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Perf Tech III (Exam 1) > Topic 5: Splanchnic > Flashcards

Topic 5: Splanchnic Flashcards

1
Q

Thoracic Cavity contains what three cavities?

A

above diaphragm

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

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2
Q

Abdominopelvic Cavity - contains what 2 cavities with what organs?

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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3
Q

Body cavities function?

A

protect organs and allow space for organ movement

like inflation of lungs or contraction of hear

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4
Q

Splanchnic circulation will refer to the vasculature w/in what?

A

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

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5
Q

Why are kidneys not considered part of the splanchnic system?

A

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

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6
Q

Limitations of research of CPB and splanchnic circulation?

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

Incidence of GI complication with CPB?

A

~ 4.1%

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8
Q

90% of nutrient absorption occurs here?

A

Small Intestine (20ft)

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9
Q

Duodenum- location and function?

A

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

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10
Q

Jejunum- length, location and function?

A

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

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11
Q

Ileum- location, length and function?

A

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

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12
Q

Stomach - function? leads to?

A

Stores and breaks down ingested food via acids and enzymes (chyme).
Release into small intestine controlled by pyloric sphincter

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13
Q

Large intestine - function? length?

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 what?

A

↓ Resistance

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15
Q

Intestinal BF during CPB seems to be independent of what two things?

A

MAP and dependent on Q

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16
Q

•Intestinal ↑BF independent of what 3 things?

A

T, pH, or pCO2 (autoregulation?)

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17
Q

Extensive use of vasoconstrictors during CPB does what to mesenteric perfusion?

A

exacerbates the risk of inadequate mesenteric perfusion

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18
Q

Cardiac surgery is associated with a relatively low incidence of GI complications but those complications cause a disproportionate level of what?

A

a vastly disproportionate level of mortality

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19
Q

Pancreas primary function?

A

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

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20
Q

Pancreas arterial blood sources?

A

Several sources from splenic, hepatic, and sup. Mesenteric

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21
Q

Pancreas - exocrine or endocrine organ?

A

Primarily an exocrine (99%) organ, but endocrine function is vital

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22
Q

Delta cells produce what?

A

somatostatin/tropin to suppress insulin and glucagon release

ENDOCRINE

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23
Q

F cells produce what?

A

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

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24
Q

Alpha cells produce?

A

glucagon

ENDOCRINE - PANCREAS

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25
Q

Beta cells produce?

A

insulin

ENDOCRINE - PANCREAS

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26
Q

Pancreas % of Endocrine? what?

A

(1%) Islets of Langerhans/ Pancreatic Islets

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27
Q

Pancrease % of Exocrine? what?

A

Acinar Cells comprise 99% of the pancreas

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28
Q

Amylase does what?

A

breaks down starch/carbs

EXOCRINE - PANCREAS

29
Q

Lipase does what?

A

breaks down lipids

EXOCRINE - PANCREAS

30
Q

Nuclease does what?

A

breaks down nucleic acids

EXOCRINE - PANCREAS

31
Q

Proteolytic enzymes do what?

A

Proteases attack large proteins
Peptidases break small peptides into amino acids
EXOCRINE - PANCREAS

32
Q

Acinar Cells (4 types)

A
  1. Amylase
  2. Lipase
  3. Nuclease
  4. Proteolytic enzymes
33
Q

CPB and the pancreatic flow?

A

poor autoregulation during CPB

34
Q

Elevated what is a common indicator for pancreatic injury?

A

[amylase]

did not correlate to negative post-op symptoms

35
Q

Amylase compared to lipase

A

Amylase more sensitive,

Lipase more specific

36
Q

How often does Pancreatitis occur on CPB in adults?

A

Infrequently (0.1-0.8%), but carries ↑ mortality

37
Q

Risk factors of developing pancreatitis on CPB?

A

CPB time and hypotension secondary to low cardiac output syndrome

38
Q

Mild pancreatitis carries what % mortality?

A

~~50%

39
Q

Severe pancreatitis carries what % mortality?

A

67%-100%

40
Q

Pancreatic injury incidence post-CPB in peds ?

A

Much higher incidence (4-8%)

41
Q

Lab tests for pancreatitis in peds?

A

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

42
Q

Spleen two main components?

A

Red pulp: big honking filter and storage

White pulp: lymphoid tissues

43
Q

Post-splenectomy patients have a substantially greater risk of what?

A

infection and a 33% greater risk of future MIs

44
Q

Largest visceral organ?

A

Liver

multifunctional as well, also serves as a large blood reservoir

45
Q

Blood flow to liver supplied by? at what rate?

A

supplied by hepatic artery at 400cc/min and portal vein at 1000cc/min

46
Q

Where does the liver drain into? Applied to perfusion cannula placement?

A

Drains to the IVC just below the diaphragm; use caution in placing venous cannula to avoid obstruction and portal HTN.

47
Q

Liver 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.

48
Q

Three main things the liver does?

A

metabolic regulation, hematologic regulation and bile production

49
Q

Hematologic regulation of liver? (4)

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
50
Q

Kupfer cells

A

Remove damaged formed elements or pathogens

IN LIVER

51
Q

How much Bile is produced each day and by what?

A

Approx. 1L produced each day by liver

52
Q

Bile function?

A

•Necessary for lipid digestion

53
Q

Concentrated Bile leads to?

A

Over concentrated bile leads to “gall stones

54
Q

Where is bile stored?

A

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

55
Q

Hepatic blood flow does what during CPB?

A

increases slightly during CPB. Perfusion is ↑ with ↑Q

56
Q

Hypothermia is primary factor in what with drugs?

A

decreased clearance of drugs

Although not all drugs illustrate ↓C

57
Q

CPB and liver damage?

A
  • No clear link exists that CPB has a direct negative impact on the liver.
  • Valve procedures, transfusions, and prolonged CPB times may show hepatic markers of injury
58
Q

when measuring Albumin what kind of test is it?

A

a hepatic function lab

59
Q

a hepatic function lab

A

Albumin:

60
Q

Fairly specific hepatocellular leakage enzymes hepatic tests? (4)

A

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

61
Q

Two types of Total Bilirubin test?

hepatic test

A
  • Unconjugated (relatively water insoluble)

* Direct (water soluble)

62
Q

Unconjugated

A

relatively water insoluble

63
Q

Direct

A

water soluble

64
Q

Alkaline phosphatase (ALP) is a hepatic test that measures what?

A

is specific to the liver’s biliary tree and represents biliary damage or cholestasis

65
Q

drugs that help dilate splanchnic vessels during massive pressor administration for sepsis ?

A

Dopaminergic (Dopamine & Dobutamine)

(explain)???

66
Q

Fenoldopam mesylate (Corlopam)

A

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

67
Q

Unlike the brain or kidneys during CPB, there appears to be a ______ response to the splanchnic circulation.

A

muted autoregulatory

68
Q

Do higher pressures aid in splanchnic perfusion?

A

Higher pressures do not seem to aid in splanchnic perfusion except to liver (overcome portal and IVC P).

69
Q

Although there is a low incidence of splanchnic injury, the consequences are what?

A

carry high mortality rates

Perf Tech III (Exam 1) (5 decks)

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