GI Review*

Question 1

This case is usually about 30 minutes to 2 hours long. Want a deeper anesthetic - use IAs. Also have Glucagon drawn up and ready to go. But if you have a diabetic patient remember to monitor blood glucose levels

Answer 1

ERCP

Question 2

Usually done laporoscopically. Treatment for chronic peptic esophagitis.

• gas insufflation, diaphragm displacement, reverse trendelenburg better but surgeons love trendelenburg
• Need them to have lower tidal volumes and increased rate
• With insufflation usually using CO2 (or N2O) anticipate ETCO2 going up (high 40s ok for a while, if gets up to 50/60s need to adjust).

Answer 2

Nissen Fundoplication

Question 3

Co-exists with chronic peptic esophagitis?
One of the most common. Ask every patient if they have this. Increased risk of Aspiration in these patients - will do RSI!
Ask patient if they have reflux, heartburn, do they sleep sitting up/need pillows to elevate themselves to sleep.

Answer 3

Hiatal hernia

Question 4

Anesthesia Considerations for the Patient with IBD:
Avoid increases in intraluminal pressure with ___.
-Use in conjunction with an ___ drug, may go on upper end of dosing.
-Go on lower end of dosing with ____.

-AVOID?

Answer 4

Anticholinesterase
Anticholinergic
reversals aka anticholinesterase
-N2O

Question 5

___ and ___ patients tend to be on steroids to suppress inflammation may need steroid stress dose.

Answer 5

Crohn’s and Ulcerative Colitis

Question 6

Treatment of Carcinoid Tumors:
-Somatostatin analogue for hypotension and bronchospasm? (careful interferes with ___ release)
~also for treatment of vaso/bronchoconstriction (SQ 50-150 mcg)
-Resection of tumor by surgery
**Carcinoid Syndrome will see (4)
-___ release serotonin, should avoid them also Avoid (4)!!
-Treat HTN with?

Answer 6

• Octreotide 100-200 mcg IV
• insulin (exacerbates diabetes)
• *cutaneous flushing, bronchospasm, hypotension, diarrhea
• catecholamines
• sympathomimetic agents, ketamine, histamine releasing drugs, N2O
• labetalol

Question 7

Reverse SOO with (3)

Answer 7

Naloxone
NTG
Glucagon

Question 8

Upper Endoscopy:

• ___ is to prevent patient from biting down on scope - they are very expensive. Place so tongue is in down position. The only way to place appropriately is to put it in before the patient is sedated.
• Have a portable system available = ___ system (bag, valve, mask)
• Need to have this available so you can breathe for the patient

Answer 8

• Bite block

- Jackson-Reese

Question 9

PUD treatment: (2) and pyloroplasty and/or vagotomy.

• NG suctioning
• RSI

Answer 9

H2 antagonists and anticholinergics

H2 may inhibit CYP450

Question 10

Gastric outlet obstruction (duodenal)

retain greater than ___ 30 minutes after drinking ___ saline

Answer 10

300 cc

750 cc

Question 11

Cholecystitis Patient:
Increased intra-abdominal pressure with insufflation (CO2) interferes with ventilation - ___ will help this.
(also impacts venous return and reflux concern - place OGT)
-___ ok, don’t use ___
-Reverse SOO spasm with (3)

Answer 11

Reverse Trendelenburg

• fentanyl
• morphine
• NTG, naloxone, glucagon