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GI Flashcards

test 4

1
Q

GI tract is ___% of total body mass

A

5%

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2
Q

What are the main functions of the GI tract? (5)

A

-motility
-digestion
-absorption
-excretion
-circulation

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3
Q

What are the layers of the GI tract? outer –> inner

A

Serosa (most outer)
Longitudinal muscle layer
Circular muscle layer
submucosa
mucosa (most inner)

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4
Q

What are the layers of the mucosa layer of the GI tract? outer –> inner
What do they do?

A

Muscularis Mucosae (outer): move the villi

Lamina propria (middle): contains blood vessels, nerve, endings, and immune cells

Epithelium (inner): GI contents are sensed, enzymes are secreted, and nutrients are absorbed

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5
Q

Which two layers of the GI tract propagate gut motility? How?

A

Longitudinal muscle layer: contracts to shorten the length

Circular muscular layer: contracts to decrease the diameter

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6
Q

The GI tract is innovated by the ________ nervous system. What does this include?

A

autonomic

Includes:
-Extrinsic nervous system (SNS & PNS)
-Enteric nervous system: independent nervous system –> controls, motility, secretions, and blood flow

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7
Q

The enteric nervous system contains the _____ & ______ plexuses. Describe them

A

myenteric:
-Lies between smooth muscle layers
-regulates the smooth muscle
-controlled motility (by enteric neurons & cells of Cajal)

submucosal:
Transmit info from the epithelium to the enteric and central nervous system
-controls, absorption, secretion, mucosal blood flow

both respond to SNS & PNS

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8
Q

What does the Celiac Plexus innervate?

A

Proximal GI organs to the transverse colon

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9
Q

What does the hypogastric plexus innervate?

A

Descending colon & distal GI tract

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10
Q

What are the ways you can block the celiac plexus? (4)

A

-Trans-crural
-intraoperative
-endoscopic ultrasound guided
-peritoneal lavage

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11
Q

GI Procedures: Upper GI endoscopy

A

Endoscope placed thru esophagus –> stomach –> pylorus –> duodenum

challenges: sharing airway w/ endo
-done w/o ETT
-performed outside of main OR (limited equipment/supplies)

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12
Q

GI Procedures: Colonoscopy

A

Done w or w/o anesthesia

challenges: pt dehydrated from bowel prep and NPO

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13
Q

GI Procedures: High resolution manometry (HRM)

A

Pressure catheter measures pressures along entire esophageal length

Used to diagnose motility disorders

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14
Q

GI Procedures: Barium swallow

A

Assessment of swallowing function & GI transit

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15
Q

GI Procedures: gastric emptying study

A

Fast for 4+ hours –> consumes meal with radio tracer –> freq imaging done for 1-2 hours

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16
Q

GI Procedures: small intestine Manometry

A

Catheter measures contraction, pressures, and motility of the small intestine

Evaluate contractions during three period periods: fasting, during a meal, and post meal

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17
Q

GI Procedures: lower GI series

A

Barium enema, outlines the intestines and is visible on radiograph

detects colon/rectal abnormalities

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18
Q

What the different esophageal groups? (3) What is included in them.

A

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

Mechanical: achalasia, esophageal spasms, hypertensive LES

Neurologic: stroke, vagotomy, hormone deficiencies

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19
Q

What are the most common symptoms of esophageal disease?

A

Dysphagia (difficulty swallowing)
-heartburn
-GERD

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20
Q

What are the different types of dysphagia?

A

Oropharyngeal: common after head/neck surgery

Esophageal: based on physiology
-esophageal dysmotility: occurs when/ both liquids & solids
-mechanical esophageal dysphasia: occurs w/ solid food only

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21
Q

What are the signs of GERD?

A

Gastroesophageal reflux disease

effortless return of gastric contents into pharynx

Symptoms: heartburn
Nausea
“lump in throat”

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22
Q

Describe Achalasia

A

Neuromuscular disorder of the esophagus

Outflow obstruction dt in adequate LES tone and a dilated hypomobile esophagus –> food unable to move forward

Symptoms: dysphagia, regurgitation, heartburn, chest pain

Dx: esophageal manometry or esophagram

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23
Q

Long-term Achalasia is associated with an increased risk of ________

A

Esophageal cancer

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24
Q

What are the 3 classes of Achalasia? Describe them.

A

Type 1: minimal esophageal pressure; responds well to myotomy

Type 2: entire esophagus pressurized; respond well to treatment, has best outcomes

Type 3: esophageal spasms with premature contractions; has worse outcomes

25
What is the Tx for Achalasia?
**All Tx is palliative** Meds: Nitrates, CCB <-- relaxes LES Endoscopic botox injections **Pneumatic dilation** most effective non Sx Tx **Laprascopic Heller Myotomy** best Sx Tx Esophagectomy -- advanced cases
26
What considerations should we have with all esophageal diseases?
Increased risk of aspiration RSI or awake intubation
27
Describe Esophageal Spasms.
Spasms in distal esophagus dt autonomic dysfunction Dx: on esophagram Symptoms: mimics angina Tx: NTG, Antidepressants, PDI
28
Describe Esophageal Diverticula and their types
Outpouching in the wall of the Esophagus Pharyngoesphageal (Zenker): bad breath dt food rentention Midesophageal: caused by old adhesions or inflamed lymph nodes Epiphrenic: may experience achalasia
29
Describe Hiatal hernia
Herniation of stomach into thoracic cavity thru Esophageal hiatus in diaphragm Symtomps: asymptomatic; associated with/ GERD
30
Describe Esophageal cancer
Symptoms: **progressive dysphagia & weight loss** Most are adenocarcinomas -- in lower Esophagus Squamous cell carcinoma -- are remainder Tx: Esophagectomy (curative or palliative) -- high risk of recurrent laryngeal nerve injury
31
Describe GERD & 3 mechanisms of incompetence
Incompetence of the gastro-esophageal junction --> reflux mechanisms of incompetence 1. Transient LES relaxation --> gastric distention 2. LES hypotension (normal 29, GERD 13) 3. Autonomic dysfunction of GE junction symptoms: heartburn, dysphagia, mucosal injury **Associated w/ Barret metaplasia & adenocarcinoma** Tx: Avoid trigger foods Meds: antacids, H2 blockers, PPIs, Reglan Sx: Nissen Fundoplication, Toupet, LINX
32
What does reflux contents include?
HCL Pepsin Pancreatic enzymes bile
33
What Preop interventions should we have w GERD?
34
What factors increase intraop aspiration
Emergent Sx Full stomach Diff airway Inadequate anesthesia depth Lithotomy Autonomic Neuropathy Gastroparesis DM Pregnancy Increased intraabdominal pressure Sever illness morbid obesity
35
Food is broken down into _____ and must be ____mm particles before entering into the _________
chyme 1-2 mm duodenum
36
How does neurohormonal control modulate GI movement?
Gastrin & motilin: increase strength/freq on contractions Gastric inhibitory peptide: inhibits contractions
37
Describe Pepic Ulcer Disease
**Most common cause of nonvariceal upper GI bleed** **associated w/ Helicobacter Pylori** symptoms: burning epigastric pain **exacerbated w/ fasting (no food) & improved w/ meals** Perforations signs: severe pain dt secretions in peritoneum --> mortality dt shock >48h
38
Describe Gastric Outlet Obstruction
Acute or chronic Acute: dt edema & inflammation inpyloric channel at beginning of duodenum symptoms: vomitting, dehydration, hyperchloremic alkalosis Tx: NTG, IVF (resolves w/i 72h) Chronic: dt repetitive ulceration & scarring
39
What is the triple therapy Tx for H. Pylori?
2 abx + PPI for 14 days
40
Describe Zollinger Ellison Syndrome
Non B cell pancreatic tumor --> gastrin hypersecretion (Normally gastric acid neg feedback loop to inhibit excess gastrin secretion, but that is absent) symptoms: peptic ulcer disease, erosive esophagitis, diarrhea Male>female 30-50yo Tx: PPI Sx: Resection of gastrinoma Considerations: correction electrolytes, increase gastric pH, RSI
41
Describe the small intestines
Mixes nutrients with/ digestive enzymes --> reducing particle size & increasing solubility circulates contents & exposes them to the mucosal wall to maximize absorption Segmentation controlled by enteric NS Motility controlled by extrinsic NS
42
What are reverible causes of small bowel dysmotility?
Mechanical obstruction: hernias, malignancy, adhesions, volvuluses Bacterial overgrowth --> alteration in absorption Ileus, electrolyte abnormalities, critical illness
43
What are nonreverible causes of small bowel dysmotility?
Structural: Scleroderma, connective tissue disorder, IBD Neuropathic: pseudo-obstruction dt extrinsic NS dysfunction
44
Describe the large intestine
Reservoir for waste & indigestible material before elimination Extracts remaining electrolytes & water Exhibits **giant migrating complexes** movements in a healthy person **6-10x daily**
45
What are the 2 primary symptoms of large intestine dysmotility?
altered bowel habits intermittent cramping
46
What are the most common large intestine dymotility diseases?
IBD IBS
47
Describe IBD
Inflammatory Bowel Disease Contractions are suppressed dt inflammation but giant migrating complexes remain the same --> compresses infamed mucosa --> erosions & hemorrhage Seen in Ulcerative Colitis & Crohns
48
Describe UC
Ulcerative Colitis Mucosal disease or part of all/part of colon Severe cases: hemorrhagic, edematous, ulcerated symptoms: diarrhea, rectal bleeding, crampy abd pain, N/V, fever, wt loss Labs: increases platelets, increased ery. sed. rate, decreased H/H, decreased albumin **Hemorrhage requiring 6u of blood in 24/48hr = sx colectomy** **Toxic Megacolon**: triggered by electrolyte disturbances -colon perforation dangerous complication
49
Describe Crohn's Disease
Acute/Chronic Can affect all/part of bowel Presistent inflammation--> fibrosis --> narrowing & stricture formation **Most common site = terminal ileum** --> RUQ pain Symptoms: wt loss, fear of eating, anorexia, diarrhea --> diarrhea decreases, chronic bowel obstruction (1/3 pts: arthritis, dermatitis, kidney stones) obstruction & inflammation --> loss of absorption surfaces --> malabsorption
50
What is Tx for IBD?
Medical: **5-Acetylsalicyclic acid (5-ASA)** - main drug abx/afx -Glucorticoids -Abs: Rifaximin, Flagyl,, Cipro -Purine analogues Sx: Last resort -Resection **-small intestine limited to <1/2 length -more than this leads to "short bowel syndrome" requiring TPN**
51
Most Carcinoid tumors originate in the _______. What do they secrete?
GI tract Peptides & vasoactive substances: gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, serotonin
52
Describe Carinoid syndrome
Occurs in 10% of ppl w/ carcinoid tumors symptoms: flushing, diarrhea, HTN/HoTN, bronchoconstriction, R heart endocardial fibrosis (L heart more protected dt lungs clearing some substances) Dx: urinary/plasma serotonin levels CT, MRI Tx: avoid serotonin serotonin antagonists somatostatin analogues **Preop: OCETROTIDE**
53
Describe Acute Pancreatitis
Inflammatory disorder Common causes: Gallstones & alcoholism -also seen in immunodeficient syndrome, hyperparathyroidism, increased Ca++ symptoms: **excruciating epigastric pain --radiates to back**, N/V, abd distention, steatorrhea, ileus, fever, tachycardia, hypotension **Hallmark labs: increased serum amylase & lipase** Dx: contrast CT, MRI, endoscopic US Tx: aggressive IVF, **NPO** to rest pancreas, enteral feeding, opioids Sx: ERCP Complications: 25% pts -- shock, ARDS, RF, necrotic pancreatic abscess
54
What prevents autodigestion of pancreas?
Proteases packages in precursors form -Protease inhibitors -Low intra-pancreatic calcium, which decreases trypsin activity **failure of any of these mechanisms can trigger pancreatitis**
55
Describe Upper GI bleeds
More common than lower GI bleeds >25% blood loss --> hypotension & tachycardia Orthostatic hypotension = HCT <30% Melena = bleed above cecum Dx: EDG Tx: Mechanical balloon tamponade last resort of uncontrolled variceal bleeding
56
Describe Lower GI bleeds
More commin in elderly Causes: diverticulosis, tumors, colitis Dx: Sigmoidoscopy, colonoscopy Tx: presistent bleeding = angiography w/ embolic therapy
57
Describe an Ileus
Loss of peristalsis --> massive dilation/distention of colon (no mechanical obstruction) Causes: electrolyte disorder, immobility, excessive narcotics, anticholinergics Tx: Restore electrolyte balance, hydrate, mobilize, NG suction, enemas Meds: Neostigmine 2-2.5 mg over 5 mins --> immediate results (requires cardiac monitoring) Untreated --> ischemia or perforation
58
What are anesthesia considerations for bowel diseases?
Higher anxiety = GI inhibition Volatile agents inhibit GI function & motility Dont use nitrous in abd Sx or when bowel is distended Neostigmine will increase PNS activity -Sugammadex has no affect on GI motility Opioids that work on the mu receptor --> delays gastric emptying & glower GI transit (constipation)

Assessment (22 decks)

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