GI diseases

Question 1

GERD - decreased resting tone of LES

Answer 1

with GERD - 13 mmHg
without - 29 mmHg

Question 2

airway effects of GERD

Answer 2

• cough
• pharyngitis
• laryngitis
• bronchitis
• pneumonia
• wheezing

Question 3

_____ of _________ have evidence of esophagitis or esophageal acid exposure

Answer 3

50% of asthmatics

Question 4

GERD aspiration risk

Answer 4

significantly increased

Question 5

carefully consider using __________ bc ____________

[GERD]

Answer 5

anti-cholinergic drugs
they decrease LES tone

Question 6

__________ increases both LES and intragastric pressure

Answer 6

Succinylcholine
(barrier pressure - LES minus intragastric pressure - is unchanged)

Question 7

H2 blockers increase ________ and decrease ____________

Answer 7

pH
gastric acid secretion

Question 8

PPIs inhibit _________ drugs and may increase ______ risks

Answer 8

anti-platelet
CAD

Question 9

GERD may require

Answer 9

cricoid pressure

Question 10

drugs that increase LES tone

Answer 10

metoclopramide
neostigmine
succinycholine
a-adrenergic stimulants

Question 11

drugs that decrease LES tone

Answer 11

atropine
glyco
b-adrenergic stimulants
propofol

Question 12

HH is herniation of stomach above _____ ______ into the _____ _______

Answer 12

hiatus diaphragm
mediastinal cavity

(can be classified from type I - IV)

Question 13

Most HH patients do NOT have _______ symptoms but may have _________

Answer 13

GERD
esophagitis

Question 14

anesthesia treats HH patients as __________ risk depending on severity of _________ symptoms with: (3 things)

Answer 14

aspiration risk
GERD

Treatment: cricoid pressure, PPIs, H2 blockers

Question 15

PUD Ulcer:

Answer 15

gastric mucosal loss and inflammation

Question 16

overproduction of _____ _____ and _______ erode protective mucosal layer. It may begin as erosions and then may penetrate deep/perforate

Answer 16

HCL acid
pepsin

Question 17

prostaglandins:

Answer 17

gastric epithelial layer for protection and repair

Question 18

NSAIDs are

Answer 18

anti prostaglandins

Question 19

90% of gastric and duodenal ulcers are caused from

Answer 19

H. pylori infections

Question 20

PUD complications (3)

Answer 20

hemorrhage
perforation
gastric outlet obstruction

Question 21

PUD hemorrhage remains unchanged since introduction of:

Answer 21

H2- receptor antagonists

Question 22

PUD perforation

Answer 22

sudden severe epigastric pain
peritoneum contaminated with gastric secretions

Question 23

PUD gastric outlet obstruction

Answer 23

caused by acute inflammation and swelling in pyloric channel and duodenum
vomiting: treat as full stomach

Question 24

ulcerative colitis - confined to mostly

Answer 24

rectum and rectosigmoid

30% of ppl have proximal involvement
20% have total colitis

Question 25

UC - mucosa becomes ulcerated, __________, and ______________.

Answer 25

edematous and hemorrhagic

Question 26

UC - inflammatory polyps can develop with

Answer 26

long standing disease

Question 27

UC - 3 major symptoms of ulcerated mucosa

Answer 27

1. rectal bleeding 2. diarrhea 3. crampy rectal pain, abdominal pain

Question 28

UC anesthesia implications - may present for colectomy

Answer 28

- colon perforation/obstruction possible - vomiting - may need aspiration precautions - dehydration - may need hydration - Hct may be low from rectal hemorrhage - electrolyte imbalances

Question 29

UC anesthesia implications - steroids

Answer 29

may need stress dosing

Question 30

UC anesthesia implications - if presenting for sx with active disease expect _________ _________ and _____ ______.

Answer 30

increased WBCs (leukocytosis) low albumin (may affect drug binding)

Question 31

Pancreatitis most common causes

Answer 31

pancreatitis is the acute inflammation of the pancreas caused by gallstones and ETOH

Question 32

pancreatitis symptoms

Answer 32

- severe mid-epigastric pain - N/V - abdominal distention, ileus - dyspnea may be from ascites or pleural effusions - fever - shock: tachycardia and hypotension

Question 33

pancreatitis lab work

Answer 33

elevated serum amylase and lipase

Question 34

pancreatitis treatment (5)

Answer 34

1. aggressive IV rehydration 2. NPO to rest pancreas**** 3. opioids 4. removal of obstructing gallstones and/or sphincterotomy (ECRP to reduce risk of cholangitis) 5. aspirate intra-abdominal fluids

Question 35

gallbladder disease cholestasis: cholelithiasis:

Answer 35

gallbladder disease cholestasis: impediment or stoppage of bile flow cholelithiasis: (gallstones) - result of western diet and prevalence increases with age, obesity, rapid weight loss, and pregnancy.

Question 36

cholelithiasis is more prevalent in

Answer 36

women

Question 37

gallbladder contraction is stimulated by

Answer 37

food intake

Question 38

cholecystitis

Answer 38

gallstone obstruction leading to acute inflammation

Question 39

cholecystitis labs

Answer 39

jaundice liver and pancreatic enzyme elevation

Question 40

cholecystitis symptoms

Answer 40

- N/V - abdominal pain (can start mid-epigastrum and then move RUQ, back) - tenderness - fever - leukocytosis - dehydration/electrolye abnormalities - murphy's sign (inspiration causes pain)

Question 41

cholecystitis treatments (4) and treatment of choice (1). (5 total)

Answer 41

- IV fluids - opioids - antibiotics - surgery - laparoscopic cholecystectomy is treatment of choice****

Question 42

cholecystitis symptoms not resolving or obstruction post lap chole:

Answer 42

- may need ECRP - sphincterotomy opens duct to allow bile drainage - pressure measurements of sphincter performed (may hold opioids to allow accurate measurement)

Question 43

biliary obstruction is an acute obstruction of the ________________ that can mimic ________________.

Answer 43

common bile duct cholecystitis

Question 44

chronic cholecystitis causes ________ ________ of gallbladder impairing ability to sufficiently excrete ________

Answer 44

fibrotic changes bile

Question 45

biliary obstruction often presents with _________ ________:

Answer 45

Charcot's Triad 1. fever/chills 2. RUQ pain 3. jaundice

Question 46

some ppl with biliary obstruction may also present with: (3)

Answer 46

1. anorexia 2. acute weight loss 3. N/V

Question 47

biliary obstruction radiographic findings:

Answer 47

dilated biliary tree and common bile duct

Question 48

biliary obstruction treatment: (2)

Answer 48

- ERCP with pressure readings can definitively diagnose stones in the common bile duct - sphincterotomy opens ductal stricture and allows stone and bile to flow through

Question 49

biliary obstruction anesthesia

Answer 49

can be GA or MAC

Question 50

bowel obstruction occurs at:

Answer 50

any place in the tract

Question 51

bowel obstruction can be caused by: (3)

Answer 51

1. cancer 2. fibrotic constriction: previous injury, adhesions 3. paralysis of gut

Question 52

effects depend on where the obstruction is ________

Answer 52

located

Question 53

stomach and small intestine obstruction effects: (3)

Answer 53

1. intestinal juices backflow leading to vomiting 2. loss of water and potassium 3. loss of acid from stomach and base from small intestine

Question 54

large intestine bowel obstruction effects: (3)

Answer 54

1. colonic dilation/ischemia leading to perforation if untreated 2. avoid opioids and anti-cholinergics 3. neostigmine dose shown to decompress colon