Gastrointestinal Assessment

Question 1

GI system constitutes approx how much of total body mass?

Answer 1

5%

Question 2

5 main functions of the GI system

Answer 2

Motility, digestion, absoprtion, excretion, circulation

Question 3

Outermost layer of the GI system

Answer 3

Serosa

Question 4

Inner most layer of the GI system

Answer 4

Mucosa

Question 5

What muslce contracts in the gi system to shorten the length of the intestional segment?

Answer 5

Longitudinal Layer

Question 6

What muscle contracts to decrease the diameter of the intestinal lumen?

Answer 6

Circular Muscle Layer

Question 7

Reguarding GI nerve innervation, which nerve inervates GI organs up to the proximal transverse colon

Answer 7

Celiac Plexus

Question 8

What nerve innervates the descending colon and distal GI tract?

Answer 8

Hypogastric plexus

Question 9

What 4 appraoches can block the celiac plexus?

Answer 9

Transcural
Intraoperative
Endoscopic ultrasound guided
Peritoneal Lavage

Question 10

Which plexus lies below smooth muslce and regulates smooth muscle?

Answer 10

Myenteric Plexus

Question 11

Which plexus transmits info from the epithelium to the enteric and CNS

Answer 11

Submucosal Plexus

Question 12

Which part of the mucosa functions to move the villi?

Answer 12

The muscularis mucosa

Question 13

Which later of the mucosa contains of the blood vessels and nerve endings?

Answer 13

Lamina Propria

Question 14

What layer of the mucosa senses gi contents, secretes enzymes, and absorbs nutrients?

Answer 14

Epithelium

Question 15

Which nervous system innervates the GI tract?

Answer 15

Autonomic

Question 16

The GI ANS consist of 2 types of nervous system subtypes

Answer 16

-Extrinsic nervous system
-Enteric Nervous sytem

Question 17

The extrinsic nervous system of the GI has what two components?

Answer 17

SNS, PNS

Question 18

Extrinsic SNS is primarily what?

Answer 18

Inhibitory; decreases gi motility

Question 19

Extrinsic PNS is

Answer 19

Primarily excitatory; activates gi motility

Question 20

Enteric nervous system of the gi trat does what?

Answer 20

independent; controls motility, secretions, blood flow

Question 21

Enteric nervous sytem consists of what two plexus?

Answer 21

Myenteric plexus
Submucosal plexus

Question 22

What specific plexus of the enteric nervous system controls motility specifically the GI pacemaker cells

Answer 22

Myenteric plexus

Question 23

Which plexus of the enteric nervous system controls absorption, secretion, and mucosal blood flow

Answer 23

Submucosal plexus

Question 24

Do the two plexus’ of the enteric nervous system respond to parasypathetic or sympathetic stimulation?

Answer 24

Respond to both

Question 25

Which scope procedure threads a scope through the persons mouth to view the stomach, pylorus, esophagus, and duodenum?

Answer 25

Upper gastrointestinal Endoscopy

Question 26

what are the challeneges with an upper gi endoscopy?

Answer 26

Sharing the airway with endoscopist - most closlely monitor airway perfomed outside of main OR

Question 27

Which gi study looks at the lower portion of the gi system?

Answer 27

Colonoscopy

Question 28

Can colonoscopy be done without anestheisa?

Answer 28

yes

Question 29

Challenges for anesthesia during a colonoscopy

Answer 29

pt dehydrated

Question 30

which test measures pressures along the entire esophageal tract?

Answer 30

HRM: High resolution manometry

Question 31

Which GI procedure assesses swallowing function?

Answer 31

gi with barium series

Question 32

Which gi study uses a radiotracer to assess the emptying effect of the stomach?

Answer 32

Gastric emptying study

Question 33

How long does a pt fast before a gastric emptying study?

Answer 33

4 hours

Question 34

Does the pt eat before a gastic emptying study?

Answer 34

fast for 4 hours first then eats meal with radiotracer

Question 35

Which test measures contraction pressures of small intestine?

Answer 35

Small intestine manometry

Question 36

Which gi test uses a barium enema to assess the detection of colon/rectal abnormalities

Answer 36

Lower gi series

Question 37

Esophageal diseases are grouped into what 3 categories

Answer 37

anatomical mechanical neurologic

Question 38

Anatomical esophageal disease consist of

Answer 38

diverticula, hiatal hernia, chroinc acid reflux changes

Question 39

Mechanical Esophageal disease

Answer 39

achalasia, esophageal spasams, hypertensive les

Question 40

3 most common symptoms of esophageal disease

Answer 40

dysphagia, heartburn, GERD

Question 41

what dysphagia is common after head and neck surgeries

Answer 41

Oropharyngeal

Question 42

Mechanical dysphagia occurs only with

Answer 42

solid foods

Question 43

Esophageal dysphagia occurs with

Answer 43

both liquids and solids

Question 44

Neuromuscular disorder that creates outflow obstruciton

Answer 44

Achalasia

Question 45

What is achalasia caused by?

Answer 45

Due to inadequate LES tone

Question 46

What cells are lost in achalasia ?

Answer 46

Ganglionic cells

Question 47

Which type of achalasia has the worst outcomes?

Answer 47

Type 3

Question 48

Which type of achalasia responds well to myotome

Answer 48

Type 1

Question 49

Which esophageal disease only has palliative treatments

Answer 49

Achlasia

Question 50

Best surgical tx for achalasia

Answer 50

Laparoscopic Hellar myotomy

Question 51

Most effective nonsurgical tx for achalasia

Answer 51

Pneumatic dilation

Question 52

Which procedure reguarding achalasia will cause 40% of people to develop a pneumothorax or pnumoperitoneum

Answer 52

POEM: Peri-oral endoscopic myotomy

Question 53

Treatment for Esophageal spasms

Answer 53

NTG, antidepressants, PD'I's

Question 54

What is called outpouchings in the wall of the esophagus?

Answer 54

Esophageal Diverticula

Question 55

Which type of esophageal diverticula has bad breath?

Answer 55

Pharyngoesphageal (zenker)

Question 56

Regarding anesthesia technique, what is indicated in all esophageal diverticula patients

Answer 56

RSI indicated; all are aspiration risks

Question 57

Herniation of stomach into the thoraic cavity

Answer 57

Hiatal hernia

Question 58

What is the prevelance of esophageal cancer

Answer 58

4-5/100,000 people

Question 59

Most common place of metastisis of esophageal cancer

Answer 59

Lymph nodes

Question 60

What do esophgeal pts usually present with

Answer 60

progressive weightloss and dysphagia

Question 61

What is the common tumor type in esophageal cancer

Answer 61

Adenocarcinomas; squamos cell is second most common

Question 62

Esophageal cancer tx

Answer 62

Esophagectomy

Question 63

What are pts at high risk of post esophagectomy

Answer 63

recurrent laryngeal nerve injury

Question 64

GERD occurs in what percent of adults

Answer 64

15%

Question 65

What two conditions are associated with GERD

Answer 65

Barrets metaplasia, adenocarcinoma

Question 66

Treatment for GERD

Answer 66

Antacids, h2 blockers, PPI's

Question 67

Preop anesthesia intervetions for GERD

Answer 67

-Cimetidine, Ranitidine Decreases acid secretion and increases PH -PPI night before Sodium Citrate Metoclopramide

Question 68

Are GERD pts high risk for aspiration?

Answer 68

Yes; RSI indicated

Question 69

Factors that increase INTRAOP aspiration risk

Answer 69

Question 70

What nerve is stimuatled by the PNS to increase stomach contractions and the force of them

Answer 70

Vagus nerve

Question 71

SNS stimulation of what nerve inhibits stomach contrations

Answer 71

Splanchnic nerve

Question 72

Most common cause of non variceal upper gi bleed

Answer 72

Peptic ulcers

Question 73

What bacteria is associated with peptic ulcer disease

Answer 73

Heliobacter Pylori

Question 74

Peptic ulcer disease epigastic pain is improved with

Answer 74

meals

Question 75

Mortality of peptic ulcer is due to

Answer 75

Shock, or perforation > 48 hours

Question 76

Pyloric Obstruction treatment

Answer 76

NGT, hydration, resolves in 73 hours

Question 77

H. Pylori tx in gastric ulcers

Answer 77

Tripple therapy, 2 abx + PPI x 14 days

Question 78

What condition is characterized by excess gastric secretion

Answer 78

Zollinger Ellison Syndrome

Question 79

What causes hypersection of gastrin in Zollinger Ellison

Answer 79

Non b cell pancreatic tumor (gastrinoma?

Question 80

Preop treatment for Zollinger Ellsion syndrome

Answer 80

Correct electrolytes, increase gastric PH, RSI

Question 81

Main function of small intestine

Answer 81

Expose contents to mucosal wall for absoprtion

Question 82

What organ acts as a reservoir for waste and indigestibe material before elimination

Answer 82

Large intestine

Question 83

How many times a day do the migrating complexes of the large intestine occur

Answer 83

6-10x a day

Question 84

Most common diseases associated with the large intestine

Answer 84

IBS, IBD

Question 85

Second most common inflammatory disease

Answer 85

IBD

Question 86

Subtype of IBD that causes inflammation fo the mucosal layer of the colon

Answer 86

Ulcerative colitis

Question 87

What condition in ulcerative colitis is triggered by electrolyte disturbances and can require a colectomy

Answer 87

Toxic mega colon

Question 88

Acute or chronic inflammatory disease that can affect all of the bowl

Answer 88

Crohns disease

Question 89

Most common site of chrons disease

Answer 89

Terminal ilium, present with ileocolitis; RUQ pain

Question 90

Which IBD causes fibrous narrowing and stricture

Answer 90

Chrons disease

Question 91

Main medial treatment for IBD

Answer 91

5-acetylsalicylic acid

Question 92

Which syndrome caused by carcinoid tumors leads to inreased amounts of serotoin and vasoactive substances

Answer 92

Carcinoid Syndrome

Question 92

What do you give a pt before surgery with carcinoid tumors to attenuate volatile hemodynamic changes

Answer 92

Octreotide

Question 93

Most common causes of pancreatitis

Answer 93

Gallstones and alcohol abuse (60-80%)

Question 94

s/s of Acute pancreatitis

Answer 94

excrucitating epigastric pain that radiates to back with n/v, fever, achy, HTN

Question 95

Serum amylase and lipase are eleveated in what condition

Answer 95

Acute pancreatitis

Question 96

Treatment for Acute pancreatitis

Answer 96

FLUIDS, NPO, enteral feeding, ERCP to remove gallstone

Question 97

Which gi bleed is more common

Answer 97

Upper gi bleed

Question 98

greater than what percent blood loss in GI bleeds will lead to HTN and tachycardia

Answer 98

>25%

Question 99

What lab is usually elevated in upper gi bleed

Answer 99

BUN>40 mg/dL

Question 100

Tx of choice for upper GI bleeding

Answer 100

EGD, ulcer ligation

Question 101

What is the last-resort treatment for uncontrolled variceal bleeding

Answer 101

Mechanical baloon tamponade

Question 102

What type of bleeding generally occurs in the elderly

Answer 102

Lower gi bleed

Question 103

Diagnosis of lower gi bleeding by

Answer 103

Sigmoidoscopy

Question 104

What medicine can we give for ileus?

Answer 104

Neostigmine 2-2.5 mg over 5 minutes - results in 80-90% of pts - monitor cardiac status post neogstigmine

Question 105

what describes an ilues

Answer 105

Massive dialtion of colon WITHOUT MECHANICAL OBSTRUCTION

Question 106

How do volatiles affect the gi system

Answer 106

depress electrical, contractile, and gi activity

Question 107

Which part of the gi system is first to recover post anesthesia

Answer 107

small intestine

Question 108

What is the last part of the gi system to recover post anesthesia

Answer 108

Colon (30-40 hours) after

Question 109

What gas should be avoided in gi surgeries due to its solubility

Answer 109

Nitrous oxide

Question 110

What receptor is located in the myenteric and submucosal plexus that leads to delayed gastric emptying post opoids

Answer 110

Mu

Question 111

Which medicaiton is often given to increase PNS and gi peristalisis

Answer 111

Neostigmine

Question 112

What medication is often given with neostigmine to counteract bradycardia

Answer 112

Glycopyrrolaten or atropine