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Summer 2020 - APA Foundations 2 - Other > GI Disturbances & Anesthesia - Quiz 4 > Flashcards

GI Disturbances & Anesthesia - Quiz 4 Flashcards

1
Q

Which nerve innervates the Nasopharynx?

A

Trigeminal Nerve

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2
Q

Which Nerve innervates back 1/3 of Tongue & Oral Pharynx?

A

Glossopharyngeal Nerve

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3
Q

Which Nerve innervates the Tongue Base & Inferior Epiglottis?

A

Superior Laryngeal Nerve (SLN)

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4
Q

Which Nerve innervates the Vocal Cords distally?

A

Recurrent Laryngeal Nerve (RLN)

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5
Q

Which Nerve controls the Larynx & Trachea?

A

Vagus Nerve

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6
Q

Where is the Esophagus located?

A

From the Pharynx (C6) to the stomach

3 Zones - Upper/Lower Esophageal Sphincter & Esophageal Body

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7
Q

What is the Esophageal Wall made of?

A

Outer Longitudinal Layer

Inner Circular Muscle Layer - Smooth & Striated

Mucosal Lining - Squamous & Columnar Epithelium

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8
Q

What are the Diaphragm Crus?

A

Tendinous structures that extends below diaphragm to vertebrae - the right crus is where the Esophagus passes thru

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9
Q

What kind of muscle makes up the External Coat of the Esophagus?

A

Upper - Skeletal Muscle

Middle - Skeletal & Smooth Muscle

Lower - Smooth Muscle

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10
Q

What is on the outside of the Esophageal External Muscular Coat?

A

Adventitia - collagen connective tissue w/ fibroblasts

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11
Q

Which Nerve Plexus is in between the muscle layers of the Esophagus?

A

Myenteric Plexus of Auerbach - parasympathetic vagus nerve

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12
Q

Where does the Esophagus get its blood supply?

A

Cervical Esophagus - Inferior Thyroid Arteries

Thoracic Esophagus - Aorta Esophageal Bronchial Arteries

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13
Q

What are the Intrinsic Nerve Plexuses of the Esophagus?

A

Auerbach Plexus & Meissner Plexus

Esophagus to Anus

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14
Q

What are the Extrinsic Nerve Plexuses of the Esophagus?

A
  • Myenteric Plexus - Sympathetic Modulator
  • Cranial Nerves IX, X, and XI - Parasympathetic - Esophageal Contraction & LES Relaxation
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15
Q

When are the Upper & Lower Esophageal Sphincters Closed?

A

At Rest

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16
Q

What Stimulates the Upper Esophageal Sphincter?

A

Inspiration

Distention

Gagging

Valsalva

Gastric Acid

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17
Q

What reduces Upper Esophageal Tone?

A

Distention

Belching

Vomiting

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18
Q

What is the Normal Lower Esophageal Sphincter tone?

A

20 mmHg

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19
Q

How does Swallowing affect the Esophagus?

A

Starts Peristalsis

↓LES Tone during Peristalsis

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20
Q

What Increases Lower Esophageal Sphincter Tone?

A

Eating a Meal & Increased Abd. Pressure via Vagal Pathways

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21
Q

What should be evaluated for pts. w/ Dysphagia?

A

Identify Underlying Cause w/ Barium Swallow or Upper Endo

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22
Q

How does Chronic ETOH affect the Esophagus?

A

Impaired Peristalsis

LES Hypotonia

Auerbach Plexus Degeneration

Mallory Weis Tear from yacking

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23
Q

What is Achalasia?

A

LES cant relax during swallowing & no peristalsis

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24
Q

What can cause Achalasia?

A

DM

Stroke

ALS

Amyloidosis

Scleroderma

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25
Q

How is Achalasia treated?

A

Heller Myotomy & Pneumatic Balloon

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26
Q

What is Barretts Esophagus?

A

When the normal Squamous epithelium changes to metaplastic columnar epithelium

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27
Q

What causes Barretts Esophagus?

A

GERD

Chronic ETOH

Smoking

Will eventually lead to Carinoma

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28
Q

What happens in GERD?

A

LES fails to function properly and lets stomach contents reflux into esophagus

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29
Q

Which meds are used to manage GERD?

A

PPIs & H2 Blockers

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30
Q

What causes a Hiatal Hernia?

A

Weak Diaphragm that lets part of the stomach move up into thoracic cavity

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31
Q

What are the different types of Hiatal Hernias?

A

Type I - Sliding

Type II, III, and IV - Paraesophageal

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32
Q

What are symptoms of a Hiatal Hernia?

A

Restosternal Pain or Burning after Meals

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33
Q

What condition are pts. w/ a Hiatal Hernia predisposed to?

A

Peptic Esophagitis

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34
Q

How are Hiatal Hernias Treated?

A

Surgery - Endoclip & Nissen Fundoplication

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35
Q

How are Esophageal Diverticula Classified?

A

By Location

  • Zenker - Upper Esophagus
  • Traction - Mid-Esophagus
  • Epiphrenic - Near LES
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36
Q

What are the risks associated w/ Esophageal Diverticula?

A

Aspiration

Need 2 Separate Surgeries

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37
Q

What is the concern when giving Daunorobucin, Doxorubicin, or Adriamycin for Esophageal Carcinomas?

A

Chemo-Induced Cardiomyopathy

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38
Q

What can happen when treating a pt w/ Esophageal Carcinoma with Bleomycin?

A

Pulm. Fibrosis

Oxygen Toxicity

Restrictive Defect

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39
Q

What are the Incisionless Procedures used for Esophageal Surgery?

A

Esophyx & Natural Orifice Transluninal Endoscopic Surgery (NOTES)

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40
Q

How is the Ivor-Lewis Repair done for Esophageal Cancer?

A

Anterior Abd. Incision & Right Thoracotomy

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41
Q

How is the Ivor-Lewis McKeown-Type Repair done for Esophageal Cancer?

A
  1. Right Neck Incision
  2. Remove Diseased Esophagus
  3. Anastamose Stomach to Cervical Esophagus
42
Q

What are the Intra-Op Complications of Esophageal Cancer Surgery?

A

Hemorrhage & Hypotension

Trach/Bronch Injury

RLN Injury

Arrythmias

43
Q

What are the Post-Op Complications of Esophageal Cancer Surgery?

A

Anastamotic Leak

CV & Respiratory Problems

Post-Op Tumor Recurrence

Mediastinitis

Sepsis

44
Q

What are the two sections of the Stomach?

A

Fundus
Thin, Upper Abd., Food Storage

Distal Stomach
Thick, Releases Chyme, Food Mixing

45
Q

What is the difference b/t the stomach and duodenum?

A

Stomach
Size of Open Hand & Varied Position

Duodenum
12 Fingers/25 cm Long & Fixed Retroperitoneal Position

46
Q

What are the different parts of the Gastric Wall?

A
  • Serosa - External Layer
    • Outer Longitidunal Muscles
    • Middle Circular Muscles
    • Inner Oblique Muslces
  • Musclaris Mucosae
  • Submucosa
  • Mucosa
47
Q

What releases Gastric Acid and how is it mediated?

A

Gastric Acid released by Parietal cells

&

Mediated By

Vagal Stimulation - Acetylcholine

Gastrin Release - G Cells

Histamine

48
Q

What does the Fundic Mucosa of the Stomach do?

A

Secretes mucus to make a protective layer from the acid

49
Q

What stimulates Pepsinogen Production?

A

Sight & Smell of Food

50
Q

What suppresses Gastrin Release?

A

Luminal Acid - Negative Feedback Loop

51
Q

What are ways to control Gastric Acid Secretion?

A

H2 Blockers

PPIs - Most effective antisecretory

Anticholinergics - Minor Effect

Surgery - Vagotomy (Not Primary Treatment)

52
Q

Besides acid secretion & digestion, what are the other Gastric Functions?

A

Protection again foreign ingestions

Thermoregulation - warms/cools ingested things

Vitamin B12 Absorption

53
Q

Where does the Stomach receive its Blood Supply?

A

4 Arteries - R/L Gastric & Gastroepiploic Arteries

54
Q

Which nerves Innervate the Stomach?

A

Right Posterior Celiac Branch of Vagus Nerve

&

Left Anterior Hapatic Branch of Vagus Nerve

55
Q

What is Peptic Ulcer Disease

A

Too much Acid & Pepsin breaking down stomach’s mucous layer

56
Q

What causes Peptic Ulcer Disease?

A

H. Pylori - Main Cause

NSAIDs

Steroids

ETOH

Smoking

Stress

Radiation

57
Q

What are the risks when using Oral Antacids to treat Peptic Ulcer Disease?

A

Acid Rebound

Milk-Alkali Syndrome

Hypercalcemia

Muscle Weakness

Hypophosphatemia

Osteoporosis

58
Q

What does Sucralfate do to help with Peptic Ulcer Disease?

A

Binds to Ulcer

↑Mucous Layer

↑Healing

No side effects

59
Q

What is a secondary med therapy used to prevent ulcers for pts who need NSAIDs?

A

Misoprostol - Synthetic Prostaglandin

60
Q

Most Gastric Neoplasms are Malignant with 95% being _________

A

Most Gastric Neoplasms are Malignant with 95% being Adenocarcinoma

61
Q

What are the Late Symptoms of Gastric Cancer?

A

Anorexia & Weight loss

62
Q

What are the treatments for Gastric Cancer?

A

Gastrectomy

Omentectomy

Splenectomy

Lymph Node Dissection

63
Q

What is the Billroth II Gastrojejunostomy?

A

Partial Gastrectomy, then the non involved part of the stomach is connected to the first part of the jejunum

64
Q

What are the Exocrine Functions of the Pancreas?

A

Adjusts duodual pH by secreting clear juice w/ a pH of 8.3 and is made up of Na+, K+, Bicarb, and Chloride

65
Q

What are the Pancreas’ Endocrine Functions?

A

Make Insulin & Glucagon

66
Q

What are symptoms of Pancreatitis?

A

Abd Pain

N/V

Fever

Jaundice

Hypotension

Ilius

Radiographic Stomach Distortion

67
Q

What are causes of Pancreatitis?

A

ETOH Abuse

Trauma

Ulcer Penetration

Infection

Biliary Tract Disease

Drugs

68
Q

How is Pancreatitis treated?

A

NG Suction

Fluids

Pain Control

Nutrition

Common Bile Duct Exploration

69
Q

What is invovled w/ Chronic Pancreatitis?

A

Abd. Pain

Pancreatic Calcification

Steatorrhea (Oily Stool)

Diabetes

70
Q

What are the Surgeries for Pancreatitis?

A

Drain Pseudocyst

Pancreatojejunostomy

Peustow Procedure

71
Q

Why is the cure rate for Pancreatic Cancer so low?

A

Must be diagnosed extremely early

Long Extensive Procedures

Serious Post Op Complications

72
Q

What is the Whipple Procedure?

A

Complex operation to remove Pancreas Head, Duodenum, and Gallbladder

73
Q

The biliary tract is what the Liver excretes through, what is the tract made of?

A

Hepatic Ducts

Gallbladder

Cystic Duct

Common Bile Duct

74
Q

What regulates the Gallbladder to contract & empty bile into the duodenum?

A

Primary - Cholecystokinin & Intraluminal acids and fats from the Duodenum

Secondary - Vagal stimulation

75
Q

What are the Functions of Bile?

A
  • Emulsify and helps absorption of fats & fat-soluble vitamins
  • Makes pathway for bilirubin, drugs, toxins, and IgA
  • Maintains Duodenal Alkalization
76
Q

What happens w/ Cholecystitis?

A

Cystic Duct Obstruction

Juandice = Complete Obstruction

Severe Epigastric pain that radiates to right abd.

77
Q

What is Murphy’s Sign in regards to Cholecystitis?

A

Breathing in causes pain

78
Q

What will a patient’s lab values look like if they have Cholecystitis?

A

↑Bilirubin

↑Amylase

↑Alkaline Phosphatase (ALP)

↑WBC

79
Q

What can happen if the Gallbladder is perforated?

A

Peritonitis

Local Tenderness

Ileus

80
Q

What needs to be ruled out before Diagnosing Cholecystitis?

A

Cardiac Event

Dehydration

Ileus

Perf’d Gallbladder = emergent Ex-Lap

May need Gallbladder U/S

81
Q

Cholecystitis is obstruction of the cystic duct. Cholelithiasis & Choledocholithiasis is obstruction of which duct?

A

Common Bile Duct

Similar Symptoms

82
Q

What is the Charcot Triangle?

A

Signs of Ductal Obstuction

Fever + Chills + Upper Quadrant Pain

83
Q

What are the Anesthesia Considerations for a Cholecystectomy?

A

N/V

Post-Op Pain

Peritonial Irritation d/t CO2 Insufflation

Volume Restoration

↓Venous Return

Bradycardia

Hypotension

84
Q

What are the lengths of the different parts of the small intestine?

A

Duodenum - 20cm

Jejunum - 100cm

Ileum - 150cm

Connected by Mesentery

85
Q

What are the Functions of the Small Intestine?

A

Digestion & Absorption

86
Q

What does Trypsin & Chymotrypsin from the Pancreas do?

A

Proteolytic enzymes that break down proteins into small peptides

87
Q

_______ splits amino acids one at a time, while _____ & _____ free the end amino acid products.

A

Carboxypeptidase splits amino acids one at a time, while Aminopeptidase & Dipeptidase free the end amino acid products

88
Q

What happens to lipids once they enter the digestive system?

A

Pancreated Lipase & Bile breaks them down into Free Fatty Acids & Monoglycerides

Bile is the middle man that holds the fat until lipase break them down

89
Q

What happens to Carbs once they enter the Digestive System?

A
  1. Broken down to Simple Sugars/Monosaccharides
  2. Pancreatic Amylase break them down to Oligosaccharides
  3. Brush Border Enzymes (Dextrinase & glucoamylase) futher break down those Oligosaccharides
90
Q

What are the types of Small Intestine Diseases?

A

Malabsorption - Fat/Protein/Gluten/Celiac Sprue

Maldigestion

Upper GI Bleed

Small Bowel Obstruction

91
Q

Which arteries supply blood to the Large Intestine?

A

Superior & Inferior Mesenteric Arteries

Internal Iliac Artery

92
Q

How long is the Colon?

A

3 - 5 Feet

93
Q

What makes up the Large Intestinal Wall?

A

Longitudinal Muscle & Outpouchings / Haustrations

94
Q

What are the Functions of the Large Intestine?

A
  • Peristalsis
  • Bacterial Digestion
  • Absorption - Vitamins B, K, Water, Na+, Cl-
  • Defecation
95
Q

What are the types of Large Intestine Diseases?

A

IBD - Crohn’s, Ulcerative Colitis

Diverticulitis/losis

Abd. Compartment Syndrome

Colon Polyps, Cancer, Volvulus

Ischemic Bowel

Appendicitis

96
Q

What is the difference b/t Ulcerative Colitis & Crohn’s?

A

Ulcerative occurs continuously throughout the Large Intestinge

Crohn’s occurs at different parts of the colon, skipping some segments

97
Q

What are symptoms of Crohn’s Disease?

A

Chronic Diarrhea

Abd Pain

Fever

Fatigue

Rectal Bleed

98
Q

How is Crohn’s Treated?

A

Anti-Inflammatory Agents

Steroids

ABX

Immune Modifiers

Surgery

(Diet has no Effect either way)

99
Q

Which anesthetic agent should be avoided for Intestinal Surgery?

A

N2O - can expand the bowel

100
Q

Which organ is the Largest Lympathic Organ and is where Lymphocyte Proliferation and Immune Response happens?

A

Spleen

(Considered Non-Vital)

101
Q

What are the Spleen’s Functions?

A

Destroys & Recycles old RBCs, Iron, & Globin and stores Functional RBCs, releasing them during hemorrhages

102
Q

When are Spelenctomies Indicated?

A

ITP

Hodgkin’s

Leukemia

Sick Cell Disease

Splenic Trauma

Thalassemia

Hemolytic Anemia

Summer 2020 - APA Foundations 2 - Other (10 decks)

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