Week 4 Mo Parturient with Systemic Diseases Flashcards Preview

SUM'20 - Advanced Principles > Week 4 Mo Parturient with Systemic Diseases > Flashcards

Flashcards in Week 4 Mo Parturient with Systemic Diseases Deck (149)
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91

Tx of RA?

NSAIDs
Steroid, methotrexate , choroquine, gold

92

Osteoarthritis, tell me the basics of this disorder?

Chronic, noninflammatory arthritis of movable joints
Degenerative joint disease- “wear and tear arthritis”
No systemic manifestation
Deterioration of articular cartilage
Osteophyte (bony spur) formation at joint surfaces.

93

Risk factors for Osteoarthritis?

Family history
Obesity
Previous joint trauma

94

What will a patient with osteoarthritis report? (hx)

Joint pain worsen by activity and weight bearing and relieved by rest
Crepitus
decreased range of motion

95

What will you find upon physical examination of a patient with osteoarthritis?

Involvement of weight bearing joints (hip, knee, lumbar)
Also involve DIP, PIP and cervical
Stiffness and marked crepitus of the affected joints

96

What will labs or imaging of someone with osteoarthritis show?

Normal ESR
X-ray: ulcerated cartilage, narrowing of joints spaces, osteophytes , dense subchondral bone

97

treatment of osteoarthritis?

Physical therapy
Weight reduction
NSAID
Intra-articular steroids for temporary relief
Replacement

98

Scoliosis, what is it, what does it affect, what changes occur if someone has scoliosis?

Lateral curvature of vertebra and deformity of rib cage
Affect cardiac and respiratory functions
Hypoxia due to V/Q mismatch
Restrictive disease with low lung volume
decreased chest compliance
increased PCO2 in severe disease
Pulmonary hypertension due to increased pul vascular resistance leading to RVH

99

Anesthetic considerations with Scoliosis?

Significant blood loss and risk of paraplegia during surgery
Monitor sensory and motor EP
Predispose to MH, arrhythmia, and adverse effects of sux i.e. hyperkalemia, myoglobinuria and sustained muscle contraction

100

Preop what labs do you want on a scoliosis patient?

PFT, ABG, ECG

101

What causes CF?

Defective chloride channels

102

What chromosome is responsible for the gene location of Cystic Fibrosis (CF)

chromosome 7

103

What is CF, what symptoms does it cause?

Hereditary disease of exocrine glands of lungs and GIT
Thick and viscous secretion difficult to clear
Recurrent pneumonia, bronchiectasis
increased RV, increased airway resistance, decreased VC, decreased expriatory flow rate
Fluid and electrolyte imbalance due to malabsorption

104

Anesthetic considerations in relation to CF?

Anticholinergic drugs are controversial
Prolong inhalation induction
Deep anesthesia for intubation
Avoid hyperventilation; may lead to shallow postop respiration
Respiratory therapy
Bronchodilators, incentive spirometry, postural drainage and proper antibiotics

105

What is Asthma?

Asthma is’ reversible’ airway obstruction by contraction of smooth muscle of bronchioles

106

What causes Asthma?

Exposure to antigen--> formation of IgE--> IgE attach to mast cells--> re-exposure to the antigen--> Mast cells release:
-Histamine
-Slow reacting substance of anaphylaxis
-Eiosinophilic chemotactic factor
-Bradykinin
-Heparin, proteolytic enzymes

107

What S/S will you see with asthma?

Inflammation ,edema and increased secretion

Bronchoconstriction

decreased FEV1 and FEV1/FVC
increased FRC ,increased RV due to air trapping
Hyperventilation- decreased PCO2

108

On X-Ray what will you see with Asthma?

Hyperinflated lungs, flatening of diaphragm , air trapping

109

Pathophysiology of Asthma?

“Reversible” increased resistance to airflow due to airway narrowing (normal physiology between the attacks)

110

Causes of ASTHMA?

Airway bronchospasm
Airway inflammation

111

Triggering factors of Asthma?

Airway irritants, environmental pollutants (including occupational exposure)
Exercise, cold air , dry air
Upper and lower resp. tract infection
Aspirin,  blockers
Gastro esophageal reflux

112

Clinical features of Asthma?

SOB
Cough , chest tightness
Wheezing
Dyspnea
Worst at night

113

Physical findings of Asthma (not during an attack)

Exam (not PFT) is normal between attacks, this a reversible disease

114

During an Asthma attack, physical findings?

Tachypnea
Insp. and exp. wheezing
Use of accessory muscles
Pulsus paradoxus
Paradoxical movement of abdomen

115

Chest x-ray with asthma?

May be normal
Hyperinflation
Flattening of diaphragm
Mucus plugging
Atelactasis

116

ABG with Asthma?

Hypocapnia
Mild hypoxemia
Hypocarbia is common.Normal CO2 or hypercapnialeading to Respiratory Emergency (40@40) leading to Respiratory failure. Immediate intubation is indicated

117

Asthma Diagnosis, what labs and measurments will be off?

Peak flow expiratory rate decrease
FVC , FEV1 and FEV1/FVC decrease
Increase RV
Normal diffusion capacity
Improvement of flow rate with bronchodilators
Bronchial hyper-responsiveness to histamine
Eosinophilia

118

What is the treatment for Asthma?

Anti-inflammatory drugs
Bronchodilators

119

Anti-inflammatory drugs as a treatment for Asthma would include?

Inhaled steroids
Systemic steroid
Cromolyn-prevents mast cell degranulation; useful for prophylaxis not for an acute attack. Also used to prevent exercise induced asthma.

120

Bronchodilators for the treatment of Asthma would include?

Beta2 agonist -inhaled and nebulizer
Anticholinergic – atropine and ipratropium
Aminophyllin (PDE inhibitor) preprations