RENAL/GI/ENDO Flashcards
Unit of the kidney
Nephron
Blood enters via the _____ arteriole, passing through the ______ and leaves via the ______ arteriole
Blood enters via the AFFERENT arteriole, passing through the GLOMERULUS and leaves via the EFFERENT arteriole
Aldosterone
Reabsorbs Na+ to aid in reabsorption of H2O and increase BP.
Pushes K+ out
RAAS
Kidneys sense decrease in BP –> renin –> angiotensin - vasoconstriction + aldosterone –> increase BP
GFR is ____ to ____ ml/min
Healthy urine output: __/__ L/day
To maintain consistent GFR, the kidneys themselves are able to autoregulate despite what systemic BP is as long as MAP stays between __ to __ mmHg
When MAP falls below ___mmHg, autoregulation of GFR is no longer possible
GFR is 100 to 125 ml/min
Healthy urine output: 1/2 L/day
To maintain consistent GFR, the kidneys themselves are able to autoregulate despite what systemic BP is as long as MAP stays between 80 to 180 mmHg
When MAP falls below 70mmHg, autoregulation of GFR is no longer possible
Activation of the SNS causes _____ GFR
Activation of the SNS causes DECREASED GFR
Capillary permeability _______ GFR
Decreases
A decrease in protein concentration ________ GFR
Decreases
Kidneys release _______ which stimulates the bone marrow to produce more _____
erythropoietin, RBCs
CKD: Decrease in function greater than ___ months
GFR < ___ and irreversible when < ___
HTN: walls of kidneys begin to thicken = narrow lumen = less blood and oxygen to kidneys = ischemic injury to the glomerulus = _______
DM: Affects ____ arteriole. Blood becomes thick and arterioles become stiff. Creates obstruction and difficult for blood to leave glomerulus = _________
Azotemia: ____ builds up in blood
Electrolyte Imbalances:
- K+ ______
- Ca+ _____
- PTH ______
- Lower GFR = more _____ = HTN
- Less EPO = _____
CKD: Decrease in function greater than 3 months
GFR < 90 and irreversible when < 60
HTN: walls of kidneys begin to thicken = narrow lumen = less blood and oxygen to kidneys = ischemic injury to the glomerulus = GLOMERULARSCLEROSIS
DM: Affects EFFERENT arteriole. Blood becomes thick and arterioles become stiff. Creates obstruction and difficult for blood to leave glomerulus = GLOMERULARSCLEROSIS
Azotemia: UREA builds up in blood
Electrolyte Imbalances:
- K+ HYPER
- Ca+ HYPO
- PTH HYPER
- Lower GFR = more RENIN = HTN
- Less EPO = ANEMIA
Dialysis does not treat renal function and does not replace metabolic functions of the kidney (____, _____ control and Vitamin ___) - these are replaced with pharmaceuticals
Dialysis does not treat renal function and does not replace metabolic functions of the kidney (EPO, BP control and Vitamin D) - these are replaced with pharmaceuticals
HD Indications:
A
E
I
O
U
PD indications:
HD Indications:
Acidosis
Electrolyte imbalance
Ingestion (acute poisoning)
Overload (fluid)
Uremia
PD indications: AEOU
Oliguria vs Anuria
Oliguria: < 400cc in 24hrs
Anuria: < 100cc in 24hrs
4 Phases of AKI Recovery:
Onset: time of _____ until S/S are seen
Oliguric: Acute _______, fluid _______, elevated BUN/Creatinine
Diuretic: Risk of complications from fluid and lyte ______
Recovery: Stabilization
4 Phases of AKI Recovery:
Onset: time of ONSET until S/S are seen
Oliguric: Acute HYPERK+, fluid OVERLOAD, elevated BUN/Creatinine
Diuretic: Risk of complications from fluid and lyte DEFICITS
Recovery: Stabilization
Enteric NS is a subdivision of the ____
It functions autonomously from the ___
ANS; CNS
Degluttition
Swallowing
Peristalsis is initiated by _______
Swallowing and chewing
Contain a network of capillaries and lymphatic vessels where nutrients are absorbed and transported to liver for further processing
Villi
Superior Mesenteric Artery: main supplier of blood to _________
_____ has a high demand for blood/oxygen = high risk of ________
The MA forms collateral circulation
Blood leaves via
Superior Mesenteric Artery: main supplier of blood to SMALL INTESTINE
SI has a high demand for blood/oxygen = high risk of ISCHEMIA
The MA forms collateral circulation
Blood leaves via MESENTERIC VEIN
When chyme enters the duodenum, it stimulates the ______ and liver to secrete ____ and the pancreas to release pancreatic enzymes
Bile aids in the breakdown of fats
When chyme enters the duodenum, it stimulates the GB and liver to secrete BILE and the pancreas to release pancreatic enzymes
Bile aids in the breakdown of fats
Hepatic artery brings oxygenated blood to the ______
_____ vein drains deoxygenated, but nutrient-rich blood from all other digestive organs and filters it before it returns to the lungs
Hepatic artery brings oxygenated blood to the LIVER
PORTAL vein drains deoxygenated, but nutrient-rich blood from all other digestive organs and filters it before it returns to the lungs
________ is produced 2* to hypoxia
Lactic acid: body tissues are not getting enough oxygen
If there is a GI bleed, there will be _________ peristalsis
Increased
The anatomical division point between upper and lower GI bleed
Ligament of Treitz
UPPER OR LOWER?
Hematemesis:
Coffee-Ground Emesis:
Melena:
Hematochezia:
Blood-streaked stool:
UPPER OR LOWER?
Hematemesis: UPPER
Coffee-Ground Emesis: UPPER
Melena: UPPER
Hematochezia: LOWER
Blood-streaked stool: LOWER
Large blood loss = increased likeliness of _____
Rebleed
_________ can be induced with rapid fluid resuscitation and can interfere with _______ leading to increased blood loss - _______ of fluids
_________ can be induced with rapid fluid resuscitation and can interfere with _______ leading to increased blood loss - _______ of fluids
Which medication reduces splanchnic blood flow, resulting in the reduced portal and variceal pressures?
Octreotide
What is the leading cause of GI hemorrhage?
Peptic Ulcer Disease
What risk does mechanical ventilation for > 48hrs pose?
What can help prevent this?
Mucosal stress ulcers
Enteral feeding + PPIs
What happens when blood cannot easily flow through the liver and blood flow is diverted?
Varices - veins become engorged and can rupture caused by HTN in the portal vein
MEDICAL EMERGENCY
What needs to be at bedside after a patient has had a balloon tamponade to treat a variceal bleed?
Scissors
Functions of the Liver:
- Breaks down ______ and stores the extra glucose as glycogen
- _______ the blood
- Produces ______, _____ factors, vitamin ___, and _____
Functions of the Liver:
- Breaks down CARBS and stores the extra glucose as glycogen
- FILTERS the blood
- Produces PROTEINS, CLOTTING factors, vitamin D, and BILE
Normal Abdominal Pressure: < ____ mmHg
7
IAP: 5-7 in critically ill adults
IAH: > ___mmHg
ACS: > _____mmHg
12; 20
Main signs of worsening ACS:
- Abdominal ________
- Difficulty _____
- Decreased ______ output
Main signs of worsening ACS:
- Abdominal DISTENSION
- Difficulty BREATHING
- Decreased URINE output
What are the pancreatic enzymes?
Amylase, protease, and lipase
Two main causes of pancreatitis
Alcohol abuse
Gallstones
Where may patient’s with pancreatitis experience pain?
What is Cullen’s sign?
What is Grey-Turner’s sign?
ULQ - radiate to back
Umbilicus
Flank
Which enzyme is more specific to pancreatitis?
Lipase
Will there be hypo or hypercalcemia in pancreatitis?
HYPO - calcium binds with fatty acids during tissue necrosis
Three big complications of pancreatitis?
Hemorrhage (hypovolemic shock)
DIC (massive inflammation)
ARDS (massive inflammation)
PANCREATITIS:
Pain: top priority - worsening pain can increase enzyme release = worsen inflammation (____ to chest position can help alleviate pain)
F/E: _____calcemia, ____magnesemia, ____glycemia, ___kalemia
Nutritional Support: _____ feeding is safe within first 24-48hrs
PANCREATITIS:
Pain: top priority - worsening pain can increase enzyme release = worsen inflammation (KNEE to chest position can help alleviate pain)
F/E: HYPOcalcemia, HYPOmagnesemia, HYPERglycemia, HYPOkalemia
Nutritional Support: ENTERAL feeding is safe within first 24-48hrs
What is the difference between mechanical and functional bowel obstruction?
Functional does not have a physical blockage present
What are the 5 mechanical BO?
Hernia
Tumour
Intussusception
Volvulus
Adhesions
What acid-base balance is present with GI bleed?
Metabolic Alkalosis
What does neuroglycopenic mean?
Results of brain glucose deprivation
What medication may make it difficult to detect early signs of hypoglycemia?
BB - it suppresses the SNS
What BG is considered pre-diabetes?
What BG is considered hyperglycemia?
5.6; 7.8
Glucose is osmotically active. What is osmosis?
Movement of water from low to high concentration gradient (think of salt)
What often triggers DKA?
Illness/Infection
