Ch. 29 Nutritional and Gastrointestinal Disease

Question 1

What is the unit for BMI?

Answer 1

kg/m^2

Question 2

What is a desirable BMI?

Answer 2

18-25kg/m^2

Question 3

What is morbid obesity?

Answer 3

40kg/m^2

Question 4

What is superobesity?

Answer 4

50kg/m^2

Question 5

What is super-superobesity?

Answer 5

60kg/m^2

Question 6

What are respiratory conditions associated with obesity?

Answer 6

OSA, restrictive lung disease, decreased residual volume

Question 7

What side of the heart is most affected by obesity? Why?

Answer 7

right; OSA and/or obesity-related hypotension syndrome cause pulmonary hypertension

Question 8

Nondiabetic obese patients have a _______ volume of gastric contents at a _______ pH than nondiabetic lean patients.

Answer 8

smaller; higher

Question 9

What are places other than the upper arm that a blood pressure cuff can be applied?

Answer 9

lower arm; calf

Question 10

What conditions does bariatric surgery improve?

Answer 10

HTN, DM II, OSA

Question 11

Feeding enteral and parenteral - what routes are these?

Answer 11

enteral - nasogastral or directly into jejunum; parenteral - IV

Question 12

What route is preferred - enteral or parenteral? Why?

Answer 12

enteral utilizes the villi of the GI tract to prevent bacterial transfer

Question 13

What is an anesthetic concern for a patient on TPN?

Answer 13

How long should they be off TPN and be NPO for induction?

Question 14

What lab should be checked when a patient is off TPN? Why?

Answer 14

glucose; insulin is a component of TPN

Question 15

What are the two categories of inflammatory bowel disease?

Answer 15

ulcerative colitis (UC) and Crohn’s Disease (CD)

Question 16

Which category of IBD is restricted to the large intestine?

Answer 16

ulcerative colitis

Question 17

How is the presence of IBD confirmed?

Answer 17

endoscopy and biopsy

Question 18

Which anesthetics are contraindicated for patients with IBD?

Answer 18

none

Question 19

What barriers must gastric contents pass in order to become aspiration?

Answer 19

lower esophageal sphincter and upper esophageal sphincter

Question 20

What percent of the general population have heartburn at least once a week?

Answer 20

20%

Question 21

How do histamine (H2) blockers work?

Answer 21

decrease gastric acid secretion

Question 22

What adverse side effects do H2 blockers have in the elderly?

Answer 22

cause confusion, agitation, psychosis

Question 23

Sulfonureas work in what way?

Answer 23

stimulate beta cells to release insulin

Question 24

Meformin works in what way?

Answer 24

inhibit gluconeogenesis (inhibit hepatic production of glucose)

Question 25

How might diabetes mask an MI?

Answer 25

if the patient has cardiac autonomic neuropathy they may not get angina pectoris

Question 26

What DM drugs should not be taken the morning of surgery? Why?

Answer 26

sulfonureas because they may cause hypoglycemia due to the absence of breakfast

Question 27

What is the difference between hyperthyroidism and thyrotoxicosis?

Answer 27

hyperthyroidism is the secretion of too much thyroid; thyrotoxicosis is the state of having elevated serum thyroid hormone

Question 28

Elevated serum levels of what characterize hyperthyroidism/thyrotoxicosis

Answer 28

thyroid hormones T3 & T4

Question 29

What is the most common cause of thyrotoxicosis?

Answer 29

Grave's disease

Question 30

Why might HTN and tachycardia be seen in patients with hyperthyroidism?

Answer 30

thyroid hormone increases cardiac sensitivity to catecholamines

Question 31

What is the most severe form of thyrotoxicosis?

Answer 31

thyroid storm

Question 32

What method is used to treat hypothyroidism initially?

Answer 32

decrease thyroid hormone synthesis

Question 33

What advantage does propanolol have vs other beta blockers for the treatment of thyroid storm?

Answer 33

blocks conversion of T4 to T3

Question 34

What condition does thyroid storm appear like?

Answer 34

MH

Question 35

Is dantrolene beneficial for treating thyroid storm?

Answer 35

yes

Question 36

What does Hashimoto's thyroiditis cause?

Answer 36

hypothyroidism

Question 37

Which nerve do you absolutely not want to injure during thyroidectomy and why?

Answer 37

(bilateral) recurrent laryngeal because it controls separation of vocal cords during breathing

Question 38

How does a NIMs tube work?

Answer 38

the tube has electrodes next to the vocal cords that send a signal to a receiver whenever the vocal cords contract; if the surgeon stimulates a larengeal nerve by retracting it or from nearby electrocautery, an audible warning sounds occurs

Question 39

What is a tumor on the adrenal gland called?

Answer 39

pheochromocytoma

Question 40

What is a tumor of the SNS ganglia called?

Answer 40

paraganglioma

Question 41

What is MEN?

Answer 41

When two or more endocrine tumor types occur in the same patient

Question 42

What are the principal hormones secretes by the adrenal cortex?

Answer 42

cortisol and aldosterone

Question 43

What is chronic insufficiency of cortisol referred to as?

Answer 43

Addison's disease

Question 44

Cortisol has what effect on catecholamines?

Answer 44

potentiates the effect of catecholamines

Question 45

Cortisol has what effect on vascular permeability?

Answer 45

reduces permeability

Question 46

Circulatory shock can be caused by a deficiency of cortisol. Why?

Answer 46

Cortisol reduces vascular permeability and without it, fluid leaves the vasculature at a higher rate. It also causes a loss of vascular tone and myocardial contractility. This leads to hypovolemic circulatory shock

Question 47

Cortisol has what effect on vascular tone?

Answer 47

maintains vascular tone

Question 48

Cortisol has what effect on contractility?

Answer 48

maintains contractility

Question 49

What induction drug can suppress adrenal cortical function?

Answer 49

etomidate

Question 50

What is normal daily cortisol production?

Answer 50

20-30mg/day

Question 51

What symptoms are associated with pituitary apoplexy?

Answer 51

severe HA, meningeal irritation, cardiovascular collapse

Question 52

How is pituitary apoplexy confirmed?

Answer 52

MRI or computed tomograpy

Question 53

What is Cushing's syndrome?

Answer 53

elevated cortisol levels in the blood

Question 54

What causes Cushing's syndrome?

Answer 54

hyperfunctioning adrenal gland or adenoma

Question 55

Cushing's can be caused by cancers of which organs? Which is the most common?

Answer 55

pituitary (most common), lung, thyroid, prostate, pancreas, or intrathoracic neuroendocrine tumors

Question 56

Can Cushings be caused by exogenous cortisol-like medications?

Answer 56

yes

Question 57

What physical changes are associated with elevated cortisol?

Answer 57

moon-face, buffalo hump, truncal obesity/thin extremities, purple abdominal striae, thinning skin