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Advanced Principles C > Vascular Anesthesia Pt.2 (Exam II) > Flashcards

Vascular Anesthesia Pt.2 (Exam II) Flashcards

1
Q

How much of CO (at rest) goes to the liver?

A

25%

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2
Q

What major vessels supply oxygenated blood to the liver? What percentage is provided by each?

A

Hepatic Artery: 30%
Portal Vein: 70%

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3
Q

What type of cells make up 75 - 80% of the liver’s cellular volume?

A

Hepatocytes

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4
Q

What is the functional unit of the liver?

A

Hepatic Lobule

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5
Q

What three structures make up the portal triad?

A
  • Portain vein
  • Hepatic artery
  • Bile Duct
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6
Q

In what zone does aerobic metabolism take place in the hepatic lobules?

A
  • Zone 1 — Periportal (outermost)
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7
Q

What zone of the liver is the major site of aerobic metabolism?

A

Zone 1

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8
Q

What vascular structure is hepatic zone 3 located next to?

A

Hepatic Vein

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9
Q

What hepatic zone is the site of glycolysis/glucuronidation?

A

Zone 3

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10
Q

What type of hepatic cells are characterized by their dormancy and only responding to cytokines during inflammatory periods?

A

Hepatic Stellate Cells

8 - 10 % of liver cells.

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11
Q

How would compensated cirrhosis compare to uncompensated cirrhosis?

A

Compensated:

  • No portal HTN
  • No GI Varices
  • No Liver dysfunction

Uncompensated:

  • Ascites
  • Portal HTN
  • Varices & hemorrhage
  • Hepatic Encephalopathy
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12
Q

How does the body attempt to compensate for portal hypertension? What is the end result?

A

Release of NO & angiogenic factors → Vasodilation & new vessels → esophageal varices.

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13
Q

Which two veins receive much increase venous flow due to portal hypertension?

A
  • Azygos vein
  • Hemiazygos vein

Contribute to esophageal varices.

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14
Q

Where are the azygos & hemiazygos veins located? What areas do they receive venous flow from?

A
  • Located on either side of vertebral column
  • Drain & thoracic & abdominal walls
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15
Q

How can esophageal varices bleeds be prevented?

A
  • non-selective β blocker
  • Endoscopic band ligation
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16
Q

How is active bleeding of esophageal varices managed?

A
  • Endoscopic banding
  • Sclerotherapy
  • Octreotide (Somatostatin)
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17
Q

How does Somatostatin treat variceal bleeding?

A
  • Vasoconstriction
  • ↓ portal HTN
  • Inhibits glucagon release
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18
Q

What does glucagon do to abdominal vessels?

A

Glucagon = Splachnic dilation

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19
Q

What is a TIPS?

A

Transjugular Intrahepatic Portosystemic Shunt

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20
Q

What two vessels are connected via TIPS to control portal HTN?

A

Hepatic Vein & Portal Vein

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21
Q

What are indications for TIPS procedure?

A
  • Secondary prophylaxis of bleeding varices after medical therapy
  • Temporary relief of portal HTN while awaiting transplantation
  • Treatment of refractory ascites
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22
Q

What are “cons” associated with TIPS procedures?

A
  • Shunt stenosis
  • Hepatic encephalopathy
  • High cost
  • Lack of availability
  • Liver waste products (like ammonia) circulate more throughout the body.
23
Q

What pulmonary volume is decreased in ascites patients?

A

FRC

24
Q

What occurs with the following in liver patients:

  • Volume of distribution (VD)
  • Protein Binding
  • Drug Metabolism
  • Drug Elimination
A
  • ↑ Volume of distribution (VD)
  • ↑ Protein Binding
  • ↑ Drug Metabolism
  • ↑ Drug Elimination
25
Q

What is pleuritic chest pain?

A

Pain when breathing/coughing

26
Q

What EKG changes are suspicious for pulmonary embolism?

A
  • ST Changes
  • A-fib
  • ↑HR
  • RBBB
27
Q

What TEE findings are suggestive of Pulmonary embolism?

A
  • Mcconnell’s Sign
  • Dilated Right heart
  • LV wall abnormalities
28
Q

What laboratory findings are suspicious for pulmonary embolism?

A
  • D-dimer
  • Troponins
29
Q

What does D-dimer measure?

A

Fibrin degradation products

30
Q

What is the gold standard for pulmonary embolism diagnosis?

A

Pulmonary Angiogram

31
Q

Spiral CT and VQ studies are used for pulmonary embolism diagnosis. What are the “pros” and “cons” of these two diagnostic methods?

A

Pros:
- Detects clots in main, lobar, and segmental arteries well

Cons:
- Misses embolism in small vessels.

32
Q

Increased risk of what occurs the longer an IVC filter is left in place?

A

Fracture and/or migration

33
Q

What patient population might benefit most from IVC filters? Why?

A

Parturients:

  • Higher risk of clots
  • Warfarin is teratogenic
  • IVC dilates during pregnancy
34
Q

Where does carotid atherosclerosis most often occur?

A

At the common carotid at the bifurcation into the IC & EC.

35
Q

What are typical symptoms of carotid disease?

A
  • Asymptomatic Bruit
  • TIA symptoms
36
Q

What are some typical symptoms associated with TIA’s?

A
  • Transient blindness
  • Paresthesias
  • Speech issues
  • Clumsiness
37
Q

How is carotid atherosclerosis diagnosed?

A

Duplex Scan
- Doppler flow w/ anatomic imaging

38
Q

How are TIA’s and strokes differentiated?

A

TIA’s resolved within 24 - 48 hours.

s/s lasting beyond this = strokes

39
Q

What two factors would lead one to wanting a carotid stent vs a carotid endarterectomy?

A

Stenting indicated if:

  • Contralateral laryngeal palsy
  • Poor surgical candidate (CHF, advanced COPD, etc.)
40
Q

A patient is unable to take clopidogrel in addition to their ASA. Is a Carotid stent or CEA a better option?

A

CEA

Carotid Stenting requires Dual (ASA + Plavix) Antiplatelet therapy

41
Q

Manipulation of the carotid sinus can result in what?

A

Baroreceptor reflex

42
Q

What is the baroreceptor reflex?

A

Sudden ↓HR and ↓BP due to carotid sinus manipulation

43
Q

How is baroreceptor reflex treated?

A
  • Cessation of manipulation
  • Lidocaine infiltration
  • Glycopyrrolate
44
Q

What regional anesthetic option is available for a CEA?

A

Cervical Plexus C2-C4 Block

45
Q

Where does innervation to most neck muscles come from?

A

Anterior rami of C1 - C4

46
Q

Differentiate a superficial vs a deep cervical plexus block.

A

Superficial:

  • Sensory block only
  • Difficult to assess depth

Deep:

  • Sensory & motor
  • Can affect phrenic nerve
  • Toxic levels of LA
47
Q

What happens if the phrenic nerve is affected by a deep cervical plexus block?

A

GETA

48
Q

Hyperperfusion syndrome can occur after what common vascular surgery?

A

CEA

49
Q

What is Hyperperfusion syndrome?

A

Abrupt increase in blood flow that results in loss of autoregulation

50
Q

What are the s/s of hyperperfusion syndrome?

A
  • HA (more common)
  • Seizure
  • Cerebral edema
51
Q

Hyperperfusion is more common in patients who…

A

Had contralateral CEA surgery

52
Q

Differentiate unilateral vs bilateral recurrent laryngeal nerve injury.

A

Unilateral:

  • Coughing
  • Hoarseness

Bilateral:

  • Life threatening obstruction
53
Q
A

Advanced Principles C (5 decks)

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