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Health Assessment > EXAM 4 GI > Flashcards

EXAM 4 GI Flashcards

learn about the ole poop chute

1
Q

Five basic layers of the GI tract

A

the serosa, longitudinal muscle layer, circular muscle layer, submucosa, and mucosa

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2
Q

Three layers of the mucosa

A

muscularis mucosae, lamina propria, and epithelium

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3
Q

What is the serosa?

A

smooth membrane of thin connective tissue and cells that secrete serous fluid to enclose the cavity and reduce friction between muscle movements

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4
Q

Compare longitudinal muscle to circular muscle layer

A

Longitudinal= short
Circular= decreased diameter

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5
Q

What are the two plexi of the GI tract?

A

Celiac and Hypogastric

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6
Q

Name the four blocks of the celiac plexus.

A

Transcrural
Intraoperative
endoscopic ultrasound-guided
peritoneallavage

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7
Q

Which plexus controls the smooth muscle layers of the GI tract?

A

Myenteric plexus.

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8
Q

The submucosal plexus is linked to what portion of the nervous system?

A

Enteric and CNS

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9
Q

The GI tract is controlled by the ANS, what functions to the SNS and PNS provide?

A

SNS= inhibition
PNS= excitatory

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10
Q

This portion of our nervous system is linked to that gut feeling and what neurotransmitter is associated with?

A

Enteric nervous system &
5-HT

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11
Q

What is the other name of the pace maker cells of the myenteric nervous system?

A

Interstitial Cells of Cajal (ICC)

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12
Q

Name the seven diagnostic procedures for the GI tract.

A

Endoscopy
Barium Swallow
Colonoscopy
Gastric emptying
High resolution manometry
Lower GI series
Small intestine Manometry

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13
Q

Name the three categories of esophageal disorders.

A

Anatomical, mechanical, and neurologic

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14
Q

what are some anatomical esophageal disorders?

A

diverticula, hiatal hernia, and changes associated w/ chronic acid reflux

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15
Q

Name some mechanical esophageal disorders

A

achalasia, esophageal spasms, and ahypertensive LES

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16
Q

what are some neurological esophageal disorders?

A

stroke, vagotomy, or hormone deficiencies

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17
Q

Common symptoms associated with esophageal disorders?

A

dysphagia, heartburn, GERD

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18
Q

Dysphagia can be classified two ways, differentiate them.

A

Mechanical Dysphagia- the inability to swallow solid food.

Dysmotility- The inability to swallow liquids or solids.

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19
Q

Soft ball question, what is GERD?

A

gastric esophageal reflux disease. This is when food leaves the stomach and refluxes into the esophagus causing pain. aka heartburn.

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20
Q

What is achalasia? How many classes does it have.

A

neuromuscular disorder of the esophagus consisting of an outflow obstruction d/t inadequate LES tone and a dilated hypomobile esophagus

Three classes

Type 1: minimal esophageal pressure, responds well to myotomy
Type 2: entire esophagus pressurized; responds well to treatment, has best outcomes
Type 3: esophageal spasms w/premature contractions; has worst outcomes

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21
Q

List treatment options for achalasia

A

Medications: nitrates & CCBs to relax LES

Endoscopic botox injections
Pneumatic dilation * most effective nonsurgicaltx

Laparoscopic Hellar Myotomy *best surgical tx

Peri-oral endoscopic myotomy (POEM)- endoscopic division of LES muscle layers
40% develop pneumothorax or pneumoperitoneum

Esophagectomy- only considered in the most advanced dz states

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22
Q

This esophageal disorder has resemblance to angina, what is it and how do we treat?

A

Diffuse Esophageal Spasms

Nitroglycerin, antidepressants, and Phosphodiesterase inhibitors.

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23
Q

An outpouching disorder that are at high risk for aspiration and linked to bad breath.

A

Esophageal Diverticula

can be upper, mid, or supradiaphragmatic.

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24
Q

Another softball, what is it called when the stomach protrudes through the esophageal aperture?

A

Hiatal hernia.

Alot of these patients experience GERD.

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25
Q

Dysphagia, weight loss, and lymph node involvement.

what am I?

A

Esophageal cancer. Poor outcomes, an esophagectomy can be performed to relieve symptoms.

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26
Q

Anesthetic considerations in the setting of esophageal cancer?

A

Hi risk for recurrent laryngeal nerve injury, dehydration, electrolyte imbalance, and pancytopenia if receiving cancer treatment.

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27
Q

Transient LES relaxation, elicited by gastric distention
LES hypotension,
Autonomic dysfunction of GE junction are associated with?

A

GERD

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28
Q

Normal LES tone?

A

29 mmHg

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29
Q

Common medical treatments for GERD?

A

H2 antagonist, PPIs, Reglan, antacids (sodium citrate preferred for anesthesia.

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30
Q

Surgical treatments for GERD?

A

Nissen Fundoplication, Toupet, LINX

all essentially return “tone” through wrapping. LINX uses magnets, so that’s dope.

31
Q

Aspiration risk factors?
its a long list yall.

A

Emergent surgery
Full Stomach
Difficult airway
Inadequate anesthesia depth
Lithotomy
Autonomic Neuropathy
Gastroparesis
DM
Pregnancy
↑ Intraabdominal pressure
Severe Illness
Morbid Obesity

32
Q

Parasympathetic stimulation increases rate and force of contraction of the stomach, what nerve is it?

A

The vagus nerve.

33
Q

What nerve inhibits the stomach?

A

splanchnic nerve

34
Q

These two hormones cause contraction

A

gastrin and motilin

35
Q

Peptic ulcer disease symptoms are relieved by this everyday activity.

A

Eating.

36
Q

Why do people die from PUD?

A

untreated perforation leading to hemorrhage or peritonitis.

37
Q

Your patient is extremely dehydrated, alkalotic, and is continuously vomiting. What are you suspicious of?

A

gastric outlet obstruction.

Ngt tube, bowel rest, and IV resuscitation. This can be recurrent if there is a stenosis.

38
Q

This is related ETOH and NSAID use?

A

Gastric ulcers.

39
Q

what are the five types of gastric ulcers?

A
40
Q

What syndrom of the GI tract is associated with a disruption of a negative feeback loop?

A

Zollinger Ellison Syndrome

41
Q

Anesthetic considerations for Zollinger Ellison Syndrome?

A

pre op/ induction

Correct lytes,↑gastric pH w/meds, RSI

42
Q

Treatment for Zollinger Ellison Syndrome?

A

PPIs and surgical resection of gastrinoma

43
Q

Why is segmentation so important for the small intestines?

A

The contractions slow the food down within the tract, giving it more time to be absorbed by the mucosa.

44
Q

What are reversible causes of small bowel dysfucntion?

A

mechanical obstruction such as hernias, malignancy, adhesions, and volvuluses
bacterial overgrowth leading to alterations in absorptive function
ileus, electrolyte abnormalities, and critical illness

45
Q

Irreversible causes of small bowel dysfunction?

A

Structural: scleroderma, connective tissue disorders, IBD
Neuropathic:pseudo-obstruction in which the intrinsic and extrinsic nervous systems are altered and the intestines can only produce weak, uncoordinated contractions

46
Q

distention of ______ allows the _________ to open, thus permitting entrance into the colon.

A

ileum and ileocecal valve.

47
Q

These are produced to allow mass movement of contents within the colon.

A

Giant migrating complexes.

complexes occur approximately 6-10x a day

48
Q

What are two categories of colonic dysmotility?

A

IBS and IBD

49
Q

What typically relieves IBS?

A

defecation relieves discomfort
pain is assoc w/abnormal frequency (> 3x per day or < 3xper week)
pain is associated with a change in the form of the stool

50
Q

What are the two common forms of IBD?

A

Chron’s and Ulcerative colitis

51
Q

Giant migrating complexes still occur in IBD, what is missing?

A

smooth muscle contractions due to the inflammation of the mucosa.

52
Q

Because of the increased frequency of giant migrating complexes, what can occur in IBD?

A

their pressure-effect further compresses the inflamed mucosa, which can lead to hemorrhage, thick mucus secretion, and significant erosions

53
Q

Ulcerative colitis is defined as ?

A

Mucosal disease of the rectum and part or all of the colon

54
Q

Common lab findings in UC?

A

↑plts,↑erythrocyte sedimentation rate, ↓H&H, ↓albumin

55
Q

How many units of blood warrant a colectomy?

A

6 plus

56
Q

This disease can effect a person anywhere in the gut and comes in two forms?

A

Crohn’s

penetrating-fistulous, or obstructing

57
Q

Complications of Crohn’s

solid list

A

Diarrhea decreases and is replaced by chronic bowel obstruction
Extensive inflammation leads to loss of absorptive surfaces, resulting in malabsorption & steatorrhea
Colonic dz may fistulize into stomach/duodenum, causing fecal vomitus
1/3 Crohn’s pts have an additional symptoms s/a arthritis, dermatitis, kidney stones

58
Q

Common IBD treatments?

A

5-Acetylsalicylic acid (5-ASA)- mainstay for IBD

PO/IV Glucorticoids during flares

Antibiotics: Rifaximin, Flagyl, Cipro

Purine analogues

59
Q

Why is surgery not ideal for crohn’s?

A

can lead to short gut syndrome and the need for TPN.

60
Q

Common symptoms of carcinoid tumors?

A

flushing, diarrhea, HTN/HoTN, bronchoconstriction

61
Q

Pre op measures for carcinoid tumors?

A

Octreotide before surgery and prior to tumor manipulation to attenuate volatile hemodynamic changes

62
Q

carcinoid tumors excrete an excess of what?

A

gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, serotonin, other biological actives

63
Q

Differentiate the different carcinoid manifestations based on location

A
64
Q

What has increased ten fold since the 1960s?

A

Acute pancreatitis, most likely to due to better diagnostic capabilities.

65
Q

What is typically elevated in acute pancreatitis?

A

↑serum amylase & lipase

66
Q

Typical causes of acute pancreatitis?

A

Gallstones obstruct ampulla of vater, causing pancreatic ductal HTN
Pancreatitis is also seen in immunodeficiency syndrome, hyperparathyroidism/↑Ca²

67
Q

Acute pancreatitis treatment?

A

Aggressive IVF, NPO to rest pancreas, enteral feeding (preferred over TPN), opioids

ERCP

68
Q

What is more common, upper of lower GI bleeding?

A

upper GI

69
Q

Dosage for neostigmine and what to watch out for in the setting of ileus?

A

2-2.5mg over 5 min

watch for bradycardia.

70
Q

Inhibition of the GI tract is proportional to what?

A

Norepinephrine levels. Keep your patients chill, and anxiety at a minimum.

71
Q

Name the sections of the GI tract that recover first to last post op?

A

small intestine, stomach, followed by large intestine.

large intestine takes about a day and a half to fully recover.

72
Q

Why is nitrous oxide an issue with the gut?

A

will dissolve into air filled compartments, increased volume and pressure. can cause abdominal or bowel distention.

73
Q

What reversal agent has no effect on GI motility.

A

sugammadex.

74
Q
A

Health Assessment (10 decks)

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