Exam 4 GI Assessment Part 1 Flashcards
(82 cards)
1
Q
The GI tract constitutes approximately ____% of the total human body mass
A
5%
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2
Q
what are the main functions of the GI system?
A
- motility
- digestion
- absorption
- excretion
- circulation
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3
Q
what are the layers of the GI tract from outer most to inner most?
A
the serosa, longitudinal muscle layer, circular muscle layer, submucosa, and mucosa
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4
Q
within the mucose (outermost to innermost) is what 3 things?
A
- muscularis mucosae
- lamina propria
- epithelium
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5
Q
The ____ is a smooth membrane of thin connective tissue and cells that secrete serous fluid to enclose the cavity and reduce friction between muscle movements
A
serosa
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6
Q
The ____ muscle layer contracts to shorten the length of the intestinal segment
A
longitudinal
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7
Q
The ____ muscle layer contracts to decrease the diameter of the intestinal lumen
A
circular
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8
Q
what 2 layers work together to propagate gut motlility?
A
longitudinal muscle layer and circular muscle layer
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9
Q
Innervation of the GI organs up to the proximal transverse colon is supplied bythe ____.
A
celiacplexus
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10
Q
Innervation of the descending colon and distal GI tract comes from the inferior____.
A
hypogastricplexus
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11
Q
what different approaches can be used to block the celiac plexus?
A
- Transcrural
- Intraoperative
- endoscopic ultrasound-guided
- peritoneallavage
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12
Q
The____lies btwthe smooth muscle layers and regulatesthesmoothmuscle
A
myenteric plexus
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13
Q
The____ transmits information from the epithelium to the entericand central nervoussystems
A
submucosal plexus
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14
Q
what is the mucosa composed of?
A
- muscularis mucosa
- lamina propria
- immune and inflammatory cells
- epithelium
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15
Q
what is the muscularis mucosa and what does it do?
A
a thin layer of smooth muscle which functions to move the vili
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16
Q
what does the lamina propria contain?
A
blood vessels and nerve endings
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17
Q
what happens in the epithelium?
A
- Gi contents are sensed
- enzymes are secreted
- nutrients are absorbed
- waste is excreted
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18
Q
what is the GI tract innervated by?
A
autonomic nervous system
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19
Q
what does the GI ANS consist of?
A
- extrinisic nervous system
- enteric nervous system
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20
Q
what are the components of the GI ANS extrinsic nervous system and how do they effect GI motility?
A
- has SNS and PNS components)
- The extrinsic SNS is primarily inhibitory anddecreases GI motility
- The extrinsic PNS is primarily excitatory and activates GI motility
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21
Q
____ is the independent nervous system, which controls motility, secretion, and blood flow
A
enteric nervous system
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22
Q
what is the enteric system comprised of?
A
myenteric plexus and submucosal plexus
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23
Q
how does the myenteric plexus control motility?
A
carried out by enteric neurons,interstitial cells of Cajal (aka ICC cells, GI pacemakers), andsmooth musclecells
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24
Q
the myenteric plexus and submucosal plexus respont to what kind of stimulation?
A
sympathetic and parasympatheticstimulation
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25
* This procedure may be diagnostic or therapeutic.
* It is performed by endoscope placed into esophagus, stomach, pylorus, and duodenum
* May be done with or w/o anesthesia but has anesthesia challenges of sharing airway with endoscopist and/or procedure performed outside of the main OR
Upper Gastrointestinal Endoscopy:
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* This procedure may be diagnostic or therapeutic/interventional
* May be done with or w/o anesthesia and has anesthesia challenges of pt dehydration d/t bowel prep & NPO status
Colonoscopy:
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this procedure is where a pressure catheter measures pressures along entire esophageal length and is generally used to dx motility disorders
High Resolution Manometry (HRM)
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what procedure uses radiologic assessment of swallowing function and GI transit
GI series with ingested barium
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What procedure has patient fasts for at least 4 hours, then consumes a meal with a radiotracer. Continuous or frequent imaging occurs for the next 1-2 hrs
Gastric emptying study
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* This procedure uses a catheter to measure contraction pressures and motility of the small intestine
* evaluates contractions during three periods: fasting, during a meal, and post-prandial.
* Normally the recording time consists of 4 hrs fasting, followed by ingestion of a meal, and 2 hrs post-meal
* Abnormal results are grouped into myopathic and/or neuropathic causes
Small intestine manometry
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This procedure involves the administration of a barium enema to a patient. The barium outlines the intestines and it is visible on radiograph. This allows for detection of colon and rectal anatomical abnormalities
lower GI series
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diseases of the esophagus are grouped into:
* Anatomical
* Mechanical
* Neurologic
*although many disease states overlap*
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Anatomical causes of esophageal disease include:
* diverticula
* hiatal hernia
* change assoc w/ chronic acid reflux.
*These abnormalities interrupt the normal pathway of food, which changes the pressure zones of the esophagus*
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mechanical causes of esophageal disease include:
* achalasia
* esophageal spasms
* hypertensive LES
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neurologic causes of esophageal disease include:
caused by neurologic disorders such as:
* stroke
* vagotomy
* hormone deficiencies
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36
what are the most common symptoms of esophageal disease?
* dysphagia
* heartburn
* GERD
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37
what is dysphagia and what are the differnt types?
* difficulty swallowing
* orpharyngeal or esophageal
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38
when is oropharryngeal dysphagia commonly seen?
after head and neck surgeries
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39
what are the 2 different types of esophageal dysphasia?
Classified based on physiology
* **Esophageal dysmotility**: sx occur w/ both liquids & solids
* **Mechanical esophageal dysphasia**: sx only occur w/solid food
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what is gastroesophageal reflux disease (GERD), and what is normal s/s?
* effortless return of gastric contents into pharynx d/t Incompetence of the gastro-esophageal junction, leading to reflux
* S/S: Heartburn, nausea, “lump in throat”, dysphagia, and mucosal injury
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41
what is achalasia?
neuromuscular disorder of the esophagus consisting of an outflow obstruction d/t inadequate LES tone and a dilated hypomobile esophagus
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what are the causes of achalasia?
* Theoretically c/b loss of ganglionic cells of the esophageal myenteric plexus
* Followed by absence of inhibitory neurotransmitters of the LES
* Unopposed cholinergic LES stimulation (LES can't relax)
* Esophageal dilation with food unable to pass into stomach
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s/s of achalasia?
* dysphagia
* regurgitation
* heartburn
* chest pain
*Long term increased rx of esophageal cancer*
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how is achalasia diagnosed?
w/esophageal manometry and/or esophagram
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what are the 3 classes of achalasia?
* 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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what is the treatment for achalasia?
* **all treatments are palliative**
* Medications
* Endoscopic botox injections
* Pneumatic dilation
* Laparoscopic Hellar Myotomy
* Peri-oral endoscopic myotomy (POEM)
* Esophagectomy
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why would we do RSI or awake intubation with pts who have achlasia?
increased risk for aspiration
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what medications can be used for achalasia?
nitrates & CCBs to relax LES
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whats the most effective nonsurgical treatment for achalasia?
Pneumatic dilation
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what is the best surgical treatment for achalasia?
Laparoscopic Hellar Myotomy
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* What is peri-oral endoscopic myotomy (POEM)?
* how many pt develop pneumothorax or pneumoperitoneum?
* endoscopic division of LES muscle layers
* 40% develop pneumothorax or pneumoperitoneum
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when is esophagectomy considered for achalasia?
only considered in the most advanced dz states
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53
* what is diffuse esophageal spasms?
* most common in?
* diagnosed with?
* pain mimics ____.
* treatment?
* Spasms that usually occur in distal esophagus; likely d/t autonomic dysfunction
* More common in elderly
* Dx on esophagram
* Pain mimics angina
* Tx: NTG, antidepressants, PD-I's
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what is esophageal diverticula?
outpouchings in the wall of the esophagus
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what type of esophageal diverticula has bad breath d/t food retention
Pharyngoesophageal (Zenker diverticulum)
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what type of esophageal diverticula may be caused by old adhesions or inflamed lymph nodes
Midesophageal:
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what type of esophageal diverticula have pts that may experience achalasia
Epiphrenic (supradiaphragmatic)
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for esophageal diverticula all are aspiration risk so what should we do?
removal of particles and RSI indicated
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59
* What is hital hernia?
* What is it caused by?
* may be ____
* often associated with ____
* Herniation of stomach into thoracic cavity, occurs through the esophageal hiatus in the diaphragm
* c/b weakening in anchors of GE junction to the diaphragm
* May be asymptomatic
* often associated with GERD
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60
this happens in 4-5 out of 100,000 people in US
esophageal cancer
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61
# Esophageal Cancer
* Presents w/
* Poor survival rate bc
* Most are adenocarcinomas, located in ____.
* ____ accounts for the rest of esophageal cancers
* progressive dysphagia and weight loss
* abundant lymphatics leads to lymph node metastasis
* lower esophagus
* Squamous cell carcinoma
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* These are r/t GERD, Barretts, Obesity
adenocarcinomas located in the lower esophagus
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what can be curative or palliative for esophageal cancer?
* esophagectomy and may be performed transthoracic, transhiatal, or minimally invasive
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____ has a high risk of recurrent laryngeal nerve injury; of which ____% resolve spontaneously.
* esophagectomy
* 40%
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things to keep in mind for pts recieving esophgectomies for cancer
* Pts often malnourished preop, and many months after
* If h/o chemo/radiation -pancytopenia & dehydration may present
* Post-esophagectomy pts are very high aspiration risk for life
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66
GERD occurs in ____% of adults.
15
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in GERD reflux contents include
* HCL
* pepsin
* pancreatic enzymes
* bile
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68
bile reflux in GERD is associated with ____ and ____.
Barrett metaplasia & adenocarcinoma
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69
3 mechanisms of GE incompetence
1. Transient LES relaxation, elicited by gastric distention
2. LES hypotension
3. Autonomic dysfunction of GE junction
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70
* normal LES pressure:
* avg GERD pressure:
* 29 mmhg
* 13 mmhg
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treatment for GERD
* avoidance of trigger foods
* **Meds**: Antacids, H2 blockers, PPIs
* **Surgery**: Nissen Fundoplication, Toupet, LINX
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Preop interventions for GERD
* Cimetidine & Ranitidine-↓acid secretion & ↑pH
* PPI’s generally given night before and morning of
* Sodium Citrate- PO nonparticulate antacid
* Metoclopramide- gastrokinetic; often reserved for diabetics, obese, pregnant
* Aspiration precautions!
* RSI indicated. Cricoid pressure has become controversial
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what factors increase intraoperative risk of aspiration?
* Emergent surgery
* Full Stomach
* Difficult airway
* Inadequate anesthesia depth
* Lithotomy
* Autonomic Neuropathy
* Gastroparesis
* DM
* Pregnancy
* ↑ Intraabdominal pressure
* Severe Illness
* Morbid Obesity
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74
the stomach is a____ sac that serves as a reservoir for large volumes of food, mixes and breaks down food to form ____, and slows emptying into the ____.
* J-shaped
* chyme
* small intestine
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75
Solids must be broken down into ____ particles before entering the duodenum
1-2 mm
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76
The motility of the stomach is controlled by?
intrinsic and extrinsic neural regulation
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77
* ____ stimulation to the vagus nerve increases the number and force of contractions
* ____ stimulation inhibits these contractions via the splanchnic nerve
* The ____ nervous system provides coordination for motility
* Parasympathetic
* Sympathetic
* intrinsic
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78
Neurohormonal control also occurs with:
* gastrin & motilin which does ....?
* and gastric inhibitory peptide does...?
* increase the strength and frequency of contractions
* inhibits contractions
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79
# What disease is this?
* Most common cause of non-variceal upper GI bleeding
* Lifetime prevalence= 10% women, 12% men
* 15,000 death per year
* may be associated with Helicobacter Pylori
peptic ulcer disease
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80
s/s of peptic ulcer disease
burning epigastric pain exacerbated w/fasting and improved w/meals
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81
# Peptic Ulcer Disease
* ____% risk of perforation in those who do not receive treatment
* Perforation s/s?
* Mortality is d/t shock or perforation >____h
* 10%
* sudden/severe epigastric pain c/b acidic secretions into peritoneum
* 48H
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82
The submucosal plexus controls what?
* absorption
* secretion
* mucosal blood flow
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