Exam 4 - Gastrointestinal Flashcards
(170 cards)
1
Q
What are the 5 functions of the GI system?
A
motility, digestion, absorption, excretion and circulation
GI tract is 5% of total body mass :)
3
2
Q
Name the layers of GI system from outer to inner (5 layers)
(3 within layers in mucosa)
A
the serosa, longitudinal muscle, circular muscle, submucosa, mucosa
~Within mucosa is muscularis mucosae, lamina propia and epithelium
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3
Q
How do the longitutional muscle and circular muscle layers propagate gut motility?
A
- longitudinal muscle contracts to shorten the length
- circular muscle contracts to decrease the diameter
- They work together and propagate motility
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4
Q
What does the celiac plexus innervate?
A
the GI organs up to the proximal transverse colon
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5
Q
What does the inferior hypogastric plexus innervate?
A
descending colon and distal GI tract
5
6
Q
Where do the submocosal plexus transmit information to?
What is the role of myenteric plexus?
A
submucosal plexus transmits info from epithelium to the enteric & CNS
-myenteric plexus lies btw smooth muscle layers and regulates smooth muscle
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7
Q
The mucosa is made up of muscularis mucosa, lamina propia and epithelium. What are their functions?
A
- muscularis mucosa -thin layer; moves the villi
-
lamina propria -contains blood vessels & nerve endings
immune and inflammatory cells - epithelium- senses GI contects, secretes enzymes,absorbs nutrients, exretes waste
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8
Q
The mucosa is made up of muscularis mucosa, lamina propia and epithelium. What are their functions?
A
- muscularis mucosa -thin layer; moves the villi
-
lamina propria -contains blood vessels & nerve endings
immune and inflammatory cells - epithelium- senses GI contects, secretes enzymes,absorbs nutrients, excretes waste
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9
Q
GI is innervated by ANS
The GI tract ANS consits of extrinsic and enteric nervous systems. What are their functions?
A
-
extrinsic nervous system
The extrinsic SNS -inhibitory and decreases GI motility
extrinsic PNS - excitatory and activates GI motility - enteric nervous system independent nervous system; controls motility, secretion, and blood flow
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10
Q
The enteric system is comprised of myenteric plexus and submucosal plexus. What are the functions of these?
A
- myenteric plexus controls motility-(carried out by enteric neurons,interstitial cells of Cajal, and smooth muscle cells)
- submucosal plexus controls absorption, secretion, and mucosal blood flow
Both these respond to sympathetic and parasympathetic stimualtion
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11
Q
Upper Gastrointestinal Endoscopy: may be diagnostic or therapeutic. Endoscope placed into what 4 structures
A
- esophagus
- pylorus
- stomach
- duodenum
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12
Q
High Resolution Manometry is a pressure catheter; measures pressures along _______?
Used to diagnose ______ _______
11
A
the entire esophageal lenght
motility disorder
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13
Q
GI series with ingested barium is a _______ assessment of _______ function and GI transit.
A
- radiologic
- swallowing
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14
Q
What is gastric empting study?
A
Pt fasts for 4 hours; then consumes a meal. There is continous imaging for 2 hours.
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15
Q
Lower GI Series involves the administration of a _____ enema to a patient. This outlines the ________ . This allows for the detection of ______ and _____ anatomical abnormalities.
A
- barium enema
- intestines
- colon
- rectal
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16
Q
Anatomical causes of Esophageal Disease include _______, ____ hernia, and changes associated with _____ acid reflux.
A
- diverticula
- Hiatal
- chronic
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17
Q
Mechanical causes of Esophageal Disease include achalasia, _______ spasm and a ______ LES
A
- Esophageal
- Hypertensive
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18
Q
Neurologic causes of Esophageal Disease may be stroke, ______ or hormone _________.
A
- vagotomy
- deficiencies
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19
Q
Oropharyngeal Dysphasia is most common after ______ and _______ surgeries.
A
- head
- neck
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20
Q
Esophageal Dysphasia is based on physiology. Includes Esophageal _______ and Mechanical ________ dysphasia.
A
- Esophageal Dysmotility (occurs w liquids and solids)
- Mechanical Esophageal (solids)
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21
Q
Gastroesphageal Reflux Disease is the effortless return of _____ contents into ________.
A
- gastric
- pharynx
14
22
Q
What are (3) Classic symptoms of GERD
A
- Heatburn
- Lump in throat
- nausea
14
23
Q
Achalasia is a ________ disorder of the _________ consisting of outflow obstuction d/t an inadequate _____ tone and _____ hypomobile esophagus.
A
- neuromuscular
- esophagus
- LES
- dilated
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24
Q
Achalsia is caused by loss of _______ cells of the esophagus ______ plexus.
Followed by an absence of ______ neurotransmitters of the LES.
Causing unopposed _________ LES stimulation (LES can’t RELAX)
A
- ganglionic
- myenteric
- inhibitory
- cholinergic
This disease was referred to as a symptom of several GI disorders later
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Achalasia causes Esophageal ____ with food ______ to pass to the stomach.
* dilation
* unable
## Footnote
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Achalsia symptoms include _______, regurgitation, ________ and chest pain. Long-term can increase risk of ________ cancer.
* dysphasia
* heart burn
* esophageal
## Footnote
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27
Achalsia Type 1: __________ esophageal pressure, responds _______ to myotomy
* minimal
* well
## Footnote
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28
Achalasia Type 2: _____ esophagus pressureized; responds well to treatment and has the ______ outcome.
* Entire
* Best
## Footnote
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29
Achalasia Type 3: Esophageal ______ w/ premature contractions; has the ______ outcome.
* spasms
* worst
## Footnote
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30
All treatments for Achalasia are __________.
* Palliative.
## Footnote
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31
Medication treatments for Achalsia include nitrates and _____ to relax LES, and Endoscopic _____ injections.
* Calcium Channel Blockers (CCB)
* Botox
## Footnote
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32
What is the most effective non surgical tx for achalasia?
Pneumatic dilation
## Footnote
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33
What is the best surgical treatment for achalasia? *hint laparascopic*
* Laparascopic Hellar Myotomy
## Footnote
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Surgical treatment for Achalasia can include Peri-oral Endoscopic Myotomy (POEM) which is the endoscopic division of the ____ muscle layers. 40% of the surgeries cause ________ or pneumoperitoneum.
* LES
* Pneumothroax
## Footnote
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35
Esophagectomy for the treatment for Achalasia is only considered in the most _________ disease states.
* advanced.
| high aspiration risk! RSI or awake intubation
## Footnote
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36
What are diffuse esophageal spasms? Why do they occur?
Spasms that usually occur in distal esophagus; likely d/t autonomic dysfunction
*Common in elderly
Tx: NTG, antidepressants, PD-I*
## Footnote
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37
What is esophageal diverticula?
outpouchings in the wall of the esophagus
## Footnote
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38
What are the (3) types of esophagela diverticula?
What are they all at risk of?
Pharyngoesophagelal (zenker diverticulum)
Midesophageal
Epiphrenic (supradiaphragmatic)
All are aspiration risks. Removal of particles and RSI indicated.
## Footnote
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What are the signs of Pharyngoesophageal (Zenker diverticulum)?
bad breath d/t food retention
## Footnote
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40
What are the causes of Midesophageal diverticula?
old adhesions or inflamed lymph nodes
## Footnote
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What does the pain from diffuse esophageal spasms mimic? What is the treatment of diffuse esophagela spasms?
Pain mimics angina.
TX: NTG, antidepressants, PD-I's
## Footnote
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42
What can Epiphrenic (supradiaphragmatic) pts experience?
achalasia
## Footnote
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43
What is Hiatal Hernia? How does it occur? What is it associated with?
- **Herniation of stomach into thoracic cavity,** occurs through the esophageal hiatus in the diaphragm
- c/b weakening in anchors of gastroesophageal junction to the diaphragm
- May be asymptomatic; often **associated with GERD**
## Footnote
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44
What type of cancer presents w/ progressive dysphagia and weight loss?
Esophageal cancer
5/100,000 ppl in US
| poor survival rate :(
## Footnote
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45
What is the most common type of esophageal cancer?
What 3 conditions does it relate to?
Most are adenocarcinomas, located in lower esophagus
These are r/t **GERD, Barretts, Obesity**
*Squamous cell carcinoma accounts for the rest of esophageal cancers*
## Footnote
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46
Why does esophageal cancer have poor survival rate?
B/c abundant lymphatics lead to lymph node metastasis
## Footnote
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47
What is the surgical intervention for esophageal cancer?
How is it performed?
**Esophagectomy**: May be curative or palliative
May be performed transthoracic, transhiatal, or minimally invasive.
## Footnote
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48
What are pts at risk of when undergoing esophagectomy?
How do these pts usually present in pre-op?
If h/o of chemo and radiation, what 2 symptoms may occur?
High risk of **recurrent laryngeal nerve injury**; of which 40% resolve spontaneously.
Patients are often malnourished preop, & months after.
If h/o chemo/radiation -**pancytopenia & dehydration** may present
## Footnote
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49
What are all patients post- esophagectomy at risk of?
High aspiration risk for life!
## Footnote
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50
# GERD
What do reflux contents include?
HCL, pepsin, pancreatic enzymes, bile
## Footnote
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51
What is GERD? what are its s/s? How frequently does it occur in adults?
Incompetence of the gastro-esophageal junction, leading to reflux
Sx: heartburn, dysphagia & mucosal injury
Occurs in **15%** of adults.
## Footnote
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52
What diseases is bile reflux associated with?
Barrett metaplasia & adenocarcinoma
## Footnote
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53
What are 3 mechanisms of GE incompetence?
1. Transient LES relaxation, elicited by gastric distention
2. LES hypotension (normal LES pressure-29mmHg, avg GERD pressure-13 mmHg)
3. Autonomic dysfunction of GE junction
## Footnote
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54
What is the treatment for GERD? (meds and surgery). What foods do you avoid?
* Meds: Antacids, H2 blockers, PPIs
* Surgery: Nissen Fundoplication, Toupet, LINX
* avoidance of trigger foods
## Footnote
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55
What are the pre-op interventions for GERD patients?
- **Cimetidine, Ranitidine**-↓acid secretion & ↑pH
- PPI’s generally given night before and morning of surgery.
* **Sodium Citrate**- PO nonparticulate antacid
* **Metoclopramide**- gastrokinetic; often reserved for diabetics, obese, pregnant
*Aspirations precautions --> RSI*
## Footnote
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56
What are the factors that increase intraop aspiration risk? (long list)
* Emergent surgery
* Full Stomach
* Difficult airway
* Inadequate anesthesia depth
* Lithotomy
* Autonomic Neuropathy
* Gastroparesis
* DM
* Pregnancy
* ↑ Intraabdominal pressure
* Severe Illness
* Morbid Obesity
## Footnote
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57
The **stomach** is ____sac that serves as a ____ for large volumes of food, mixes and breaks down food to form ____, and slows emptying into the small intestine
J- shaped
reservoir
chyme
## Footnote
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58
What does gastrin and motilin do?
What does gastric inhibitory peptide do ?
Gastrin & motilin increase the strength and frequency of contractions
Gastric inhibitory peptide inhibits contractions
| These are controlled by neurohormonal
## Footnote
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59
What is the effect of PNS and SNS on the motility of the stomach?
**Parasympathetic** stimulation to the vagus nerve increases the number and force of contractions
**Sympathetic** stimulation inhibits these contractions via the splanchnic nerve
## Footnote
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60
What does the intrinsic nervous system do for motility?
Provides coordination
## Footnote
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61
What controls the motility of the stomach?
**intrinsic** and **extrinsic** neural regulation
## Footnote
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62
What are solids must be broken down into before entering duodenum?
1-2 mm particles
## Footnote
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63
Peptic Ulcer Disease ::
* Most common cause of ____________________
* Prevalence= ___ women, ___ men
* ____ death per year
* may be associated with _______________
non-variceal upper GI bleeding
10% ,, 12%
15,000
Helicobacter Pylori
slide 25
64
Gastric Outlet Obstruction
What are 2 causes of acute obstructions
edema & inflammation in pyloric channel at beginning of duodenum
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Peptic Ulcer Disease ::
* Sx :: ______ epigastric pain exacerbated w/ ______ and improved w/ _______
* 10% risk of__________ in those who do not receive treatment
Mortality is d/t (2 things)
BURNING epigastric pain exacerbated w/ FASTING and improved w/ MEALS
perforation
shock or perforation >48h
slide 25
66
# PUD
Perforation is sudden/severe ______ pain from _____ secretions into ________
sudden/severe EPIGASTRIC pain c/b ACIDIC secretions into PERITONEUM
slide 25
67
What is the treatment for gastric outlet obstruction? (2)
Normally resolves in ___ hrs
Repetitive ______ & _____ may lead to fixed-stenosis and chronic obstruction
NGT + IV hydration
72 hrs
ulceration + scarring
slide 26
68
Gastric Ulcers ::
What is the treatment for H. Pylori
Triple therapy
2 abx + PPI x 14 days
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What are 3 symptoms of pyloric obstruction?
Recurrent vomiting
dehydration
hyperchloremic alkalosis
Slide 26
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What are 3 primary causes of gastric ulcers?
NSAIDs, alcohol, H. Pylori
## Footnote
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71
What are the 5 types of gastric ulcers
Location -- acid hyper secretion?
1 = Lesser curvature close of incisura -- NO
2 = TWO ulcers : gastric body + duodenal - YES
3 = prepyloric - YES
4 = lesser curvature of gastroesophageal junction - NO
5 = anywhere - usually d/t NSAID use
## Footnote
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72
Zollinger Ellison Syndrome ::
_________ tumor of the pancreas, causing ______ hypersecretion
Usually, gastrin stimulates gastric acid ________.
Gastric acid ________ further gastrin release (neg feedback)
This feedback loop is ________ in ZE syndrome
Non B cell islet
gastrin
secretion
inhibits
absent
## Footnote
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73
Zollinger Ellison Syndrome ::
WHat are 2 treatments?
Pts have ↑ gastric fluid_______, ________imbalances, &________ abnormalities
Preop :: Correct ______, ↑ gastric ____ w/meds
Induction technique?
PPIs and surgical resection of gastrinoma
volume ... electrolyte ... endocrine
electrolytes ... pH
RSI
## Footnote
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74
Zollinger Ellison Syndrome ::
* 3 symptoms
* Occurs in ______ of PUD pts
* Gender affected?? Most commonly btw ages _____
Up to 50% of pts w/gastrinomas are______ at time of dx
peptic ulcer dz, erosive esophagitis, diarrhea
0.1-1%
Males > females agees 30-50
metastatic
## Footnote
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75
Small Intestine ::
* motility mixes contents of the stomach with _____ ________, further reducing particle___ and increasing _____
* Major function :: _____ the contents and expose them to the ______ _____ to maximize absorption of ____, ______, and _______ before entering the large intestine
digestive enzymes ... size .... solubility
circulate ... mucosal wall ...water, nutrients, vitamins
## Footnote
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Small Intestine ::
The_____ and _________ muscle layers coordinate to achieve SEGMENTATION
Segmentation occurs when two areas _______ and thereby isolate a segment of intestine
Segmentation allows the contents to remain in the _______ long enough for the essential substances to be _______ into the circulation
It is controlled mainly by the ________ nervous system with modulation of motility by the _____ nervous system
circular ... longitudinal
contract
intestine .... absorbed
Enteric ....EXtrinisic
## Footnote
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Small bowel Dysmotility
5 Reversible Causes
2 types Nonreversible causes
* Mechanical Obstruction (hernias, adhesions)
* bacterial overgrowth
* ileus
* electrolyte abnormalities
* critical illness
Nonreversible:
* Structural - scleroderma , IBD , connective tissue dx
* neuropathic - intrinsic + extrinsic NS altered + produce weak contractions >>> n/v, bloating, abd pain
## Footnote
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Large Intestine ::
The colon also exhibits giant _______ complexes
These serve to produce mass _______ across the large intestine
In the healthy state, these complexes occur approximately ______x a day
Migrating
movements
6-10
## Footnote
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79
Large Intestine ::
* Acts as a reservoir for _____ and ______ material before elimination
* extracts remaining ______ and water
* _______ of the ileum will RELAX the _____ valve to allow intestinal contents to enter the colon
* Subsequent _____ distention will CONTRACT the ileocecal valve
waste .. indigestible
electrolytes
Distention ... ileocecal
cecal
## Footnote
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What are the most common diseases associated with Colonic dysmotility?
## Footnote
Large Intestine
* **IBS** (Inflammatory Bowel Syndrome)
* **IBD** (Inflammatory Bowel Disease)
## Footnote
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81
Rome II criteria defines IBS as having abdominal discomfort along with 2 of the following features?
| there are 3 features
* defecation relieves discomfort
* pain is assoc w/abnormal frequency (> 3x per day or < 3x per week)
* pain is associated with a change in the form of the stool
## Footnote
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In IBD, the contractions are suppressed due to colonic wall ____ by the inflamed mucosa, but the giant ____ complexes remain
In IBD, the contractions are suppressed due to colonic wall **compression** by the inflamed mucosa, but the giant **migrating** complexes remain
## Footnote
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The ↑ frequency of the giant migrating complexes and their pressure effect = ↑ compression of inflamed mucosa which can lead to?
* hemorrhage
* thick mucus secretion
* significant erosions
## Footnote
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What is the 2nd most common inflammatory disorder (after RA)?
IBD
Incidence 18:100,000 ppl
## Footnote
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What is a mucosal disease of rectum and part or all of the colon?
Ulcerative Colitis?
## Footnote
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In severe cases of Ulcerative Colitis, what is the condition of the mucosa?
* hemorrhagic
* edematous
* ulcerated
## Footnote
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What are the s/s of Ulcerative Colitis?
* diarrhea
* rectal bleeding
* crampy abdominal pain
* N/V
* fever
* weight loss
## Footnote
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What are the lab results of Ulcerative Colitis?
↑plts
↑erythrocyte sedimentation rate
↓H&H
↓albumin
## Footnote
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What intervention to do after giving 6+ units of blood in 24-48 hours of hemorrhage of Ulcerative Colitis?
**surgical colectomy**
~ ½ cases resolve and ½ require colectomy
## Footnote
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What are 2 primary symptoms that manifests with Colonic dysmotility?
**altered bowel habits**
and/or
**intermittent cramping**
## Footnote
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What is a complication of Ulcerative Colitis triggered by electrolyte disturbances?
Toxic megacolon
## Footnote
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What is a dangerous complication of toxic megacolon?
Colon perforation
## Footnote
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What is acute or chronic inflammatory process that may affect any/all of the bowel?
Crohn's Disease
## Footnote
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Where is the most common site of Cronh's disease?
Terminal ilium
## Footnote
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What does presentation of Cronh's disease?
w/ ileocolitis
w/ RLQ pain
& diarrhea
## Footnote
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What are 2 patterns of Cronh's disease?
* penetrating-fistulous
* obstructing
## Footnote
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What are s/s of Cronh's disease?
* weight loss
* fear of eating
* anorexia
* diarrhea
## Footnote
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What does *persistent inflammation* of Crohn's disease gradually progresses to?
* fibrous narrowing
* stricture formation
## Footnote
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What replaces diarrhea with Cronh's disease progression?
Chronic bowel obstruction
## Footnote
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Colonic disease may ____ into stomach/duodenum, causing fecal ____
Colonic disease may **fistulize** into stomach/duodenum, causing fecal **vomitus**
## Footnote
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What are additional symptoms of 1/3 Cronh's patients?
* arthritis
* dermatitis
* kidney stones
## Footnote
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What are medical treatments of IBD?
* **5-Acetylsalicylic acid (5-ASA)** - for antibacterial & anti-inflammatory
* **PO/IV Glucorticoids** - during flares
* **Antibiotics** - Rifaximin, Flagyl, Cipro
* **Purine analogues**
## Footnote
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What intervention should be the last resort for IBD?
Resection surgery
## Footnote
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What length should small intestestine resection be limited to?
< 1/2 length
Resected segment should be as conservative as possible
## Footnote
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What does > 2/3 of small intestine resection leads to? And what does it require?
“short bowel syndrome"
requiring TPN
## Footnote
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Where do most carcinoid tumors originate from? Where can they occur?
GI tract
occur in any GI tissue/segment
## Footnote
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What kind of products are secreted by Carcinoid tumors?
peptides & vasoactive substances
(gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, serotonin, other biological actives)
## Footnote
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What occurs to 10% of patients with Carcinoid tumors where large amounts of serotonin and vasoactive substances reach systemic circulation?
Carcinoid syndrome
## Footnote
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What are s/s of Carcinoid syndrome?
* flushing
* diarrhea
* HTN/HoTN
* bronchoconstriction
## Footnote
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Effects of Carcinoid sydrome on CV:
May acquire *right heart* endocardial ____
*Left heart* generally more ____ as the lungs clear some of the vasoactive substances
May acquire *right heart* endocardial **fibrosis**
*Left heart* generally more **protected** as the lungs clear some of the vasoactive substances
## Footnote
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How to diagnose Carcinoid syndrome?
* urinary or plasma serotonin levels
* CT/MRI
## Footnote
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What are the treatments for Carcinoid syndrome?
* avoid serotonin-triggers
* control diarrhea
* serotonin antagonists
* somatostatin analogues
## Footnote
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What medication to give before surgery and prior to tumor manipulation of Carcinoid syndrome and why?
Ocreotide
to attenuate volatile hemodynamic change
## Footnote
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What are the secretory characteristics in the Foregut of Carcinoid tumors?
**↓ Serotonin** secretion
secreted **ACTH, 5-HTP, GRF**
**Atypical** Carcinoid syndrome
## Footnote
S38 table
115
What are the secretory characteristics in the Midgut of Carcinoid tumors?
**↑ Serotonin** secretion
secreted **Tachykinins, rarely 5-HTP, ACTH**
**Typical** Carcinoid syndrome
## Footnote
S38 table
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What are the secretory characteristics in the Hindgut of Carcinoid tumors?
**rare** Serotonin secretion
**rarely** 5-HTP, ACTH, other peptides
**rare** Carcinoid syndrome
## Footnote
S38 table
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What are the presentations of Carcinoid Tumors at the Small Intestines?
* Abdominal pain
* Intestinal obstruction
* tumor
* GI bleeding
## Footnote
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What are the presentations of Carcinoid Tumors at the Rectum?
* Bleeding
* constipation
* diarrhea
## Footnote
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What is the presentation of Carcinoid Tumors at the Bronchus?
Asymptomatic
## Footnote
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What is the presentation of Carcinoid Tumors at the Thymus?
Anterior mediastinal mass
## Footnote
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What is the presentation of Carcinoid Tumors at the Ovary and Testicle?
Mass discovered on physical examination or ultrasound
## Footnote
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Where do Carcinoid Tumors metastasize to and what is the presentation?
in the Liver
presents as Hepatomegaly
## Footnote
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How is autodigestion normally prevented to prevent trigger of Pancreatitis?
* Proteases packaged in precursor form
* Protease inhibitors
* Low intra-pancreatic calcium → decreases trypsin activity
## Footnote
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What are the most common causes of Pancreatitis?
1. **Gallstones** - obstruch ampula of vater → pancreatic ductal HTN
2. **Alcohol abuse**
## Footnote
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Pancreatitis is also seen in which 2 disorders?
immunodeficiency syndrome hyperparathyroidism (↑Ca++)
## Footnote
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What are s/s of Acute Pancreatitis?
* excruciating epigastric pain that radiates to back
* N/V
* abd distention
* steatorrhea
* ileus
* fever
* tachycardia
* HoTN
## Footnote
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What are the hallmark labs of Acute Pancreatitis?
↑serum amylase & lipase
## Footnote
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what are some imaging for acute pancreatitis?
contrast CT or MRI, endoscopic US (EUS)
## Footnote
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what are some complications of acute pancreatitis?
25% experience serious complications s/a shock, ARDS, renal failure, necrotic pancreatic abscess
## Footnote
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What are the treatments for Acute Pancreatitis?
* Aggressive IVF
* NPO (to rest pancreas)
* enteral feeding (preferred over TPN)
* opioids
| TPN associated w/greater risk of infectious complications
## Footnote
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what is an ERCP? Interventions include what 4 things?
Fluoroscopic examination of biliary & pancreatic ducts
Interventions include
stone removal
stent placement
sphincterotomy
hemostasis
## Footnote
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which GI bleed is more common? (upper or lower?)
Upper GI bleed
## Footnote
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what vital sign changes will u see w/ >25% blood loss?
hypotension and tachycardia
## Footnote
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what does orthostatic hypotension normally indicate?
HCT <30%
## Footnote
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what does melena indicate?
GI Bleed that is above the cecum!!
(Cecum is where small intestine meets colon)
## Footnote
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why does the BUN go up >40 mg/dL during a GI bleed?
because absorption of nitrogen into bloodstream
## Footnote
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what is the therapeutic procedure of choice and also diagnostic for GI bleeds?
EGD (Esophagogastroduodenoscopy)
for endoscopic ulcer ligation and ligation of bleeding varices
## Footnote
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what is the last resort for uncontrolled variceal bleeding?
Mechanical balloon tamponade
## Footnote
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who usually has lower GI bleeds and what are some causes?
elderly
causes - diverticulosis, tumors, colitis
## Footnote
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What procedure can be performed for Lower GI bleeding as soon as HD stabilizes?
Unprepped sigmoidoscopy
## Footnote
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What procedure can be done for Lower GI bleeding if pt can tolerate prep?
Colonoscopy
## Footnote
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What 2 interventions are warranted if persistent bleeding occurs with Lower Gi bleed?
angiography and embolic therapy
## Footnote
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what is an adynamic ileus?
Colonic ileus characterized by massive dilation of the colon without mechanical obstruction
## Footnote
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what leads to distention of colon?
loss of peristalsis
## Footnote
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what is an adynamic ileus caused by?
electrolyte disorders, immobility, excessive narcotics, anticholinergics
## Footnote
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146
what could be the neural reason for adynamic ileus?
thought to be due to neural-input imbalance of excessive sympathetic stimulation along with inadequate parasympathetic input to the colon
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whats the tx for adynamic ileus?
* Restore e-lyte balance
* hydrate
* mobilize
* NG suction
* enemas
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what med and dose will u give for adynamic ileus?
and what do monitoring do u need if u give it?
neostigmine 2-2.5 mg over 5 min
- produces immediate results 80-90%
- CARDIAC MONITORING REQUIRED
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what happens if u leave an adynamic ileus untreated?
ischemia and perforation!
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what is inhibition GI activity directly proportional to?
amount of norepinephrine secreted from SNS stimulation, so the **higher anxiety = higher inhibition**
## Footnote
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151
what do volatiles do to the GI system?
**depress the spontaneous, electrical, contractile, and propulsive activity** in the stomach, small intestine, and colon
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whats the process of recovery of GI system?
1. small intestine --> **first part of GI tract to recover**
2. followed by stomach in approx 24 hrs
3. then, colon 30-40 hours post-op
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what is important about nitrous oxide and gas containing cavities?
* N2O is 30x more soluble than nitrogen in blood
* will d**iffuse into gas-containing cavities from the blood faster than the nitrogen can diffuse out**
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do NMBs affect GI motility?
No, NMBs only affect skeletal muscle, so GI motility remains intact
## Footnote
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when should N2O be avoided?
in lengthy abdominal surgeries or when the bowel is already distended
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what does gut distention correlate to?
* pre-existing amount of gas in the bowel
* **duration** of nitrous oxide administration
* **concentration** of nitrous oxide administered
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what will neostigmine (AChE-I) cause w/ GI system?
what will offsets the cholinergic activity of neostigmine?
increase PNS activity and bowel peristalsis by increasing the frequency & intensity of contractions
- concurrent admin of anticholinergics (glycopyrrolate or atropine)
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What is sugammadex's effects on motility?
NONE, Sugammadex does not appear to have any effect on motility
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159
What is known to cause reduced GI motility and constipation?
How?
Opioids
by exerting their function on **both** central & peripheral mu, delta, and kappa receptors
* and there's a high density of peripheral mu-opioid receptors in the myenteric and submucosal plexuses!!!
* **Activation of the mu-receptors causes delayed gastric emptying and slower transit through the intestine**!!!
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what are some adverse events w/ opioids and the GI system?
* nausea
* anorexia
* delayed digestion
* abdominal pain
* excessive straining during bowel movements
* incomplete evacuation
## Footnote
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161
what are the 5 main functions of the GI tract?
* motility
* digestion
* absorption
* excretion
* circulation
## Footnote
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162
name the layers of GI tract wall from outermost to innermost
outermost to innermost
1. serosa
2. longitudinal muscle
3. circular muscle
4. submucosa
5. mucosa
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name the layers of the mucosa from **outer to inner**
1. muscularis mucosae
2. lamina propria
3. epithelium
## Footnote
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164
how do the SNS and PNS act on the GI motility?
The extrinsic nervous system consists of:
SNS --> primarily inhibitory
PNS --> primarily excitatory on GI tract motility
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what does the enteric nervous system control?
motility, secretion, and blood flow
## Footnote
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166
what are the 2 primary movements w/in and along the GI tract?
mixing and propulsive movements
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What can hemodynamic changes, bowel manipulation and open abdominal surgeries induce?
ileus, inflammatory states, mesenteric ischemia, and partial or total disruption of myogenic continuity
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