Flashcards in Week 4 Mo Parturient with Systemic Diseases Deck (149)
Tx of RA?
Steroid, methotrexate , choroquine, gold
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.
Risk factors for Osteoarthritis?
Previous joint trauma
What will a patient with osteoarthritis report? (hx)
Joint pain worsen by activity and weight bearing and relieved by rest
decreased range of motion
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
What will labs or imaging of someone with osteoarthritis show?
X-ray: ulcerated cartilage, narrowing of joints spaces, osteophytes , dense subchondral bone
treatment of osteoarthritis?
Intra-articular steroids for temporary relief
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
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
Preop what labs do you want on a scoliosis patient?
PFT, ABG, ECG
What causes CF?
Defective chloride channels
What chromosome is responsible for the gene location of Cystic Fibrosis (CF)
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
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
Bronchodilators, incentive spirometry, postural drainage and proper antibiotics
What is Asthma?
Asthma is’ reversible’ airway obstruction by contraction of smooth muscle of bronchioles
What causes Asthma?
Exposure to antigen--> formation of IgE--> IgE attach to mast cells--> re-exposure to the antigen--> Mast cells release:
-Slow reacting substance of anaphylaxis
-Eiosinophilic chemotactic factor
-Heparin, proteolytic enzymes
What S/S will you see with asthma?
Inflammation ,edema and increased secretion
decreased FEV1 and FEV1/FVC
increased FRC ,increased RV due to air trapping
Hyperventilation- decreased PCO2
On X-Ray what will you see with Asthma?
Hyperinflated lungs, flatening of diaphragm , air trapping
Pathophysiology of Asthma?
“Reversible” increased resistance to airflow due to airway narrowing (normal physiology between the attacks)
Causes of ASTHMA?
Triggering factors of Asthma?
Airway irritants, environmental pollutants (including occupational exposure)
Exercise, cold air , dry air
Upper and lower resp. tract infection
Gastro esophageal reflux
Clinical features of Asthma?
Cough , chest tightness
Worst at night
Physical findings of Asthma (not during an attack)
Exam (not PFT) is normal between attacks, this a reversible disease
During an Asthma attack, physical findings?
Insp. and exp. wheezing
Use of accessory muscles
Paradoxical movement of abdomen
Chest x-ray with asthma?
May be normal
Flattening of diaphragm
ABG with Asthma?
Hypocarbia is common.Normal CO2 or hypercapnialeading to Respiratory Emergency (40@40) leading to Respiratory failure. Immediate intubation is indicated
Asthma Diagnosis, what labs and measurments will be off?
Peak flow expiratory rate decrease
FVC , FEV1 and FEV1/FVC decrease
Normal diffusion capacity
Improvement of flow rate with bronchodilators
Bronchial hyper-responsiveness to histamine
What is the treatment for Asthma?
Anti-inflammatory drugs as a treatment for Asthma would include?
Cromolyn-prevents mast cell degranulation; useful for prophylaxis not for an acute attack. Also used to prevent exercise induced asthma.