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AnDY 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
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 Innervate the GI tract?

A

Celiac and Hypogastric

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6
Q

4 Approaches to blocks 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
Colonoscopy

Barium Swallow
Gastric emptying
Lower GI series

High resolution manometry
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? (3)

A
  • Diverticula
  • Hiatal hernia
  • Changes w/ chronic acid reflux
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15
Q

Name some mechanical esophageal disorders (3)

A

Achalasia
Esophageal spasms (Type 3 achalasia)
Hypertensive LES

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16
Q

what are some causes of neurological esophageal disorders? (3)

A

Stroke
Vagotomy (CNX)
Hormone deficiencies

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17
Q

Common symptoms associated with esophageal disorders? (3)

A

dysphagia, heartburn, GERD

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18
Q

2 Esophageals Dysphagia Classifications
and how to 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

Esophageal Neuromuscular Disorder
- 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
Meds (2)
Non-Sx
Best Sx
Sx (2) and Side Effect (1)

A

Meds: Nitrates & CCBs to relax LES
Endoscopic botox injections

Non-Sx: Pneumatic dilation * most effective

Best Sx: Laparoscopic Hellar Myotomy

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

Sx: Esophagectomy- advanced dz states

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22
Q

What esophageal disorder has resemblance to angina?
how do we treat? (3)
Most common in?

A

Diffuse Esophageal Spasms

Nitroglycerin, antidepressants, and Phosphodiesterase inhibitors (PDE-I)
Common in elderly

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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

What is seen with Pharyngoesophageal Diverticula?
Another name?

A

bad breath d/t food retention
Zenker diverticulum

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25
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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26
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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27
Q

2 Types of most Esophageal Cancers

A

Most are adenocarcinomas in lower esophagus
Rest are squamous cell carcinoma

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28
Q

Anesthetic considerations in the setting of esophageal cancer?

A

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

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29
Q

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

Normal LES?
GERD pressure?

A

GERD
(normal LES pressure-29mmHg, avg GERD pressure-13 mmHg)

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30
Q

Bile reflux is associated w/ (2)

A

Barrett metaplasia & adenocarcinoma

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31
Q

Normal LES tone?

A

29 mmHg

32
Q

Common medication treatments for GERD? (4)

A

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

33
Q

3 Surgical treatments for GERD?

A

Nissen Fundoplication, Toupet, LINX

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

34
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

35
Q

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

A

The vagus nerve.

36
Q

What nerve inhibits the stomach?

A

splanchnic nerve

37
Q

These two hormones cause contraction

A

gastrin and motilin

38
Q

Peptic ulcer disease symptoms are relieved by this everyday activity.

A

Eating.

39
Q

Why do people die from Peptic Ulcer Disease!

A

untreated perforation leading to hemorrhage or peritonitis.

40
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.

41
Q

What condition can be caused by ETOH and NSAID use?

A

Gastric ulcers.

42
Q

what are the five types of gastric ulcers?

A
43
Q

What syndrome of the GI tract is associated with a disruption of a negative feedback loop?

A

Zollinger Ellison Syndrome -> gastrin hypersecretion

Gastric acid normally inhibits further gastrin release (neg feedback)

44
Q

Anesthetic pre op considerations for Zollinger Ellison Syndrome? (3)

A

During Pre-Op:
- Correct lytes
- ↑gastric pH w/meds
- RSI

45
Q

Treatment for Zollinger Ellison Syndrome? (2)

A

PPIs and surgical resection of gastrinoma

46
Q

Why is segmentation so important for the small intestines?

A

Slow the food down -> more absorption time for the mucosa.

47
Q

What are reversible causes of small bowel dysfunction? ( 3 main causes and subsets)

Mechanical: ______, _________, malignancy, and volvuluses
-_________ overgrowth: altered ________
-_____, electrolyte abnormalities, and critical illness

A

-mechanical : hernias, malignancy, adhesions, and volvuluses
-bacterial overgrowth: altered absorption
-Ileus, electrolyte abnormalities, and critical illness

48
Q

Irreversible causes of small bowel dysfunction? (4)

A

Structural: scleroderma, connective tissue disorders, IBD
Neuropathic:pseudo-obstruction (causes uncoordinated contractions)

49
Q

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

A

ileum and ileocecal valve.

50
Q

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

How many occur a day?

A

Giant migrating complexes.

complexes occur approximately 6-10x a day

51
Q

What are two categories of colonic dysmotility?

A

IBS and IBD

52
Q

IBS s/s:
Relieves IBS?
Causes pain?

A
  • defecation relieves discomfort
  • pain w/ abnormal frequency (> 3x day or < 3xweek)
53
Q

What are the two common forms of IBD?

A

Crohn’s and Ulcerative colitis

54
Q

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

A

smooth muscle contractions due to the inflammation of the mucosa.

55
Q

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

3 side effects

A

their pressure-effect further compresses the inflamed mucosa → hemorrhage, mucus secretion, and erosions

56
Q

Ulcerative colitis is defined as ?

A

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

57
Q

Common lab findings in UC?
2 highs
2 lows

A

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

58
Q

How many units of blood warrant a colectomy?

A

6+ units blood in 24-48 hrs

59
Q

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

A

Crohn’s

Forms: penetrating-fistulous, or obstructing

60
Q

Complications of Crohn’s (2)

__________ → chronic _______ obstruction

Extensive __________ → loss of _____________ surfaces → ______________ & ______________

A

Diarrhea → chronic bowel obstruction

Extensive inflammation → loss of absorptive surfaces → malabsorption & steatorrhea

61
Q

Common IBD treatments? (4)
Think ASA…. Andddd

A

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

PO/IV Glucorticoids during flares

Antibiotics: Rifaximin, Flagyl, Cipro

Purine analogues

62
Q

Why is surgery not ideal for crohn’s?

A

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

63
Q

Common symptoms of carcinoid tumors? (5)

A

bronchoconstriction
Right heart endocardial fibrosis
HTN/HoTN, diarrhea
flushing,

64
Q

Carcinoid Tumors Dx: (2)

A

urinary or plasma serotonin levels
CT/MRI

65
Q

Pre op Drug for carcinoid tumors?
Benefit?

A

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

66
Q

carcinoid tumors excrete an excess of what? (3)

A

gastrin, motilin,
insulin, glucagon,
somatostatin, neurotensin, tachykinins, serotonin
(More biological actives)

67
Q

Differentiate the different carcinoid manifestations based on location

A
68
Q

What has increased ten fold since the 1960s?

A

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

69
Q

What is labs are elevated in acute pancreatitis? (2)

A

↑serum amylase & lipase

70
Q

Typical causes of acute pancreatitis? (3)

A

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

71
Q

Acute pancreatitis treatment?
Meds (2)
Food
Procedures (2)

A

NPO
Food: Enteral feeding > TPN
Meds: Aggressive IVF, Opioids
Pro: ERCP

72
Q

What is more common, upper of lower GI bleeding?

A

upper GI

73
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.

74
Q

Inhibition of the GI tract is proportional to what?

A

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

75
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.

76
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.

77
Q

What reversal agent has no effect on GI motility.

A

sugammadex.

AnDY Health Assessment (9 decks)

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