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Health Assessment > GI > Flashcards

GI Flashcards

1
Q

GI tract consitutes what percent of the human body mass

A

5%

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2
Q

main function of the GI tract

A

motility, digestion, absorption, excretion, and circulation

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3
Q

outermost to innermost layer of GI tract

A

serosa –> longitudinal muscle layer –> circular muscle layer –> submucosa –> mucosa

Kahoot Q

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4
Q

within the GI mucosa what are the layers innermost to outermost

A

Everyone loves me (epithelium. Lamina propria. Muscularis

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5
Q

serosa is a smooth membrane of thin connective tissue and cells that secrete what?

A

serous fluid to enclose the cavity and reduce friction between muscle movements

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6
Q

which muscle layer contracts to shorten the length of the intenstinal segment

A

longitudinal muscle

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7
Q

which muscle layer contracts to decrease the diameter of the intestinal lumen

A

circular muscle layer

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8
Q

what two muscle layers work together to propagate gut motility

A

longitudinal and circular muscle layer

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9
Q

which plexus innervates the GI organs proximal to transverse colon

A

celiac plexus

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10
Q

which plexus innervates the descending colon and distal GI tract

A

inferior hyogastric plexus

kahoot Q

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11
Q

how can you block the celiac plexus (4)

A

transcural
intraoperative
endoscopic ultrasound guidedd
peritoneal lavage

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12
Q

which plexus lies between the smooth muscle muscle layers and regulates the smooth muscle

A

myenteric plexus

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13
Q

which plexus transmits information from the epithelium to the enteric and central nervous system

A

submucosal plexus

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14
Q

the mucosa is composed of a thin layer of smooth muscle called

A

muscularis mucosa, which functions to move the villa

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15
Q

the mucosa is composed of lamina propria which contain

A

blood vessels & nerve endings, immune and inflammatory cells

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16
Q

the mucosa is composed of an epithelium where the Gi contents are sensed and

A

enzymes are secreted, nutrients are absorbed, and waste is excreted

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17
Q

the extrinsic nervous system has which ANS components

autonomic nervous system

A

SNS and PSNS
SNS - inhibits and decreases GI motility
PSNS - excites and activates GI motility

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18
Q

the enteric nervous system is the independent nervous system that

A

controls motility, secretion, and blood flow

Kahoot Q

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19
Q

the enteric system is comprised of

A

myenteric plexus and submucosal plexus

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20
Q

myenteric plexus controls motility, which is carried out by

A

enteric neurons, interstital cells of Cajal (ICC cells, GI pacemakers), and smooth muscle cells

Respond to SNS and PSNS stimulation

Kahoot Q

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21
Q

the submucosal plexus controls

A

absorption, secretion, and mucosal blood flow

Respond to SNS and PSNS stimulation

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22
Q

upper GI endsocopy anesthesia challanges

A

sharing airway with an endoscopist
procedure performed outside the main OR

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23
Q

colonscopy anesthesia challanges

A

patient dehydration due to bowel prep and NPO cases

Kahoot Q

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24
Q

high-resolution manometry uses a pressure catheter along the length of the entire esophagus and is used to diagnosis what

A

motility disorders

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25
Q

GI series with ingested barium assess what

A

swallowing function and GI transit

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26
Q

Gastric emptying study requires a 4 hour fast and to consume a meal with radio tracer with frequent imaging over the next 1-2 hours. what can be diagnosed through this

A

used to diagnose gastroparesis

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27
Q

small intestine manometry measures contraction pressure and motility of the small intestine and evaluates contractions during which periods

A

fasting, during a meal, and post prandial

abnormal results are grouped into myopathic and/or neuropathic

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28
Q

lower GI series involves administration of what

A

barium enema.. it outlines the intestine to detect colon and rectal abnormalities

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29
Q

anatomical causes of esophageal disease

A

diverticula, hiatal hernia, and changes associated with chronic acid reflux

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30
Q

mechanical causes of esophageal disease

A

achalasia, esophageal spasms, and a hypertensive LES

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31
Q

causes of neurologic esophageal disease

A

stroke, vagatomy, or hormone deficiencies

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32
Q

dysphagia is _________ and classified into oropharyngeal or esophageal

A

difficulty swallowing

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33
Q

oropharyngeal dysphagia is common after

A

head and neck surgery

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34
Q

dysphagia is separated into esophageal dysmotility and mechanical esophageal dysphagia

A

esophageal dysmotility: symptoms with liquids and solids
mechanical esophageal dysphagia: symptoms with solid food only

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35
Q

what is GERD , and what are some symptoms

A

return of gastric contents into pharynx
Nausea, Heartburn, “lump in throat”

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36
Q

what is Achlasia

A

neuromuscular disorder of the esophagus consisting of an outflow obstruction due to inadequate LES tone and dilated hypomobile esophagus

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37
Q

achalasia is theorectically caused by

A

loss of ganglionic cells of the esophageal myenteric plexus

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38
Q

what happens with Achalasia that makes food unable to pass down into the stomach

A

esophageal dilation

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39
Q

symptoms of achalasia

A

dysphagia, regurgitation, heartburn, chest pain

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40
Q

what are the 3 classes of achalasia

A

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

Kahoot Q

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41
Q

Achalasia treatment
medication:
nonsurgical:
surgical:

A

nitrates & CCB to relax LES
endoscopic Botox Injection into LES
Pneumatic Dilation: most effective non-surgical
laproscopic Hellar Myotomy (surgical)

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42
Q

what is a POEM: peri-oral endoscopic myotomy?? and most common complication??

A

endoscopic division of LES muscle layers
40% develop a pneumothorax or pneumoperitoneum

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43
Q

achalasia patients are at increased risk of aspiration… what are some airway considerations

A

RSI or awake intubation

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44
Q

diffuse esophageal spasms usually occur in the _________ esophagus and likely due to ___________ ____________

A

distal esophagus; autonomic dysfunction

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45
Q

diffuse esophageal spasms are prevalent in which populations?
how is it diagnosed?
symptoms?
treatment?

A

elderly
esophagram
pain that mimicking angina
NTG, antidepressants, PD-I

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46
Q

esophageal diverticula are ______ in the wall of the esophagus

A

outpouchings

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47
Q

types of esophageal diverticula

A

Pharyngoesophageal (Zenker diverticulum): bad breath d/t food retention
Midesophageal: may be caused by old adhesions or inflamed lymph nodes
Epiphrenic supradiaphragmatic: pts may experience achalasia

ALL ASPIRATION RISKS. REMOVE PARTICLES AND RSI

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48
Q

Hiatal hernia

A

herniation of the stomach into the thoracic cavity- occurs through the esophageal hiatus in the diaphragm
may be asymptomatic; often assicated with GERD

c/b weakening anchors of gastroesophageal junction to the diaphragm

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49
Q

esophageal cancers presentation and survival rate

A

present with progressive dysphagia and weight loss
poor survival rate due to abundant lymphatics lead to lymph node metastasis

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50
Q

types of esophageal cancers

A

most adenocarcinomas located in lower esophagus

squamous cell carcinoma accounts for the rest

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51
Q

esophageal cancer treatment

A

esophagectomy
* high risk of recurrent laryngeal nerve injury, of which 40% resolve spontaneously
* post esophagectomy high of aspiration for life
chemo/radiation - pancytopenia and dehydration

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52
Q

GERD is incompetence of

A

gastro-esophageal junction leading to reflux
symptoms: heartburn, dysphagia, and mucosal injury

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53
Q

reflux contents of GERD include

A

HCL, pepsin, pancreatic enzyme, bile

bile reflux is associated with barrett metaplasia and adenocarcinoma

54
Q

3 mechanisms of GE incompetence

A
  1. transient LES relaxation, elicited by gastric distention
  2. LES hypotension (normal -29 mmHg, GERD -13 mmHg)
  3. autonomic dysfunction

Kahoot Q

55
Q

treatment for GERD

A

avoidance of trigger foods
antacids, H2 blockers, PPIs
sx: nissen fundoplication, toupet, LINX

56
Q

preop interventions for GERD

A
  • Cimetidine, Ranitidine -↓acid secretion & ↑pH
  • PPI’s generally given the night before and the morning of
  • Sodium Citrate - PO nonparticulate antacid (OB pts)
  • Metoclopramide- gastrokinetic; often reserved for diabetics, obese, pregnant
  • Aspiration precautions!

RSI indicated. Cricoid pressure has become controversial

57
Q

what factors can increase intraop aspiration risk (12🫣)

A

Emergent surgery
Full Stomach
Difficult airway
Inadequate anesthesia depth
Lithotomy
Autonomic Neuropathy
Gastroparesis
DM
Pregnancy
↑ Intraabdominal pressure
Severe Illness
Morbid Obesity

57
Q

The ______ is a J-shaped sac that serves as a reservoir for large volumes of food, mixes and breaks down food to form _________ , and slows emptying into the small intestine.

A

stomach; chyme

58
Q

The motility of the stomach is controlled by

A

intrinsic and extrinsic neural regulation.

59
Q

at the stomach, Parasympathetic stimulation to the vagus nerve increases

A

the number and force of contractions

60
Q

at the stomach, sympathetic stimulation

A

inhibits these contractions via the splanchnic nerve

61
Q

neurohormonal control in the stomach

A

gastrin & motilin increase the strength and frequency of contractions
gastric inhibitory peptide inhibits contractions

62
Q

leading cause of non-variceal upper GI bleed

A

peptic ulcer disease may be associated with H.pylori

63
Q

symptoms of Peptic ulcer disease

A

burning epigastric pain exacerbated w/fasting and improved w/meals

  • 10% risk of perforation in those who do not receive treatment
  • Perforation- sudden/severe epigastric pain c/b acidic secretions into the peritoneum
  • Mortalityis d/t shock or perforation >48h
64
Q

gastric outlet obstruction

A

Acute obstructions c/b edema & inflammation in the pyloric channel at the beginning of the duodenum

Pyloric obstruction sx: Recurrent vomiting, dehydration & hyperchloremic alkalosis

65
Q

Gastric Outlet Obstruction treatment

A

NGT decompression, IV hydration; Normally resolves in 72h
Repetitive ulceration & scarring may lead to fixed-stenosis and chronic obstruction

66
Q

causes of gastric ulcers

A

excessive NSAIDS, H. Pylori, ETOH

Kahoot Q

67
Q

gastric ulcer therapy

A

Tx: Antacids, H2 blockers, PPIs, prostaglandin analogs, cytoprotective agents
H. Pylori- Triple therapy (2abx+ PPI) x 14 days

68
Q

classification of GI ulcers

A
69
Q

Zollinger Ellison Syndrome

A

Non-B cell islet tumor of the pancreas, causing gastrin hypersecretion

Gastrin stimulates gastric acid secretion. Gastric acid normally inhibits further gastrin release (neg feedback) This feedback loop is absent in ZE syndrome

70
Q

Zollinger Ellison Syndrome symptoms and treatment

A

peptic ulcer dz, erosive esophagitis, diarrhea
PPIs and surgical resection of gastrinoma

71
Q

Zollinger Ellison Syndrome anesthesia considerations

A

Pts have ↑ gastric fluid volume, possible electrolyte imbalances, & endocrine abnormalities.
Preop: Correct lytes,↑gastric pH w/meds, RSI

72
Q

The major function of the small intestine is to circulate the contents and expose them to the mucosal wall to

A

maximize absorption of water, nutrients, and vitamins before entering the large intestine

73
Q

Segmentation occurs when _____ nearby areas contract and thereby isolate a segment of _____
Segmentation allows the contents to remain in the intestine long enough for the essential substances to be ______ into the circulation.

A

Segmentation occurs when two nearby areas contract and thereby isolate a segment of intestine
Segmentation allows the contents to remain in the intestine long enough for the essential substances to be absorbed into the circulation.

It is controlled mainly by the enteric nervous system with modulation of motility by the extrinsic nervous system

74
Q

reversible causes of small bowel dysmotility

A

mechanical obstruction such as hernias, malignancy, adhesions, and volvuluses
Bacterial overgrowth leading to alterations in absorptive function, ileus, electrolyte abnormalities, and critical illness

75
Q

structural nonreversible causes of bowel dysmotility

A

scleroderma, connective tissue disorders, IBD

76
Q

neuropathic nonreversible causes of bowel dysmotility

A

pseudo-obstruction in which the intrinsic and extrinsic nervous systems are altered and the intestines can only produce weak, uncoordinated contraction

This leads to bloating, nausea, vomiting, and abdominal pain

77
Q

The large intestine acts as a reservoir

A

for waste and indigestible material before elimination and it extracts remaining electrolytes and water

78
Q

Distention of the _____ will relax the _______ valve to allow intestinal contents to enter the colon

A

Distention of the ileum will relax the ileocecal valve to allow intestinal contents to enter the colon

Subsequent cecal distention will contract the ileocecal valve

79
Q

The colon also exhibits ______ _______ complexes. these complexes serve to produce mass movements across the _____ ________

A

The colon also exhibits giant migrating complexes
Giant migrating complexes serve to produce mass movements across the large intestine

In the healthy state, these complexes occur approximately 6-10x a day

80
Q

Colonic dysmotility manifests with two primary symptoms:

A

altered bowel habits and intermittent cramping

81
Q

Rome II criteria defines IBS as having abdominal discomfort along with 2 of the following features:

A
  • defecation relieves discomfort
  • pain is assoc w/abnormal frequency (> 3x per day or < 3xper week)
  • pain is associated with a change in the form of the stool
82
Q

In IBD the contractions are suppressed due to

A

colonic wall compression by the inflamed mucosa, but the giant migrating complexes remain

There is an increased frequency of the giant migrating complexes and their pressure effect further compresses the inflamed mucosa, which can lead to hemorrhage, thick mucus secretion, and significant erosions

83
Q

ulcerative colitis

A

Mucosal disease of rectum and part or all of the colon
In severe cases, the mucosa is hemorrhagic, edematous, ulcerated

84
Q

Hemorrhage requiring ______ units blood in 24-48 hrs warrants _________

A

Hemorrhage requiring 6+ units blood in 24-48 hrs warrants surgical colectomy
Toxic megacolon is a complication triggered by e-lyte disturbances
About ½ cases resolve, ½ require colectomy

Colon perforation is a dangerous complication- mortality 15%

85
Q

symptoms and labs of ulcerative colitis

A

diarrhea, rectal bleeding, crampy abdominal pain, N/V, fever, weight loss
may have ↑plts,↑erythrocyte sedimentation rate,↓H&H,↓albumin

86
Q

Most common site of Crohn’s Disease

A

terminal ilium, usually presenting w/ileocolitis w/ RLQ pain & diarrhea

87
Q

symptoms of Crohn’s Disease

A

Persistent inflammation gradually progresses to fibrous narrowing & stricture formation
Diarrhea decreases and is replaced by chronic bowel obstruction
Extensive inflammation leads to loss of absorptive surfaces, resulting in malabsorption & steatorrhea

Kahoot Q

88
Q

Colonic disease may fistulize into stomach/duodenum, causing

A

fecal vomitus

1/3 Crohn’s pts have an additional symptoms s/a arthritis, dermatitis, renal calculi

89
Q

IBD medical treatment

A

5-Acetylsalicylic acid (5-ASA)- mainstay for IBD *antibacterial & anti-inflammatory
PO/IV Glucorticoids during flares
Antibiotics: Rifaximin, Flagyl, Cipro
Purine analogues

Kahoot Q

90
Q

surgical treatment of IBD

A

Last resort. Resected segment should be as conservative as possible.
Small intestine resection should be limited to <1/2 length.
>2/3 SI resection leads to “short bowel syndrome”, requiring TPN

91
Q

Most carcinoid tumors originate

A

in any GI tissue/segment

92
Q

Carcinoid Tumors secrete

A

Secrete peptides & vasoactive substances: gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, serotonin, and other biological actives.

93
Q

what is carcinoid syndrome

A

Lg amounts of serotonin & vasoactive substances reach the systemic circulation
Sx: flushing, diarrhea, HTN/HoTN, bronchoconstriction
* May acquire right heart endocardial fibrosis

The left heart is generally more protected as the lungs clear some of the vasoactive substances.

94
Q

diagnosis, treatment for carcinoid tumors

A

Dx: urinary or plasma serotonin levels, CT/MRI
Tx: avoid serotonin triggers, control diarrhea, serotonin antagonists & somatostatin analogs

95
Q

preop considerations for carcinoid tumor

A

Octreotide before surgery and before tumor manipulation to attenuate volatile hemodynamic changes

Kahoot Q

96
Q

acute pancreatitis

A

inflammatory disorder of the pancreas

incidence has increased 10-fold likely due to ETOH and better diagnostics

97
Q
A
98
Q

autodigesion is normally prevented by

A

proteases packaged in precursor form
protease inhibitors
low intra-pancreatic calcium, which decreases trypsin activity

failure of any of these mechanisms can trigger pancreatitis

99
Q

gallstones and ETOH abuse associated with acute pancreatitis

A

gall stones obstruct the ampulla of Vater, causing pancreatic ductal HTN
pancreatitis is also seen in immunodeficiency syndrome, hyperparathyroidism, and hypercalcemia

100
Q

symptoms and labs of acute pancreatitis

A

excrutiating epigastric pain that radiates to back, N/V, abdominal distention, steatorrhea, ileus, fever, tahcycardia, and Hypotension
Hallmark Labs: increased serum amylase and lipase

101
Q

complications of acute pancreatitis

A

complications such: as shock, ARDS, renal failure, necrotic pancreatic abscess

102
Q

medical treatment for acute pancreatitis

A

aggressive IVF, NPO to rest pancreas, enteral feeding > TPN, opioids

TPN associated with higher infectious complications

103
Q

interventional treatment for acute pancreatitis

A

ERCP - fluroscopic examinatino of biliary and pancreatic ducts
*stone removal, stent placement, sphincterotoy, hemostasis

104
Q

which is more common
upper or lower GI bleed

A

upper GIB

105
Q

blood loss greater than what will lead to hypotension and tachycardia

A

> 25%

106
Q

what does orthostatic hypotension indicate

A

HCT< 30%

107
Q

melena indicates that the bleed is above the

A

cecum (where small intestine meets the colon)

108
Q

what BUN levels are associated with GI bleeding

A

BUN > 40 mg/dL due to absorbed nitrogen into bloodstream

109
Q

treatment for GI bleeding

A

EGD is diagnositc/therapeutic procedure of choice
ulcer ligation
ligation of bleeding varices
mecanichal balloon tamponade is the last resort for uncontrolled variceal bleeding

110
Q

causes of lower GI bleed

A

diverticulosis, tumors, colitis

generally occurs in the elderly

111
Q

which scope can be done unprepped
which scope is performed with prep

prep = bowel prep

A

sigmoidoscopy - unprepped preformed when hemodynamically stable
colonoscopy performed if pt can tolerate prep

112
Q

persistent lower GI bleeding warrants

A

angiography and embolic therapy

113
Q

adynamic ileus is characterized as

A

massive dilation of the colon without mechanical obstruction
*loss of peristalsis leads to distention of the colon

114
Q

causes of adynamic ileus

A

electrolyte disorders, immonility, excessive narcotics, anticholinergics

115
Q

treatment for adynamic ileus

A

restore electroylte balance, hydrate, mobilize, NG suction, enemas
neostigmine 2-2.5 mg over 5 minutes produces immediate results in 80-90%
bradycardia - give glycorpyrrolate

116
Q

if an adynamic ileus is left untreated what could occur

A

ischemia, and peforation may occur

117
Q

Inhibition of GI activity is directly proportional to the amount of

A

NE from SNS stimulation

higher anxiety = higher inhibition

118
Q

volatile anesthetics depress the spontaneous, electrical, contractile, and propulsive activity in

A

the stomach, small intestine, colon

119
Q

which part of the GI tract is first to recover postoperatively

A

small intestine - followed by stomach in approx 24 hours and then the colon (30-40 hrs postop)

120
Q

T/F volatile agents, coupled with sympathetic nervous system hyperactivity associated with surgery can excite GI function and motility

A

false, it inhibits GI function and motility

121
Q

Gut distention and nitrous oxide correlates with

A

pre-existing amount of gas in the bowel, duration of nitrous oxide administration, and concentration of nitrous

Kahoot Q

122
Q

when should nitrous oxide be avoided

A

lengthy abdominal surgey or when the bowel is distended

123
Q

is GI motility affected by NMBDs

A

no - only affects skeletal muscles

124
Q

Neostigmine (AChE-I) will increase _______ activity and bowel _______ by increasing frequency and intensitiy of contractions

A

PSNS, bowel peristalsis

125
Q

the cholinergic activity is partially offset by concurrent administration of

A

anticholinergic meds (glycopyrrolate or atrpoine) used to counteract the bradycardia assocaited with neostigmine

126
Q

will sugammadex effect motility

A

no

127
Q

opioids are known to cause reduced GI motility and constipation bc there is a high densitity of peripheral mu receptors in the

A

myenteric and submucosal plexuses

128
Q

activation of mu-receptors in myenteric and submucosal plexus leads to

A

delayed gastric emptying and slower transit through the intestine

129
Q

adverse events of opioids

A

nausea, anorexia, delayed digestion, abdominal pain, excessive straining during BMs, and incomplete evacuation

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