GI

Question 1

Name some factors/agents that decrease LES tone

Answer 1

-inhaled anesthetics
-propofol
-opioids
-anticholinergics
-beta agonists
-glucagon
-obesity
-hiatal hernia
-pregnancy
-cricoid pressure

Question 2

Name some factors/agents that increase LES tone

Answer 2

-SCh (RSI w/ this)
-cholinergics
-acetylcholine
-anticholinesterase
-alpha agonist
-antacids
-serotonin
-histamine
-metoprolol
-metoclopramide

Question 3

What CNs innervate the LES?

Answer 3

CN 9, 10, 11

Question 4

What is achalasia

Answer 4

LES can’t relax, so food backs up in esophagus and leads to regurg

Question 5

What disorders have development of achalasia

Answer 5

-DM
-CVA
-ALS
-Amyloidosis
-Scleroderma

Question 6

What is barrett’s esophagus

Answer 6

Chronic GERD leading to epithelial cell changes (malignancy risk)

Question 7

When elements from abdominal cavity (usually stomach) herniates through the esophageal hiatus to the mediastinum

Answer 7

Hiatal hernia

Question 8

What do you worry about w/ hiatal hernia?

Answer 8

Aspiration (decreased LES tone)

***Aspiration profilaxis if pt. is symptomatic

Question 9

What is the worst complication w/ gastritis?

Answer 9

Major gastric bleeding

Question 10

With severe bleeding w/ gastritis, what 3 blood products are you giving?

Answer 10

RBCs/Plts/FFP

Question 11

Main focus on gastritis tx. (non-emergent)

Answer 11

H. pylori (via antibiotics)

Question 12

2 most common causes of peptic ulcer disease

Answer 12

H pylori

NSAIDs

Question 13

Is bleeding risk w/ PUD similar to gastritis?

Answer 13

Yes

Question 14

Most frequent complication of gastric ulcer disease

Answer 14

Perforation

Question 15

4 Big anesthesia takeaways/implications for gastritis/PUD/GUD

Answer 15

-Avoid placing anything in esophagus

-GI profilaxis

-RSI

-A-line & be ready to give blood products/volume resuscitation

Question 16

What 2 complications would you put in NGT and drain preop?

Answer 16

Adynamic colon

Colon obstruction

Question 17

What meds do you avoid w/ GI obstruction????

Answer 17

GI prokinetics

***REGLAN

***N2O

Question 18

__________ analgesia can be used to reduce post op Ileus

Answer 18

Multimodal

Question 19

what is the most common general surgery emergency?

Answer 19

appendicitis

Question 20

Classic presentation of appendicitis

Answer 20

-RLQ pain
-N/V
-anorexia
-fever

Question 21

Signs of appendix perforation

Answer 21

abd pain gets more intense and diffuse

Abdominal rigidity

HR increase

Temp increase

Question 22

Does appendectomy require GA?

Answer 22

Yes

Question 23

Aspriation risk w/ appendectomy?

Answer 23

YESSS

Question 24

Is routine GI profilaxis recommended?

Answer 24

No

Question 25

Take GERD meds DOS?

Answer 25

Yes

Question 26

Most important factor in aspiration risk reduction

Answer 26

Know your patient

Question 27

Name some risk factors for aspiration

Answer 27

-full stomach -emergency surgery -OB pts (esp. C-section) -GI obstruction -DM -GERD -Hiatal hernia -inadquate anesthesia -hypotension -Low LES tone -head injury -decrease LOC -seizures -obesity -N/V -opioids -cardiac arrest -scleroderma

Question 28

Where do we look w/ ultrasound to check gastric volume?

Answer 28

Pyloric antrum

Question 29

Effects of preop fasting?

Answer 29

-insulin resistance/postop hyperglycemia -dehydration -muscle waisting -immune compromise

Question 30

clear liquids minimum fasting period

Answer 30

2 hrs

Question 31

Breast milk minimum fasting period

Answer 31

4hrs

Question 32

Infant formula, non-human milk, light meal minimum fasting period

Answer 32

6hrs

Question 33

t/f, type of liquid matters more than volume w/ preop fasting

Answer 33

true

Question 34

High fat content w/ meal requires ___hrs of fasting

Answer 34

8hrs

Question 35

If post pyloric, can TF be continued?

Answer 35

Yes

Question 36

If not post pyloric, how long to hold TF?

Answer 36

8hrs

Question 37

NO fluid or solid fluid ___hrs prior to procedure

Answer 37

2hrs

Question 38

Meals NPO > ___ hrs may be detrimental

Answer 38

8hrs

Question 39

_______ antacids are NOT recommended at all

Answer 39

Particulate antacids

Question 40

Non-particulate antacids (bicitrate/sodium citrate) do what?

Answer 40

increase pH

Question 41

H2 receptor antagonists & PPIs do what?

Answer 41

reduce volume increase pH

Question 42

How many doses of PPI preop

Answer 42

2

Question 43

When should you not give gastric prokinetics (reglan)?

Answer 43

Parkinsons Bowel obstruction

Question 44

Antiemedics do what?

Answer 44

moderate N/V

Question 45

Do antiemetics help prevent aspiration?

Answer 45

NOO

Question 46

Are anticholinergics (atropine/glycopyrrolate) recommended at all?

Answer 46

NOO