GI d/o and PONV PPT-Josh Flashcards Preview

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Flashcards in GI d/o and PONV PPT-Josh Deck (67):
1


What is a long term or recurrent d/o of the gasrointestinal FUNCTIONING, it usually involves disturbances in the large intestines and small intestines?


IBS

2


IBS disturbances involve what 3 things?

 

  • Motor function (motility)
  • Sensation
  • Secretion

3


IBS:

what is the specific etiologic agent or structural or biochemical defecit

None known

4


IBS:

is characterized by what?

 

  • Cramping
  • abd pain
  • bloating
  • constipation
  • diarrhea

5


IBS:

what is a diagnostic test that shows IBS?


None

it is diagnosed based off exclusion

r/o other d/o w/ labs, KUB, X-rays, CT, colonoscopy

6


IBS:

what is the basic criteria for diagnosis?


abd pain / discomfort for at least 12 weeks out of previous 12 months (does not have to be consecative)

7


IBS:

has it been shown to lead to serious other disease i.e. Cancer?


nope

8


IBS:

IBS has been called other names like colitis, mucous colitis, spastic colon, or spastic bowel. Thus is here a link b/t IBS and inflammatory diseases like Crohn's and UC?


nope

9


IBS: Anesthesia Implications:

if they have severe constipetion and feelings of fullness what should you consider?


RSI

10


IBS: Anesthesia Implications:

what type of tube?


cuffed for airway protection

11


IBS: Anesthesia Implications:

what should you consider if recent diarrhea?


hypovolemia

electrolyte disturbances

12


what is a Chronic inflammatory condition of GI most often found at the end of small bowel (ileum) and the begining of Colon, but may affect any part of the GI tract, from mouth to anus?


Crohn"s disease

13


Crohn"s disease:

affects mainly what part of GI tract


end of small bowel (ileum) and beginning of large bowel (colon)

14


what is the main clinical difference b/t Crohn's and UC?


Crohn's can effect the ENTIRE THICKNESS of bowel wall, while UC only involves the inner most layer of colon

15


Crohn"s disease:

what is the patho?

  • healthy bacteria are mistaken for harful invaders and the immuune system mounts a response
  • inflammation doesn't subside
  • Leads to chronic inflammation, ulceration, and thickening of the intestinal wall
  • pt develops symptoms

16


Crohn"s disease:

what is the difference b/t crohn's and UC distribution inside bowel?


Crohn's can skip areas leaving patches of normal areas b/t inflamed bowel

UC does not do this

17

What is a disease that effects the innermost lining of the large intestine (COLON) and rectum, It occurs through continuous stretches of colon, which occurs anywhere in ther digestive tract and often spreads deeply into the affected tissues


Ulcerative Colitis

18


Ulcerative Colitis:

whay are usual symptoms?


abd pain

Fever

Bloody diarrhea

19

Ulcerative Colitis:

UC is typically chronic w/relativly low grade symptoms, such as bloody stools, malaise, diarrhea, and pain. In approximatly 15% of pt's UC has an acute phase where symtpoms are ______, _________, ______.


severe abd pain, profuse rectal bleeding, high fevers

20


Ulcerative Colitis:

besides the mentioned normal symptoms, associated symptoms are what?


Vomiting

Anorexia

Profound weakness

pallor

weightloss

21


Ulcerative Colitis VS Crohn's: say which one it is:

Diarrhea?


both

22


Ulcerative Colitis VS Crohn's: say which one it is:

rectal bleeding?


UC

(occasionaly crohn's but almost always w/UC)

23


Ulcerative Colitis VS Crohn's: say which one it is:

Abd pain?


both

Crohn's mod - severe

UC mild - mod

24


Ulcerative Colitis VS Crohn's: say which one it is:

palpable mass


Crohn's

25


Ulcerative Colitis VS Crohn's: say which one it is:

anal complaints?


crohn's

crohn's > 50%

UC < 20%

26


Ulcerative Colitis VS Crohn's: say which one it is:

Ileal disease on radiology


crohn's

27


Ulcerative Colitis VS Crohn's: say which one it is:

nodularity, fuzziness of radiology


UC

28


Ulcerative Colitis VS Crohn's: say which one it is:

Skip areas on X-ray

Crohn;s

29


Ulcerative Colitis VS Crohn's: say which one it is:

distribution is rectum extending upward


UC

30


Ulcerative Colitis VS Crohn's: say which one it is:

Linear, coblestone ulcers?


Crohn's

31


Ulcerative Colitis VS Crohn's: say which one it is:

collar button ulcers


UC

32


Inflammatory Bowel Disease:

what drug may be needed preop?


steroids (likely on chronic)

33


Inflammatory Bowel Disease:

what must be monitored and maybe replaced preop?


electrolytes

34


Inflammatory Bowel Disease:

when would you want to avoid N2O in these pt's


if you suspect distended bowel

35


Inflammatory Bowel Disease:

if on TPN do you continue it intraop?


yeppers

36


what is ischemic injury to the bowel that occurs under numerous circumstances, including advanced atherosclerosis, shock, vasculitis, hypercoagulopathy, and amyloidosis?


Mesenteric Ischemia

37



Mesenteric Ischemia:

what is a surgical iatrogenic cause?


interruption of the inferior mesenteric artery as a result of cross clamping during abdominal aortic sx

38



Mesenteric Ischemia:

what thinkgs place pt's at greater risk for deeloping this

 

  • Hypotension
  • advanced age
  • DM
  • HTN
  • Atherosclerosis

39



Mesenteric Ischemia:

Bowel infartion is an uncomon but grave d/o that imposes a ___-___% death rate. largly b/c the window of time b/t onset of symptoms and perforation is small,


50-75%

40



Mesenteric Ischemia:

what other disease processes look like this and are often misdiagnosed


Ischemic colitis

Diverticulitis

Inflammatory bowel disease

41



Mesenteric Ischemia:

what is definatiove diagnosis?


endoscopic exam and biopsy

42



Mesenteric Ischemia:

what is the main anesthetic Implication?


Volume resuscitation

43



Mesenteric Ischemia:

the funsimental goal od volume resuscitation is to allow weaning and removal of _________ support b/c many of these agents further contribute to mesenteric ischemia

Pharmacological vasopressors

44



Mesenteric Ischemia:

what vasopressors are particularly deleterious to meseteric ischemia


Norepi

Phenylephrine

45



Mesenteric Ischemia:

________ is mre appropriate inotropic agent with AMI in low doses, as it may act as a mesenteric vasodilator, and in higher doses, it produces less severe mesenteric vasoconstriction than other agents such as levo and neo

Dopamine

46



Mesenteric Ischemia: Anesthesia Implications:

usually considered what?


full stomachs

47



Mesenteric Ischemia: Anesthesia Implications:

what type of IV do you want?


large bore

48



Mesenteric Ischemia: Anesthesia Implications:

what type of monitoring should be used


invasive

49


what is the subjectively unpleasent sensation in the epigastrium and throat associated w/ urge to vomit

Nausea

50


what is the forceful expulsion of the upper GI contents through the mouth, caused by the powerful sustained contraction of the abd muscles?


vomiting

51


What si the labored rhythmatic activity of the respiratory muscles, including the diaphragm and abdominal muscles, w/o expulsion of gastric contents


Retching

52


what is the pt's most undesirable outcome of sx


Vomiting

53


what are the 4 main factors of PONV


Female

Nonsmoker

Hx of PONV

Postop Opioids

54


PONV:

if you have 1 risk factor what is your % of having PONV?

What about 2?

3?

4?

  • 0=10%
  • 1=20%
  • 2=40%
  • 3=60%
  • 4=80%

55


what are the 4 receptors that pharmacologically block PONV?


5-HT3

H-1

A-CH

D2

56


what drug blocks serotonin receptors centrally in chemoreptor triggerzone and peripherally at the vagal nerve terminals in the intestine. this action reduces nausea and vomiting by preventing serotonin release in the small intestine and by blocking sihgnals to the CNS


Serotenergic 5-HT3

57


what are 3 examples of sertotenergic 5-HT3 receptor drugs


Ondansetron

Dolastetron

Tropisetron

58


do H-1 drugs inhibit the release of histamine 1?


nope

59


what drugs do not inhibit the release of histamine, but rather attach tot he recptors and prevent responses mediated by histamine such as secretion of hydrogen ions from parietal cells and CNS system stimulation


Histamine H-1

60


What drugs block muscarinic chlinergic CNS emetic receptors in the cerebral cortex and pons


Cholinergic (muscarinic)

61

When should scopalamine be allplied?


evenning prior or 4 hours before the end of sx b/c 2-4 hour onset

62


D2-neuroleptics are antagonist at the dopaminergic receptors in teh chemoreceptor trigger zone of the meddula that are most effective in treating what?

Opioid induced N/V

63


What are 2 classes of neuroleptics utilized for N/V


Phenothiazines- Chloropromazine

Butyrophenones- Droperidol

64


Extrapyramidal effects are induced by neuroleptics causing what?


hypotension, dysphoria,

restlessness laryngospasm, and sedation

65


you should not administer neuroleptics to


Parkinson's

66


what are other Pharm agents not disscussed for PONV?


Corticosteroids

Benzodiazepines

Aplha 2-agonist

Propofol

Metoclopramide

67

facts:

alot of her studies stated that administering Zofran 30 in prior to conclusion of sx was better than before as package insert states


but the reason for early adminstration is to block the stimulus befre it occurs