Gastrointestinal (Exam 4) Flashcards
(165 cards)
1
Q
What percentage of total body mass does the GI Tract constitute?
A
5%
2
Q
What are the main functions of the GI system?
A
Motility
Digestion
Absorption
Excretion
Circulation
3
Q
What are the layers of the GI tract (Outer to Inner)?
A
Serosa
Longitudinal Muscle Layer
Circular Muscle Layer
Submucosa
Mucosa
4
Q
What are the layers of the Mucosa (Outer to Inner)?
A
Muscularis mucosae
Lamina Propria
Epithelium
5
Q
What is the Serosa and its function?
A
Smooth membrane of connective tissue.
Secretes serous fluid to enclose the cavity and reduce friction between muscle movements
6
Q
What does the longitudinal muscle layer do?
A
Contracts to shorten the length of the intestinal segment.
7
Q
What does the circular muscle layer do?
A
Contracts to decrease the diameter of the intestinal lumen.
8
Q
What do the longitudinal and circular muscle layer do together?
A
Propagate gut motility
9
Q
Innervation of the GI organs up to the proximal transverse colon is supplied by what?
A
Celiac Plexus
10
Q
Innervation of the descending colon and distal GI tract is supplied by what?
A
Inferior Hypogastric Plexus
11
Q
The Celiac Plexus can be blocked by which four techniques?
A
Transcrural
Intraoperative
Endoscopic US-guided
Peritoneal Lavage
12
Q
The Mesenteric (Myenteric) Plexus lies between what two layers?
A
Longitudinal and Circular muscle
13
Q
What is the function of the Mesenteric (Myenteric) Plexus?
A
Regulate the smooth muscle
14
Q
What is another name for the Mesenteric (Myenteric) Plexus?
A
Auerbach’s Plexus
15
Q
What is the function of the Submucosal (Meissner’s) Plexus?
A
Transmit information from the epithelium to the enteric and central nervous system
16
Q
What is the function of the Muscularis Mucosae?
A
Layer of smooth muscle that moves the villi
17
Q
The lamina propria contains what?
A
Blood vessels
Nerve endings
18
Q
What type of cells are located in the mucosa?
A
Immune cells
Inflammatory cells
19
Q
What happens in the epithelium?
A
GI contents are sensed
Enzymes are excreted
Nutrients absorbed
Waste excreted
20
Q
The GI tract is innervated by what system?
A
Autonomic Nervous System
21
Q
The GI ANS consists of what two systems?
A
Extrinsic Nervous System
Enteric Nervous System
22
Q
T/F
The Extrinsic Nervous System has SNS and PNS components?
A
True
23
Q
What is the function of the Extrinsic SNS?
A
To inhibit and decrease GI motility
24
Q
What is the function of the Extrinsic PNS?
A
To excite and activate GI motility
25
What is the function of the Enteric Nervous System?
Independent system that controls:
Motility
Secretion
Blood flow
26
The Enteric System is composed of what two plexus?
Myenteric Plexus
Submucosal Plexus
27
The Myenteric Plexus controls motility via what three things?
Enteric Neurons
Interstitial Cells of Cajal
Smooth Muscle Cells
28
The Submucosal Plexus controls what three things?
Absorption
Secretion
Mucosal Blood Flow
29
Does the Enteric System Respond to sympathetic and parasympathetic stimulation?
Yes
30
Upper Gastrointestinal Endoscopy can be used to observe what four areas?
Esophagus
Stomach
Pylorus
Duodenum
31
What anesthesia challenges are present with a UGE?
Sharing the airway with an endoscopist
Procedure typically not done in an OR
32
What anesthesia challenges are present with a colonoscopy?
Dehydration from bowel prep
Dehydration from being NPO
33
What is a High-resolution Manometry (HRM)?
A pressure catheter that measures pressures along the entire esophageal length
34
What is an HRM used for?
Diagnosis of Motility Disorders
35
What is a GI series with ingested Barium used for?
Assessing swallowing function and GI transit
36
How long does a patient fast for a Gastric Emptying Study?
4 hours
37
With Small Intestine Manometry, contractions are being observed during what 3 periods?
Fasting (4hrs)
During a meal
Post-prandial (2 hrs post)
38
How is a Lower GI series performed?
Via barium enema
39
What is a Lower GI series used for?
Detection of colon and rectal anatomical abnormalities
40
Diseases of the esophagus are divided into what 3 categories?
Anatomical
Mechanical
Neurologic
41
What abnormalities are considered anatomical in nature?
Diverticula
Hiatal Hernia
Changes w/chronic acid reflux
42
What abnormalities are considered mechanical?
Achalasia
Esophageal Spasms
Hypertensive LES
43
What can cause neurologic GI diseases?
Stroke
Vagotomy
Hormone Deficiencies
44
What are the 3 common symptoms of esophageal disease?
Dysphagia
Heartburn
GERD
45
What is dysphagia?
Difficulty swallowing
46
What can lead to oropharyngeal dysphagia?
Head and neck surgery
47
Esophageal dysmotility relates to trouble with swallowing what?
liquid AND solid foods
48
Mechanical esophageal dysphagia has trouble swallowing what?
solid food
49
What is Achalasia?
Disorder of the esophagus consisting of an outflow obstruction d/t inadequate LES tone and a dilated hypo-mobile esophagus
50
What symptoms are present with Achalasia?
Dysphagia
Regurgitation
Heart burn
Chest pain
51
Long-term Achalasia puts you at risk for what condition?
Esophageal cancer
52
How is Achalasia diagnosed?
Esophageal manometry
Esophagram
53
Achalasia is divided into how many classes?
Three
54
What occurs with Type I Achalasia?
Minimal esophageal pressure
Responds well to myotomy
55
What occurs with Type II Achalasia?
How are the outcomes?
Entire esophagus is pressurized
Responds well to treatment, has the best outcomes
56
What occurs with Type III Achalasia?
How are the outcomes?
Esophageal spams with premature contractions
Has worst outcomes
57
What medications are used to treat Achalasia?
Nitrates and CCBs to relax the LES
58
What type of injection can be given for Achalasia?
Endoscopic botox
59
What is the most EFFECTIVE treatment for Achalasia?
Pneumatic dilation
60
What is the BEST SURGICAL treatment for Achalasia?
Laparoscopic Hellar Myotomy
61
What other type of Myotomy can be used for Achalasia?
Peri-oral endoscopic myotomy (POEM)
62
What is POEM?
What complications can develop?
Endoscopic division of LES muscle layers
40% chance of pneumothorax or pneumoperitoneum
63
When would an esophagectomy be considered for Achalasia?
Last-ditch in advanced disease state
64
What type of intubation technique would be best for Achalasia patients?
Why?
RSI or awake intubation
high risk for aspiration
65
What is Diffuse Esophageal Spasm?
Spasm of the distal esophagus
66
What causes Diffuse Esophageal Spasm
Autonomic dysfunction
67
Who is most prone to Diffuse Esophageal spasm?
Elderly patients
68
How do you diagnose Diffuse Esophageal spasm?
Esophagram
69
Diffuse Esophageal Spasm pain mimics what condition?
Angina
70
How do you treat Diffuse Esophageal Spasm?
NTG
Antidepressants
PDE-I's
71
What is Esophageal Diverticula?
Outpouching in the wall of the esophagus
72
How many different types of diverticula are there?
Three
73
What symptom can occur with Pharyngoesophageal or Zenker diverticulum?
Bad breath (d/t food retention)
74
What can cause Midesophageal Diverticulum?
Old adhesions or inflamed lymph nodes
75
What can cause Epiphrenic or Supradiaphragmatic diverticulum?
Achalasia
76
Are patients with any of the 3 diverticula aspiration risks?
Yes; remove the particles and perform RSI
77
What is a hiatal hernia?
What causes it?
What symptoms can occur?
Herniation of the stomach into the thoracic cavity
Weakening anchors of GE junctions to the diaphragm
Can be asymptomatic or have GERD like symptoms
78
Esophageal Cancer affects how many people in the US?
4-5 out of 100,000
79
What two cancers cause Esophageal Cancers?
Adenocarcinoma ( r/t GERD, Barretts, Obesity)
Squamous Cell Carcinoma
80
What surgical option is available for Esophageal Cancer?
Esophagectomy
81
What risk come with an esophagectomy?
Recurrent laryngeal nerve injury
82
What considerations must we be aware of with Esophageal Cancer patients?
Malnourishment pre/post-op
Pancytopenia
Dehydration
High aspiration risk
83
What is GERD?
What symptoms are present?
Gastro-esophageal reflux disease
Heartburn, dysphagia, mucosal injury
84
GERD occurs in what percentage of the population?
15%
85
What are the contents of GERD reflux?
HCL
Pepsin
Pancreatic enzymes
Bile
86
Bile reflux is associated with what 2 conditions?
Barrett metaplasia
Adenocarcinoma (worst)
87
What's a normal LES pressure?
29 mmHg
88
What is the average LES pressure with GERD?
13 mmHg
89
What are the treatments for GERD?
Avoid trigger foods
Antacids, H2 Blockers, PPIs
Toupet procedure
LINX
Nissen procedure (severe)
90
What are the pre-op considerations for GERD?
Cimetidine, Ranitidine
PPIs night before
PPIs morning of
Sodium Citrate (OB pts)
Metoclopramide (DM, OB)
Aspiration precautions
91
What are the discussed 12 factors that increase intra-op aspiration risk?
Emergent surgery
Full stomach
Difficult airway
Inadequate anesthesia
Lithotomy
Autonomic Neuropathy
Gastroparesis
DM
Pregnancy
Inc Intraa-abd pressure
Severe illness
Morbid obesity
92
The stomach breaks down food to form what compound?
Chyme
93
Food must be broken down to what size before entering the duodenum?
1-2 mm
94
Parasympathetic stimulation of the Vagus nerve causes what in the stomach?
Increase number and force of contractions
95
Sympathetic stimulation of the stomach does what?
inhibits contractions via the Splanchnic Nerve
96
What two compounds increase the strength and frequency of contractions in the stomach?
Gastrin
Motilin
97
What compound inhibits contractions in the stomach?
Gastric inhibitory peptide
98
What is the most common cause of non-variceal upper GI bleed?
Peptic Ulcer Disease
99
What's the prevalence of PUD in males and females?
12% men
10% women
100
What bacteria is PUD often associated with?
H. Pylori
101
What symptoms occur with PUD?
What improves symptoms?
epigastric pain w/fasting
Eating
102
What is the risk of perforation if PUD isn't treated?
10%
Mortality increases >48h post-shock or perforation
103
What causes Gastric Outlet Obstruction?
Edema and inflammation in the pyloric channel at the beginning of the duodenum
104
What signs occur with pyloric obstruction?
Recurrent vomiting
Dehydration
*Hyperchloremic Alkalosis
105
How do you treat Gastric Outlet Obstruction?
How long until it resolves?
NGT decompression
IV hydration
72 hours
106
What are the 3 main causes of gastric ulcers?
Excessive NSAID use
H. Pylori
ETOH
107
Repetitive ulceration can lead to what two conditions?
Fixed stenosis
Chronic obstruction
108
How many classifications are there for Gastric Ulcers?
Five
109
Describe a Type I ulcer
Along the lesser curvature near incisura; no acid hypersecretion
110
Described a Type II ulcer
Two ulcers, first on gastric body, second duodenal; usually with acid hypersecretion
111
Describe a Type III ulcer
Prepyloric with acid hypersecretion
112
Describe a Type IV ulcer
At lesser curvature near GE junction; no acid hypersecretion
113
Describe a Type V ulcer
Anywhere in the stomach, seen with NSAID use
114
What are the five medication treatments for Gastric Ulcers?
Antacids
H2 antagonists
PPIs
Prostaglandin analogues
Cytoprotective agents
115
What is the treatment for H. Pylori?
Triple Therapy
2 abx + PPI x 14 days
116
What is Zollinger Ellison Syndrome?
Non-B cell islet tumor of the pancreas causing gastrin hypersecretion.
This causes high levels of gastric acid
117
What signs are seen with Zollinger Ellison Syndrome?
Peptic ulcer disease
Erosive esophagitis
Diarrhea
118
Does Zollinger Ellison occur more frequently in males or females?
Males, ages 30-50
119
What percentage of patients with gastrinoma are metastatic when diagnosed with ZES?
up to 50%
120
What are the treatment options for ZES?
PPIs
Surgical resection of gastrinoma
121
What preoperative considerations are there for patients with ZES?
Correct electrolytes
Increase pH (alkalize)
RSI
122
What is the small intestines major function?
Circulate contents
Maximize absorption of water, nutrients, and vitamins
123
What is segmentation?
When two nearby areas contract and isolate a segment of intestine
124
What two things coordination segmentation?
Circular and longitudinal muscle layers
125
What are reversible causes of small bowel dysmotility?
Mechanical obstructions
Bacterial overgrowth
ileus
electrolyte imbalances
critical illness
126
What are nonreversible causes of small bowel dysmotility?
Scleroderma, IBD
Pseudo-obstruction
127
The large intestine is a reservoir for what two things?
waste
indigestible material
128
Movement of the large intestine and colon are called what?
How often do they occur?
Giant migrating complex
6-10 times a day
129
Colonic dysmotility has what two symptoms?
Altered bowel habits
Intermittent cramping
130
What two commons diseases are associated with colonic dysmotilty?
IBS
IBD
131
Per Rome II criteria IBS is defined as abdominal discomfort along with __
defecation relieving discomfort
pain associated w/abnormal frequency
pain associated with change in form of stool
132
What is the second most common inflammatory disorder?
Inflammatory bowel disease (IBD)
133
IBD is divided into what two diseases?
Ulcerative colitis
Crohn's disease
134
What is Ulcerative Colitis?
Mucosal disease of the rectum and part or all of the colon
135
What are signs of UC?
Diarrhea
Rectal bleeding
Abdominal cramp/pain
N/V
Fever
Weight loss
136
What is a complication of UC?
Toxic Megacolon
May require colectomy
137
Colon perforation has a _ mortality rate
15%
138
What is Crohn's Disease?
Acute or chronic inflammation that may affect any/all bowel
139
What is the most common site affected by Crohn's?
Terminal ilium
140
Persistent inflammation with Crohn's can lead to what 4 issues?
Fibrous narrowing
Stricture formation
Chronic Bowel Obstruction
Malabsorption
Steatorrhea
Fecal vomitus via fistula
141
How do you treat IBD?
5-ASA
Glucocorticoids
Rifaximin, Flagyl, Cipro
Purine analogues
Bowel resection (last)
Limit to < 1/2 length
142
Most carcinoid tumors originate where?
GI tract
143
Why are carcinoid tumors problematic?
Release of peptides and vasoactive substances
144
What is carcinoid syndrome?
How prevalent is it?
Large amounts of serotonin and vasoactives reach the systemic circulation
10% of patients with carcinoid tumors
145
What are signs of Carcinoid Syndrome?
Flushing
Diarrhea
HTN/HoTN
Bronchoconstriction
146
What is the treatment for Carcinoid Syndrome?
Avoid serotonin triggers
Control diarrhea
serotonin antagonist
somatostatin analogues
147
What are pre-op considerations for Carcinoid Syndrome?
Give octreotide to attenuate hemodynamic changes
148
What are the two most common causes of Acute Pancreatitis?
Gallstones
ETOH abuse
60-80% of cases
149
What other conditions can cause Acute Pancreatitis?
Immunodeficiency Syndrome
Hyperparathyroidism
150
How do gallstones cause acute pancreatitis?
Obstruction of Ampulla of Vater
Pancreatic ductal HTN
151
What are the hallmark signs and lab values for Acute Pancreatitis?
Epigastric pain radiating to the back
Elevated Serum amylase and lipase
152
What type of nutrition is preferred for Acute Pancreatitis?
Enteral feeding
153
Which type of GI bleed is more common, upper or lower?
Upper GI bleed
154
Melena is an indication of _?
Bleed is above the cecum
155
How do we treat an Upper GI bleed?
EGD with ligation
Mechanical balloon tamponade (last resort)
156
Lower GI bleeds typically occur in what population?
Elderly patients
157
What are the 3 main causes for Lower GI bleeds?
Diverticulosis
Tumors
Colitis
158
What is an Adynamic Ileus?
Ileus with massive dilation of the colon without mechanical obstruction
Loss of peristalsis
159
What are possible causes for an ileus?
Electrolyte imbalance
Immobility
Excessive narcotics
Anticholinergics
Neurological imbalance
160
What are the treatment options for an ileus?
Replace electrolytes
Hydration
Mobilization
NGT decompression
Enema
Neostigmine 2-2.5 mg (over 5 mins)
161
What effects do volatile anesthetics have on the GI tract?
Depress spontaneous, electrical, contractile, and propulsive activity
162
List the parts of the GI tract in which they recover post anesthesia?
Small intestine
Stomach (post 24 hrs)
Colon (post 30-40 hrs)
163
What anesthetic gas should be avoided with GI surgery?
Nitrous Oxide
164
Do NMBs affect the GI system?
No
165
Activation of what pain receptor causes delayed gastric emptying?
Mu-receptor
