid, plasma, lymph, transcellular fluids, synovial, pleural abdominal, CSF (can contribute to volume deficits in disease)

19
Q

What is colloid oncotic pressure

A

Colloid oncotic pressure = osmotic pressure generated by proteins (albumin)

20
Q

What is Starling’s law?

A
21
Q

What is the normal pH

A

7.35-7.45

22
Q

What 2 main mechanisms can be employed to correct pH

A

Alveolar ventilation modified within hours

Renal adaptation (increased HCO3 reabsorption; net acid secretion) 2-5 days to take maximal effect

23
Q

Define the 4 primary acid-base disorders

A

Metabolic acidosis:

Decreased HCO3

Causes:

Lactic acid (poor perfusion)

HOC3 losses from diarrhea

Metabolic alkalosis:

Increased HCO3

Associated with disproportionate loss of chloride

Respiratory acidosis:

PCO2 increased

Alveolar hypoventilation

Respiratory alkalosis:

PCO2 decreased

24
Q

What is the equation for anion gap

A
25
Q

What is the difference between acidosis and academia

A

Acidosis/alkalosis = processes

Acidemia/alkalemia = pH of ECF

26
Q

What is the difference between osmolarity and osmolality

A

Osmolality:

Concentraiton of osmotically active particles in solution per kg of solvent (mOsm/kg)

275-312 mOsm/kg (lower values in foals)

Osmolarity:

Number of particles of solute per liter of solvent (mOsm/L)

Equine Surgery: QOD (13 decks)

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