GI Diseases (Exam IV)-Mordekai Flashcards
(112 cards)
1
Q
How much of the total body mass does the GI tract constitute?
A
5%
2
Q
What are the main functions of the GI system?
A
- Motility
- Digestion
- Absorption
- Excretion
- Circulation
3
Q
What are the layers of the GI system from the outermost to the innermost?
A
- Serosa
- Longitudinal muscle layer
- Circular muscular layer
- Submucoas
- Mucosa
4
Q
What are the layers of the mucosa from the outermost to innermost?
A
- Muscularis mucosae
- Lamina propria
- Epithelium
5
Q
What is the serosa layer of the GI system?
A
A smooth membrane of thin connective tissue and cells that secrete serous fluid to enclose the cavity and reduce friction between muscle movements.
6
Q
What is the longitudinal muscle layer of the GI system?
A
This layer contracts to shorten the length of the intestinal segment.
7
Q
What is the circular muscle layer of the GI system?
A
This layer contracts to decrease the diamter of the intestinal lumen.
8
Q
What 2 GI layers work together to propogate gut motility?
A
- Longitudinal muscle layer
- Circular muscle layer
9
Q
What innervates the GI organs up to the proximal tranverse colon?
A
The celiac plexus
10
Q
What innervates the descending colon and distal GI tract?
A
The inferior hypogastric plexus
11
Q
What 4 approaches can block the celiac plexus?
A
- Transcrural
- Inraoperative
- Endoscopic ultrasound-guided
- Peritoneal lavage
12
Q
Where is the myenteric plexus located?
A
- Lies between the smooth muscle layers and regulates the smooth muscle.
* Located in the muscularis layer
13
Q
Where is the submucosal plexus located?
A
- Transmits information from the epithelium to the enteric and central nervous system
- Located in the submucosa layer
14
Q
What is the mucosa layer of the GI tract composed of?
A
- A thin layer of smooth muscle called the muscularis mucosa, which functions to move the villi.
- The lamina propria, chich contains blood vessels and nerve endings.
- Immune and inflammatory cells
- The epithelium, Where the GI contents are sensed, enzymes are secreted, nutrients are absorbed, and waste is excreted.
15
Q
What innervates the GI tract?
A
Autonomic nervius system
16
Q
What does the GI ANS consist of?
A
- The oextrinsic nervous system - Has SNS and PNS components. SNS is primarily inhibitory and decreases GI motility. PNS is primarily excitatory and activates GI motility.
- Enteric nervous system - This is the independent nervous system that controls motility, secretion, and blood flow.
17
Q
What does the myenteric plus control?
A
Motility which is carried out by enteri neurons, interstitial cells of cajal (ICC. GI pacemaker), and smooth muscle cells.
18
Q
What 3 things does the submucosal plexus control?
A
- Absorption
- Secretion
- and mucosal blood flow
19
Q
True/False
The myenteric and submucosal plexus respond to sympathic and para sympathetic stimulation,
A
true
20
Q
What is an upper gastrointestinal endoscopy?
A
- May be diagnostic or therapeutoc endoscope placed into the esophagus, stomahc, pylorus, and duodenum.
- May be done with ot out anesthesia
- Anesthesia challenges = sharing airway with endoscopist
- Procedure is typically performed outside the main OR.
21
Q
What is a colonoscopy?
A
- May be diagnostic, therapeutic or interventional
- May be done with or without anesthesia
- Anesthesia challenges = patient dehydration due to bowel prep and NPO status.
22
Q
What is a high resolution manometry (HRM)?
A
- A pressure catheter that measures pressure along the entire esophageal length.
- Generally used to diagnose motility disorders
23
Q
What is a GI series with ingested barium test?
A
A radiologic assessment of swallowing function and GI transit
24
Q
What is a gastric emptying study?
A
The patient fasts for at least 4 hours, then consumes a meal with a radiotracer. Continuous or frequent imaging occurs for the next 1-2 hours
25
What is a small intestine manometry?
* A catheter that measures contraction pressures and motility of the small intestine.
* Evaluates contractions during 3 periods: fasting, during a meal, and post-prandial.
* Normally the recording time consists of 4 hours fasting, followed by ingestion of a meal, and then 2-hours post meal.
* Abnormal results are grouped into myopathic and/or neuropathic causes
26
What is a lower GI series test?
* Involves the administration of a barium enema to the patient.
* The barium outlines the intestines and it is visible on radiograph.
* This allows for detection of colon and rectal abnormalities.
27
* What is an esophageal disease?
* What are the 3 different groups?
* Diseases of the esophagus
* Groups = anatomical. mechanical, and neurologic.
28
What are anatomical causes of esophageal diseases?
* diverticula
* hiatal hernia
* changes associated with chronic acid reflux.
* These abnormalities interupt the normal pathway of food, which changes the pressure zones of the esophagus.
29
What are the mechanical causes of esophageal diseases?
* Achalasia
* esophageal spasms
* hypertensive LES
30
What are the neurologic causes of esophageal diseases?
* May be caused by neurologic disorders such as a stroke, vagotomy, or hormone deficiencies.
31
What are general symptoms of esophageal diseases?
- Dysphagia
- Heartburn
- GERD
32
* What is dysphagia?
* Differentiate the 2 types.
* Difficulty swallowing, may be oropharyngeal or esophageal
* Oropharyngeal dysphagia = common after head and neck surgeries.
* Esophageal dysphagia = classified based on physiology. Esophageal dysmotility symptoms occur with both liquids and solids. Mechanical esophageal dysphagia symptoms occur only with solid food.
33
* What is GERD?
* What are the symptoms?
* Gastroesophageal reflux disease
* An effortless return of gastric contents into the pharynx
* Symptoms include heartburn, nausea, and lump in the throat feeling.
34
What is achalasia?
What does it cause?
* A neuromuscular disorder of the esophagus consisting of an outflow obstruction due to inadequate LES tone and a dilated hypomobile esophagus.
* Reduced peristalsis and dilated espophagus
35
What is achalasia caused by?
* Theoretically caused by loss of ganglionic cells of the esophageal myenteric plexus.
* Followed by absence of inhibitory neurotransmitters of the LES.
* Unopposed cholinergic LES stimulation (LES can't relax)
* Esophageal dilation with food unable to pass into the stomach.
36
* What are the symptoms of achalasia?
* What is achalasia a long term increased risk of?
* S/S = dysphagia, regurgitation, heartburn, and chest pain.
* Long term increased risk for esophageal cancer
37
How is achalasia diagnosed?
Diagnosis made with esophageal manomertry and or esophpgram.
38
What is a type 1 achalasia class?
* Minimal esophageal pressure
* responds well to myotomy
39
What is a type 2 achalasia class?
* Entire esophagus pressurized
* Responds well to treatment
* Has the best outcomes
40
What is a type 3 achalasia class?
* Esophageal spasms with premature contractions
* Has the worst outcomes
41
What are the treatments for achalasia?
* All treatments are palliative.
* Medications = nitrates and CCBs to relax LES
* Endoscopic botox injections
* Pneumatic dilation (most effective nonsurgical treatment)
* Laparoscopic hellar myotomy (best surgical treatment)
* POEM - peri-oral endoscopic myotomy. Endoscopic division of LES muscle layers. (40% develop pneumothorax or pneumoperitoneum).
* Esophagectomy - only considered in the most advanced disease states.
42
What are achalasia patients at risk for and what type of intibation is indicated?
* Increased risk for aspiration.
* Needs RSI or awake intubation
43
Differentiate dysphagia and odynophagia.
- **Dysphagia** - difficulty swallowing
- **Odynophagia** - painful swallowing
44
What is a normal LES (lower esophageal sphincter) resting tone?
29 mmHg
45
What is the biggest risk with achalasia?
How would anesthetic practices change for a achalasia patient?
- Aspiration
- NPO for 24-48 hours prior to Heller myotomy or POEM.
46
How would a esophageal motility vs structural issue be delineated?
- Structural = difficulty w/ solids
- Motility = difficulty w/ solids & liquids.
47
* What is a diffuse esophageal spasm?
* What population is it more common in?
* How is it diagnosed?
* What are the S/S?
* A spasm that usually occurs in the distal esophagus likely due to autonomic dysfunction,
* More common in the elderly
* Diagnosed with an esophram
* S/S - pain mimics angina
48
What would an esophageal spasm look like under direct visualization?
- Corkscrew or rosary bead appearance.
49
What medications could be used to treat esophageal spasms?
- Nitroglycerin
- Trazodone
- Imipramine
- Sildenafil
- Antidepressants
- PD-I's
50
What is an esophageal diverticulum?
What kinds are there?
Esophageal wall out-pouching
- Pharyngoesophageal (**Zenker's**)
- Mid-esophageal
- Epiphrenic (supradiaphragmic)
51
What are the main symptoms of esophageal diverticula?
- Halitosis (bad breath)
- Dysphagia (worse with larger pockets)
52
What is the treatment for esophageal diverticula?
- Small - medium: nothing
- Medium - large: removal
53
What are anesthesia considerations and risks for esophageal diverticula?
- **No cricoid pressure**
- **Avoid NGT**
- Intubate w/ head elevated
- Aspiration risk
54
What type of hernia is depicted by 1 on the figure below?
Normal (no hernia)
55
What type of hernia is depicted by 2 on the figure below?
Sliding Hiatal hernia
56
What type of hernia is depicted by 3 on the figure below?
Paraesophageal Hiatal hernia
57
What types of cancer are normally seen with esophageal cancer?
Where are they located typically?
- Squamous cell carcinoma (mid-esophagus)
- Adenocarcinomas (distal esophagus)
58
What signs/symptoms are indicative of esophageal cancer?
- Progressive dysphagia
- Weight loss
- Pancytopenia
- Lung Injury
- Malnourishment/dehydration
59
What is the treatment for esophageal cancer?
- Esophagectomy
- Chemotherapy
- Radiation
60
What deficient LES pressure is typically seen with GERD?
13 mmHg
61
What typically causes GERD?
- LES hypotension
- GE junction abnormality (hiatal hernia)
62
What complications can occur with chronic GERD?
- Esophagitis
- Laryngopharyngeal reflux
- Recurrent pulmonary aspiration (chronic cough)
63
What treatments are used for GERD?
- Lifestyle modifications
- PPIs > H2 antagonists
- Niessen fundiplocation
64
What are anesthesia considerations for GERD patients?
Manage Aspiration risk
- **Ranitidine** > cimetidine
- PPI's
- Na⁺ citrate + reglan
- **RSI + Cricoid pressure** recommended.
65
What is peptic ulcer disease (PUD) ?
How does it present and what causes it?
- Ulcers of mucosal lining of stomach or duodenum causing a burning epigastric pain; caused by *H. Pylori* decreasing normal gastric mucosa HCO₃⁻ .
- ***H. Pylori*** + **NSAIDs**.
66
Who is at greater risk for PUD?
- Alcoholics
- Elderly
- Malnourished
67
What significant risk factors come from untreated PUD?
- Bleeding
- Peritonitis → **sepsis**
- Dehydration
- **Perforation**
68
What is the mortality risk of bleeding from PUD?
- 10 - 20%
69
What sort of perforation risk is conferred from untreated PUD?
What symptom is seen with perforation?
- 10% risk
- Sudden and severe epigastric pain
70
What drugs (along with abbreviated MOA's) are used to treat PUD?
- Antacids (OTC relief of dyspepsia)
- H2 receptor antagonists (*ranitidine & famotidine* are better than *cimetidine*)
- PPI's
- Prostaglandin Analogues (*Misoprostol* maintains mucosal integrity)
- Cytoprotective agents (*Sucralfate* creates chemical barrier)
71
How is H. Pylori treated?
- **PPI + 2 ABX for 14 days**
72
Which antibiotics are used for H. Pylori treatment?
- Clarithromycin and amoxicillin or metronidazole.
73
What is post-gastrectomy dumping syndrome?
- **Release of GI vasoactive hormones** from pyloric sphincter dysfunction causing food to move from the stomach into small bowel too early.
74
Differentiate Early vs Late Dumping syndrome.
- **Early** - lots of symptoms (cramping, ↓BP, N/V/D, etc)
- **Late** - Hypoglycemia
75
What is the treatment for dumping syndrome?
- Dietary modifications
- Octreotide
76
What is ulcerative colitis?
What are all the signs/symptoms?
- Mucosal disease involving all or most of the colon to rectum.
- Bleeding, tenesmus, N/V/D, fever, and weight loss.
77
What is tenesmus?
- Tenesmus = Urge to poop
78
What major complications can occur with severe ulcerative colitis ?
- Massive hemmorrhage
- Toxic megacolon
- Obstruction
- Perforation
79
What is the surgical treatment for ulcerative colitis?
- Total proctocolectomy
80
What is Crohn's disease?
What are the symptoms?
- Acute/Chronic bowel inflammation
- Weight loss, inflammatory mass, bowel spasm, steatorrhea, & stricture formation.
81
What anatomical feature separates the small and large intestine?
Ileocecal valve
82
What surgical treatment exists for severe Crohn's disease?
- Bowel resection
- Proctocolectomy
83
What medical treatment exists for mild-moderate IBS?
What meds are used in severe cases?
- Normal cases: 5-ASA, glucocorticoids, ciprofloxacin and metronidazole.
- Severe cases: Azathioprine & 6MP or methotrexate & cyclosporine
84
What organs are a part of the foregut?
- Thymus
- Esophagus
- Lungs
- Stomach
- Duodenum
- Pancreas
85
What organs are a part of the midgut?
- Appendix
- Ileum
- Cecum
- Ascending Colon
86
What organs are a part of the hindgut?
- Distal large intestine
- Rectum
87
Less than _____% of carcinoid tumors originate in the lung tissue.
What "gut" are the lungs located in?
- 25%
- Foregut
88
What do carcinoid tumors secrete?
- **Insulin**
- **Histamine**
- **Serotonin**
*GI peptides and/or vasoactive substances*
89
Compare/contrast serotonin secretion from all parts of the gut.
- **Foregut** - Low serotonin secretion
- **Midgut** - High serotonin secretion
- **Hindgut** - Rare serotonin secretion
90
Which part of the gut is prone to development of carcinoid syndrome?
- Midgut
*Foregut is atypical, hindgut is rare*.
91
What is carcinoid crisis/syndrome?
What are the signs & symptoms?
- Release of serotonin and/or histamine from carcinoid tumor.
- Flushing, diarrhea, ↓↑BP, bronchostriction/wheezing.
92
What symptoms commonly present with small intestine carcinoid tumor?
- Abdominal pain (51%)
- Intestinal obstruction (31%)
93
What symptoms commonly present with rectal carcinoid tumors?
- Bleeding (39%)
94
What symptoms commonly present with bronchus carcinoid tumors?
- Asymptomatic (31%)
95
Where are metastases from carcinoid tumors most often found?
What is the presenting symptom?
- Liver; found via hepatomegaly
96
What most often provokes carcinoid crisis?
- **Biopsy** of tumor
- Chemo
- Stress
97
What drugs may provoke mediator release (serotonin, histamine, etc) from carcinoid tumors?
- Succinylcholine
- Atracurium
- Epi/NE
- Dopamine
- Isoproterenol
- Thiopental
98
What drugs are used in the treatment of carcinoid tumor crisis?
- 5HT blockers
- H-antagonists
- Somatostatin analogues (*Octreotide*)
- Ipratropium
99
How do somatostatin analogues treat carcinoid tumor patients?
- Prevention of Carcinoid Crisis
100
What are the causes of acute pancreatitis?
- **Gallstones & EtOH abuse** (60-80% of cases)
- AIDS
- Hyperparathyroidism
- Trauma
101
What lab values indicate acute pancreatitis?
- ↑ serum amylase & lipase
102
What do the Ranson criteria indicate?
What would the below indicate:
- 0-2 criteria?
- 3-4 criteria?
- 5-6 criteria?
- 7-8 criteria?
- Ranson Criteria indicate severity & mortality of acute pancreatitis.
- 0-2 = <5% mortality
- 3-4 = 20% mortality
- 5-6 = 40% mortality
- 7-8 ≈ 100% mortality
103
What are treatments for acute pancreatitis?
- Aggressive IV fluids
- Colloids
- NPO
- Enteral/TPN
- NGT suction
- Pain management
- Gallstone removal
104
What are signs/symptoms of chronic pancreatitis?
- Post-prandial epigastric pain
- Emaciated
- Steatorrhea
- DM
105
What conditions put one at risk of chronic pancreatitis?
- Chronic EtOH
- Cystic fibrosis (?)
- Hyperparathyroidism
106
What's the number one cause of upper gastric GI bleeding? Number 2?
1. Varices
2. Peptic Ulcer Disease
107
Where are bleeding uclers most often found in peptic ulcer disease?
- Duodenal (36%)
- Gastric (24%)
108
What is the most common cause of lower GI bleeding?
- Colonic Diverticulosis (41%)
109
What characterizes initial acute upper GI bleeding?
- ↓BP and ↑HR w/ 25% or more blood loss
- HCT normal at beginning
- Anemia
110
What are signs of chronic upper GI bleeding?
- Orthostatic hypotension from Hct <30%
- BUN >40mg/dL
111
What anesthetic technique should be employed for upper GI bleeding?
- RSI (rapid sequence intubation)
112
In patients with carcinoid tumors, how early should octreotide be administered to prevent crisis during surgery:
A. 4 hours
B. 24 hours
C. 12 hours
D. 8 hours
B. 24 hours
