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CV Perf Tech III > Splanchnic Viscera- Exam 1 > Flashcards

Splanchnic Viscera- Exam 1 Flashcards

1
Q

What is viscera?

A

Pertaining to the internal organs located within the ventral body cavity

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2
Q

Where is the thoracic cavity?

A

Above the diphragm

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3
Q

What cavities are contained within the thoracic cavity?

A

Left pleural cavity
Right pleural cavity
Mediastinal cavity (includes pericardial)

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4
Q

What are the two cavities within the abdominopelvic cavity?

A

Abdominal cavity

Pelvic cavity

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5
Q

Abdominal cavity

A

stomach, liver, spleen, GI Pancreas, kidneys

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6
Q

Pelvic cavity

A

Last part of the large intestines and reproductive organs

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7
Q

What do body cavities do?

A

Body cavities protect organs and allow space for organ movement like inflation of lungs or contraction of heart

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8
Q

Splanchnic Circulation

A

Refer to the vasculature within the abdominopelvic cavity priot to the iliac bifurcation of renal vessels

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9
Q

What is not considered part of the splanchnic system due to positioning function?

A

Independent autoregulation
Direct aortic and IVC drainage
Kidneys

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10
Q

What are the limitations of research?

A

Small sample size
Difficulty in monitoring abdominal viscera and correlating to outcomes
Conflicting data
Controlling for other variables

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11
Q

Updated Research: Incidence of GI Complication

A

4.1%

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12
Q

Updated Research: LOS

A

19.3 vs 8.8

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13
Q

Updated Research: Inpatient Mortality

A

12.0% vs 2.5%

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14
Q

Risk Factors for Mortality of CPB and Splanchnic Circulation

A 
Age > 65
Dialysis
IABP 
\+Valve procedure
urgency
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15
Q

Stomach

A

Stores and breaks down ingested food via acids and enzymes (chyme); release into the small intestine controlled by pyloric sphincter

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16
Q

Chyme

A

pulpy acidic fluid that passes from the stomach to the small intestine, consisting of gastric juices and partly digested food

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17
Q

What percent of nutrient absorption occurs in the small intestine?

A

90%

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18
Q

How long is the small intestine?

A

20ft

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19
Q

Duodenum

A

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

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20
Q

Jejunum

A

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

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21
Q

Ileum

A

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

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22
Q

How long is the large intestine?

A

5’

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23
Q

What happens in the large intestine?

A

Small amount of nutrient absorption, primarily vitamins from bacterial byproducts, fluid, and bicarb reabsorption; compaction and storage of chyme into fecal matter

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24
Q

CPB and GI Effects

A

CPB results in an increase in intestinal blood flow due to decrease in R

Increase in BF independent of T, pH, or pCO2. *Autoregulation
Most studies show slight decrease in pH, but did not correlate to negative outcome
Intestinal BF during CPB seems to be independent of MAP and dependent on Q

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25
Q

Extensive use of what during CPB exacerbates the risk of inadequate mesenteric perfusion?

A

Vasoconstrictors

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26
Q

What’s the incidence of GI complications in cardiac surgery?

A

Low

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27
Q

What’s the level of mortality in the GI instances in cardiac surgery?

A

High

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28
Q

Risk equation

A

Risk = probability x severity

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29
Q

Pancreas Function

A

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

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30
Q

What are the arterial blood sources of the pancreas?

A

Splenic, hepatic, sup. Mesenteric

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31
Q

The pancreas is primarily an _________ organ, but endocrine function is vital.

A

Exocrine (99%)

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32
Q

What percent of pancreas are islets of langerhans/pancreatic islets?

A

1%

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33
Q

What cells are in the islets of langerhands/pancreatic islets?

A

Alpha cells
Beta cells
Delta cells
F cells

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34
Q

Alpha Cells

A

produce glucagon

35
Q

Beta cells

A

Produce insulin

36
Q

Delta cells

A

produce somatostatin/tropin to suppress insulin and glucagon release

37
Q

F cells

A

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

38
Q

What cells comprise 99% of the pancreas?

A

Acinar Cells

39
Q

Amylase

A

breaks down starch/carbs

40
Q

Lipase

A

breaks down lipids

41
Q

Nuclease

A

breaks down nucleic acids

42
Q

Proteolytic enzymes

A

proteases attack large proteins

peptidases break small peptides into amino acids

43
Q

What is a common indicator for pancreatic injury? Does it correlate with negative post op symptoms

A

Elevate [amylase], did not correlate

44
Q

Is amylase or lipase more sensitive?

A

Amylase more sensitive

45
Q

Is amylase or lipase more specific?

A

Lipase more specific

46
Q

How often does pancreatitis occur?

A

0.1-0.8 %, but carries increase mortality

47
Q

What are the risk factors for pancreatitis?

A

CPB time
hypotension
Secondary to low cardiac output syndrome

48
Q

What percent mortality does mild pancreatitis carry?

A

50% mortality

49
Q

What percent mortality does severe pancreatitis carry?

A

67-100%

50
Q

Incidence of pancreatic injury post-CPB in peds?

A

4-8%

51
Q

What are the lab tests for pancreatitis in peds?

A

Trypsinogen-2

Trypsin-2-alpha-1- antitrypsin

52
Q

Red pulp in the Spleen

A

Big honking filter and storage

53
Q

White pulp

A

lymphoid tissues

54
Q

Post-splenectomry patients have what risk of infection and a _____% greater risk of future MIs

A

33%

55
Q

What is the largest visceral organ and multifunctional?

A

Liver

56
Q

Blood flow supplied by hepatic artery at what rate?

A

400 cc/min

57
Q

Blood flow supplied by the portal vein at what rate?

A

1000 cc/min

58
Q

What does the liver drain to?

A

Drains to IVC just below the diaphragm

59
Q

Why should you use caution in placing venous cannula?

A

To avid obstruction and portal HTN

60
Q

What does the liver also serve as?

A

Large blood reservoir

61
Q

All blood leaving the absorptive sections of the GI tract flows where?

A

Into the liver via the hepatic portal vein

62
Q

Blood leaving the liver allows nutrients and toxins to do what?

A

Be removed, stored, or allowed into the systemic circulation

63
Q

Intrinsic regulation determines what?

A

Nutrient storage and release

64
Q

Removal of damaged formed elements or pathogens is via what cells? (Livers)

A

Kupfer cells

65
Q

Hematological Regulation of the Liver

A

Plasma protein synthesis
Antibody, toxin, hormone removal occur by various mechanisms
Carboxylation of Vit K dependent coagulation factors

66
Q

How much bile is produced each day?

A

1L

67
Q

What is necessary for lipid digestion?

A

Bile production

68
Q

Where is bile stored?

A

Stored in gall bladder and release upon lipid detection in the duodenum (cholecystokinin stimulation bile production and gallbladder contraction)

69
Q

What leads to “gall stones”?

A

Over concentrated bile leads

70
Q

What blood flow increases slightly during CPB?

A

Hepatic blood flow

71
Q

What is a primary factor in decreased clearance of drugs?

A

Hypothermia (although not all drugs illustrate decreased C)

72
Q

What is an example of a hepatic function lab?

A

Albumin

73
Q

What is an example of hepatocellular leakage enzymes?

A

SGOT (AST)

SGPT (ALT)

74
Q

Types of total bilirubin

A

Unconjugated

Direct

75
Q

Unconjugated

A

relative water insoluble

76
Q

Direct

A

Water soluble

77
Q

Alkaline Phosphatase (ALP)

A

Hepatic test; specific to the liver’s biliary tree and represents biliary damage or cholestasis

78
Q

What are some other hepatic tests?

A

INR
PT
LDH
5’ Nucleotidase (5’ NTD)

79
Q

Splanchnic Flow Drugs

A 
Dopaminergic (dopamine & dobutamine)
Fenoldopam mesylate (corlopam)
80
Q

Dopaminergic (dopamine and dobutamine)

A

drugs help dilate splanchnic vessels during massive pressor administration for sepsis

81
Q

Fenolopam mesylate (corlopam)

A

selective D1 agonist with no B effects, therefore the best choice for splanchnic perfusion

82
Q

Describe the autoregulatory response to splanchnic circulation.

A

Muted autoregulatory response

83
Q

Higher pressures do not seem to aid in splanchnic perfusion except to which organ?

A

Liver; overcome portal and IVC P

84
Q

What pre-existing conditions predispose patients to a higher incidence risk of injury?

A

Advanced age, athersclerosis, redo procedures, combined procedures predispose patients to a higher incidence risk of injury

CV Perf Tech III (16 decks)

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