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Perf tech 3 > splanchic > Flashcards

splanchic Flashcards

1
Q

What is Viscera

A

Def: pertaining to the internal organs located within the ventral body cavity

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2
Q

Thoracic Cavity- above diaphragm

A

a. left pleural cavity
b. right pleural cavity
c. mediastinal cavity (includes pericardial

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3
Q

Abdominopelvic Cavity

A

a. abdominal cavity- stomach, liver, spleen, GI, pancreas, kidneys…
b. pelvic cavity- last part of large int. and reproductive organs

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4
Q

Splanchnic circulation will refer to the

A

vasculature w/in the abdominopelvic cavity prior to the iliac bifurcation with the exception of renal vessels.

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5
Q

kidneys are not considered part of splanchnic system. because

A

Due to positioning, function, independent autoregulation, and direct aortic and IVC drainage,

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6
Q

CPB and Splanchnic Circulation

Limitations of research

A
  1. Small sample size
  2. Difficulty in monitoring abdominal viscera and correlating to outcomes
  3. Conflicting data
  4. Controlling for other variables
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7
Q

risk factors for splanchic circulation and bypass

A

age > 65, dialysis, IABP (2o), +valve procedure, urgency

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8
Q

Release into small intestine controlled by

A

pyloric sphincter

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9
Q

how long is small intestine and how much food is absorbed here

A

20 ft. 90%

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10
Q

Duodenum- first

A

10”, serves as “mixing bowl” for chyme and digestive enzymes from liver and pancreas

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11
Q

Jejunum-

A

approx 8’, primary site of chemical digestion and nutrient absorption

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12
Q

Ileum-

A

approx 12’, last section before large int. Large [ ] of lymphoid nodules to protect SI from bacteria in LI.

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13
Q

Large Intestine

A

(5ft)
•Small amount of nutrient absorption, primarily vitamins from bacterial byproducts, fluid, and bicarb resorption
•Compaction and storage of chyme into fecal matter

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14
Q

CPB results in an increase in intestinal blood flow due to

A

a decrease in resistance

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15
Q

increase BF is independent of

A

T, pH, or pCO2. (autoregulation?)

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16
Q

Intestinal BF during CPB seems to be independent of

A

MAP and dependent on Q

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17
Q

Extensive use of vasoconstrictors during CPB exacerbates the risk

A

inadequate mesenteric perfusion

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18
Q

Takeaway: Cardiac surgery is associated with a relatively low incidence of GI complications but those complications cause

A

a vastly disproportionate level of mortality

Risk = probability X severity

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19
Q

Pancreas

•Primary function is

A

production of digestive enzymes and buffers (NaHCO3) to neutralize acidic chyme.

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20
Q

Several arterial blood sources from pancreas

A

splenic, hepatic, and sup. Mesenteric

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21
Q

pancreas is 99%

A

exocrine

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22
Q

Alpha cells

A

produce glucagon

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23
Q

beta cells

A

produce insulin

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24
Q

delta cells

A

produce somatostatin/tropin to suppress insulin and glucagon release

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25
Q

F cells-

A

pancreatic polypeptide; inhibits gall bladder contraction and some regulation of enzyme production

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26
Q

Acinar Cells comprise

A

99% of pancreas

27
Q

Amylase

A

break down starch and carbs

28
Q

lipase

A

breaks down lipids

29
Q

nuclease breaks down

A

nucleic acids

30
Q

Proteolytic enzymes

A

Proteases attack large proteins

•Peptidases break small peptides into amino acids

31
Q

Elevated [amylase], a common indicator

A

for pancreatic injury did not correlate to negative post-op symptoms Amylase more sensitive, Lipase more specific

32
Q

Pancreatitis occurs infrequently

A

(0.1-0.8%), but carries ↑ mortality

33
Q

risk factors for pancreatitis

A

CPB time and hypotension secondary to low cardiac output syndrome

34
Q

Mild pancreatitis carries

A

50% mortality

35
Q

Severe pancreatitis carries

A

67-100 %

36
Q

Much higher incidence of pancreatic injury post-CPB in

A

peds (4-8%)

37
Q

Lab tests for pancreatitis in peds are

A

trypsinogen-2 and trypsin-2-α 1-antitrypsin

38
Q

Red pulp

A

big honking filter and storage

39
Q

White pulp:

A

lymphoid tissues

40
Q

Post-splenectomy patients have a substantially greater risk of

A

infection and a 33% greater risk of future MIs.

41
Q

Blood flow supplied by hepatic artery at

A

400cc/min and portal vein at 1000cc/min

42
Q

liver Drains to the

A

IVC just below the diaphragm

43
Q

use caution in placing venous

A

cannula to avoid obstruction and portal HTN.

44
Q

Liver

1.Metabolic Regulation

A

All blood leaving the absorptive sections of the GI tract flows into the liver via the hepatic portal vein.
•This allows nutrients and toxins to be removed, stored, or allowed into the systemic circulation
•Intrinsic regulation determines nutrient storage or release

45
Q

Liver

2.Hematological Regulation

A

Removal of damaged formed elements or pathogens via Kupfer cells
•Plasma protein synthesis
•Antibody, toxin, and hormone removal occur by various mechanisms
•Carboxylation of vit K dependent coagulation factors

46
Q

Liver
3.Bile production
•

A

Approx. 1L produced each day
•Necessary for lipid digestion
•Stored in gall bladder and released upon lipid detection in the duodenum (cholecystokinin stimulates bile production and gallbladder contraction)
•Over concentrated bile leads to “gall stones”

47
Q

Hepatic blood flow increases

A

slightly during CPB. Perfusion is ↑ with ↑Q.

48
Q

cpb and liver. Hypothermia is primary factor in decreased

A

clearance of drugs (Although not all drugs illustrate ↓C)

49
Q

may show hepatic markers of injury

A

Valve procedures, transfusions, and prolonged CPB times

50
Q

Hepatic tests:

–Albumin

A

a hepatic function lab

51
Q

Serum glutamic and oxaloacetic transaminase (SGOT) / Aspartate aminotransferase (AST) and Serum Glutamic pyruvic transaminase (SGPT) / Alanine aminotransferase (ALT

A

are fairly specific hepatocellular leakage enzymes

52
Q

Total Bilirubin:

•Unconjugated

A

water insoluble

53
Q

conjugated or direct bilirubin

A

water soluble

54
Q

Alkaline phosphatase (ALP) is specific

A

to the liver’s biliary tree and represents biliary damage or cholestasis
–Others (INR, PT, LDH, 5’ Nucleotidase (5’NTD)

55
Q

Dopaminergic (Dopamine & Dobutamine) drugs help

A

dilate splanchnic vessels during massive pressor administration for sepsis (explain)

56
Q

Fenoldopam mesylate (Corlopam)

A

is a selective D₁ agonist with no β effects, therefore best choice for splanchnic perfusion

57
Q

Unlike the brain or kidneys during CPB

A

there appears to be a muted autoregulatory response to the splanchnic circulation

58
Q

Higher pressures do not seem to aid in

A

splanchnic perfusion except to liver (overcome portal and IVC P).

59
Q

Although there is a low incidence of splanchnic injury,

A

the consequences carry high mortality rates.

60
Q

The one constant is that longer CPB times have

A

higher incidence of post-op complications.

61
Q

Pulsatile perfusion may ameliorate some short term dysfunction but

A

has not been proven to reduce gross injury.

62
Q

In theory, increasing CPB flow during longer pumps times may

A

reduce complications

63
Q

OPCAB splanchic

A

No apparent benefit

64
Q

Pre-existing conditions that predispose patients to splanchic injury

A

(ie ulcer), advanced age, atherosclerosis, redo procedures, and combined procedures

Perf tech 3 (14 decks)

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