Otterbein/Grant CRNA A&p Final Review - No Diagrams

The acinus or hepatic lobule is the functional unit of the liver. This means that it is the smallest structure within the liver that performs all of the essential functions of the organ. The acinus is responsible for processes such as detoxification, metabolism, and the production of bile. It is made up of hepatocytes, which are the main functional cells of the liver. These cells work together to carry out the various tasks required for the liver to maintain its normal function and support overall health.

• Left lobe segments II , III & IV
• Right lobe segments V,VI,VII & VIII
• Caudate lobe

25%

Oxytocin is the correct answer because it is involved in a positive feedback loop. During childbirth, oxytocin is released, which stimulates contractions. These contractions then lead to the release of more oxytocin, creating a positive feedback loop. This loop continues until the baby is delivered.

Do not want to lower LES or raise intragastric pressure.
Cricoid pressure LOWERS LES pressure.

LES normally 10-30
Intragastric normally 5-10

Platelets are small, disc-shaped cell fragments that are formed in the bone marrow by megakaryocytes. They play a crucial role in blood clotting and hemostasis. A normal platelet count ranges from 150-300,000/mm3. Platelets have a relatively short lifespan of 8-12 days before they are removed from circulation.

Newborns have the highest total body water compared to weight because water makes up a larger proportion of their body composition. This is because newborns have a higher percentage of water in their bodies due to their underdeveloped organs and tissues. As they grow and develop, the proportion of water in their bodies decreases. Therefore, newborns have the highest total body water compared to weight.

Protein catabolism everywhere but the liver.

Biological half-life = 20 min

The statement is true because over 90% of thyroid hormones released from the thyroid gland epithelial cells is in the form of T4. T4 is then converted to the more active form, T3, at the target tissue. Additionally, when circulating in the bloodstream, thyroid hormones are highly protein bound, with approximately 99% of them being bound to proteins.

The statement is true because in newborns, the process of nerve myelination, which is the formation of a protective covering around nerve fibers, is not yet complete. This incomplete myelination leads to slower conduction of nerve impulses. However, it is also true that the distance that these impulses have to travel in a newborn is shorter compared to adults. Therefore, while the conduction is slower, the shorter distance compensates for it.

Also stimulated by stretch receptors in LA and pulmonary veins
Normal osmolality - 285 mOsm/L

And:
Increased Na+ concentration, decreased BP, pain, stress, nausea, Angiotensin II, positive-pressure ventilation, volatile agents, and B-adrenergic stimulation

The nephron is the functional unit of the kidney. It is responsible for filtering the blood and producing urine. Each kidney contains millions of nephrons, which consist of a glomerulus, a tubule, and associated blood vessels. The glomerulus filters waste products and excess water from the blood, while the tubule reabsorbs essential nutrients and regulates the concentration of urine. The nephron plays a crucial role in maintaining the body's fluid balance and removing waste products from the bloodstream.

TPN causes total gastric stasis.

The average lifespan of a red blood cell (RBC) is 120 days. This means that, on average, a red blood cell will live for approximately 120 days before it is removed from circulation and replaced by a new one. This lifespan is important for maintaining a healthy blood supply and ensuring that oxygen and nutrients are efficiently transported throughout the body.

The correct answer is respiratory rate. In newborns, their alveoli are immature and their ratio of alveolar surface to body surface is smaller compared to adults. However, to compensate for this, newborns have a higher minute ventilation, which is the amount of air they breathe in one minute. This higher ventilation is achieved through an increased respiratory rate, meaning they take more breaths per minute. This helps them maintain adequate oxygen levels in their body despite their immature alveoli.

Fetal hgb has a greater affinity for oxygen compared to adult Hgb. This means that fetal hgb is able to bind to oxygen more strongly, allowing it to efficiently transport oxygen to the developing fetus. As a result, fetal hgb is the main oxygen transport protein until 6 months of age, when adult Hgb takes over this role.

The liver is indeed responsible for synthesizing most of the clotting factors in the body. Clotting factors are proteins that play a crucial role in the formation of blood clots to stop bleeding. However, vWF (von Willebrand factor), tissue factor, and calcium are not synthesized in the liver. vWF is produced by endothelial cells and megakaryocytes, tissue factor is released by cells at the site of injury, and calcium is obtained from the diet and is not synthesized by any specific organ. Therefore, the statement is true.

Positive pressure ventilation, hypoxemia, hypercarbia, sympathetic stimuli, CHF, fluid overload, cirrhosis, and anesthesia all contribute to a decrease in hepatic blood flow. These factors can lead to increased resistance in the hepatic vasculature, causing a reduction in blood flow to the liver. This can have implications for liver function and metabolism, as well as drug clearance and detoxification processes.

The secretion of hydrochloric acid in the stomach is stimulated by histamine, acetylcholine, vagal stimulation, and gastrin. These substances increase the secretion of hydrochloric acid, leading to higher levels of acid in the stomach.

Glucocorticoids, catecholamines, glucagon, and thyroid hormone enhance gluconeogenesis, which is the process of synthesizing glucose from non-carbohydrate sources. This is in contrast to insulin, which inhibits gluconeogenesis. These hormones stimulate the production of enzymes involved in gluconeogenesis and promote the breakdown of glycogen and fats to provide substrates for glucose synthesis. As a result, they increase the rate of gluconeogenesis and help maintain blood glucose levels during periods of fasting or stress.

Increases

No benefit to volume loading due to fixed SV.

When there is a decrease in hepatic venous pressure caused by hypovolemia or hemorrhage, blood moves from the hepatic veins and sinusoids into the central circulation. This results in an increase in the circulating blood volume by approximately 500 mL's, which is close to 10% of the total blood volume. Therefore, the statement is true.

Glucocorticoids are a class of hormones that increase glucose production in the body while simultaneously decreasing inflammatory responses. This means that they promote the synthesis and release of glucose into the bloodstream, helping to raise blood sugar levels. At the same time, they suppress the immune system's inflammatory response, which can be beneficial in managing conditions such as allergies, asthma, and autoimmune diseases.

Increased

Newborns are actually at an increased risk of hypothermia intraoperatively because they rely on shivering to generate heat, as they do not have a well-developed brown fat breakdown system like adults. Therefore, the statement given in the question is incorrect.

Decreased ability to reabsorb Na, bicarb, glucose, aa and phosphates - obligate Na losers

Negative feedback loop

Faster induction w/inhalation agents but slower w/IV agents – be patient to redose

Autologous transfusions, which involve using a patient's own blood during surgery, can lead to perioperative anemia and an increased chance of needing a transfusion. This is because the process of collecting and reinfusing the blood can result in a decrease in the patient's overall blood volume, leading to anemia. Additionally, there may be unforeseen circumstances during the surgery that require additional blood transfusions. Therefore, it is true that autologous transfusions can subject patients to perioperative anemia and an increased likelihood of requiring a transfusion.

The metabolic demands of a newborn are 6 mL/kg/min, which is double that of an adult. This means that for every kilogram of body weight, a newborn requires 6 milliliters of oxygen per minute to meet their metabolic needs. This higher metabolic demand is due to the rapid growth and development that occurs during the neonatal period.

Surgical stress triggers the release of stress hormones such as epinephrine and cortisol, which activate the sympathetic nervous system (SNS). Activation of the SNS leads to an increase in glycogenolysis, the breakdown of glycogen into glucose. This process provides a quick source of energy during times of stress. Gluconeogenesis, the synthesis of glucose from non-carbohydrate sources, may also be stimulated to maintain blood glucose levels. However, the release of insulin, which promotes glucose uptake by cells, is unlikely during surgical stress as it opposes the actions of stress hormones.