Test 4: 40: renal Flashcards
two types of nephrons
cortical nephrons
juxtamedullary nephrons
why are cat kidneys more at risk of hypoxia
cats have wider medullas= more juxtamedullar nephrons = less blood supply by the vasa recta
what are some ways anesthesia effect renal perfusion
Primarily indirect mechanisms
- Effects of stress-induced release of E, NE, renin, ATII, AVP, etc. on systemic & renal vasculature →Reduction in RBF (hypotension, vasoconstriction) → GFR ↓
- Inhibition of SNS activity or impact of MV (esp. PEEP) →Reduction in CO and/or ABP → RBF ↓ → GFR ↓ and the Activation of RAAS
- Pneumoperitoneum during laparoscopy → Reduction in CO and/or ABP → RBF ↓ → GFR ↓
- Impaired autoregulation
- Neuraxial anesthesia with sympathetic blockade of T4-T10 → Blocks sympathetic innervation to kidneys
what are some perioperative risks caused by kindey damage
Arrhythmias
Hypotension
Renal hypoperfusion
Hypoxemia
Hypothermia
Acidosis
Pulmonary edema
how to treat hyperkalemia
calcium and dextrose+ insluin
will co transport potassium into the cell → ↓K in the blood
what premeds should you avoid for renal pts
Phenothiazines/Butyrophenones (acepromazine, droperidol)
- Vasodilation and hypotension
⍺2-Agonists (e.g. medetomidine, dexmedetomidine)
- Vasoconstriction (multiple organ ischemia)
- Dysrhythmias (AV block; bradycardia)
- Decrease in CO
- Hyperglycemia
- will ↑ urine production
which injectables for renal
combo of propofol, alfaxalone, ketamine
can continue as TIVA or convert to iso
how does ketamine effect renal
increase renal blood flow
less CV and respiratory effect then propofil and alfaxalone
why measure USG post op renal pbstruction
if pt can’t concentrate urine they will go through postobstructive diuresis and become dehydrated from loss of water, Na and K, can reblock
need to make sure stays hydrated until kidney recovers
why give diurectics post op renal surgery
to make sure pt is producing urine
where does liver get blood
20-25% of CO
hepatic artery
portal vein
the hepatic artery supplies — % of blood and O2 to the liver
25-35% of blood
40-60% (up to 90%) of O2
the portal vein supplies — % of blood and O2 to the liver
65-75% of blood
50-60% of O2
how fast does blood move in liver
8-9 sec transit time through sinusoids
functions of the liver
- Protein biosynthesis (e.g. albumin) & metabolism
- Carbohydrate metabolism (glucose homeostasis)
- Lipid and lipoprotein biosynthesis
- Hormone homeostasis
- Vitamin synthesis (Vit. K) and storage (A, B12, E, D, K)
- Coagulation factor biosynthesis (except F. VIII, vWF) Bile acid synthesis
- Foreign product/drug metabolism
- Filter function as RES organ
- Immunological functions
