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Foundations II > GI Disturbances > Flashcards

GI Disturbances Flashcards

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1
Q

Esophagus originates where?

A

The level of the sixth cervical vertebra

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2
Q

Esophageal Wall Consists of:

A

Outer longitudinal Layer

Inner Circular Layer

Mucosal Lining

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3
Q

Why does GI cancer metastasize so quickly:

A

Large amount of lymphatic tissue

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4
Q

Blood supply to the esophagus

A

Inferior Thyroid Arteries (supply cervical esophagus)

Aorta Esophageal branches of bronchial arteries (supply thoracic esophagus)

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5
Q

Innervation of the GI Tract

A

Intrinsic: (2 interconnected plexuses)

1) Myenteric (Auerbach Plexus)
2) Submucosal (Meissner Plexus)

*Continuum that extends from esophagus to anus

_Extrinsic: _

1) Sympathetic (act on myenteric to modulate rather than control)
2) Parasympathetic (Cranial nerves IX, X, XI)
- Cause esophageal contractions and relaxation of LES
3) Somatic

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6
Q

Resting State of Esophagus

A

UES and LES closed at rest

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7
Q

What excites the UES

A
  • Inspiration
  • Esophageal Distention
  • Gagging
  • Valsalva Maneuver
  • Acidity of Gastric Contents
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8
Q

UES tone is reduced by:

A
  • Distention
  • Belching
  • Vomiting
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9
Q

Normal LES Tone:

A

20- 30 mmHg

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10
Q

What is Achalasia and what is the primary concern?

A

Failure of LES tone to relax during swallowing accompanies by a lack of peristalsis

***Huge aspiration Risk***

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11
Q

Barret Esophagus

A

Occurs secondary to chronic GERD, ETOH abuse, smoking

Closely associate with esophageal CA

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12
Q

GERD (Definition and Treatment)

A

Failure of LES to function properly allowing stomach contents to reflux

Therapy: PPIs and H2 blockers

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13
Q

Hiatal Hernia (Definition, types, symptoms)

A

Weakness in the diaphragms that allows a portion of the stomach to migrate up into the thoracic cavity.

Type 1(sliding)- upper portion of stomach pops up through (GE junction)

Type 2 (Paraesophageal)- esophagus in place but portion of stomach comes up

Type 3 (Mixed)- Combines I&II

Type 4- Stomach and other organs (small bowel)

Retrosternal pain of a burning quality common after means, treated surgically

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14
Q

What is the most dangerous Esophageal Diverticula?

A

Zenker (upper esophagus)–> big aspiration risk

  • Epiphrenic (LES)
  • Traction (mid esophagus)
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15
Q

Does daunorubicin and doxorubicin cause cardiomyopathy or pulmonary fibrosis

A

Causes cardiomyopathy

These meds are used in hte treatment of Esophageal CA, do a cardiac workup if taking these

Also: Bleomycin causes pulmonary fibrosis which is a restrictive disease

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16
Q

Anesthetic Consideration for Esophageal Disease

A
  • History of GERD: plan for aspiration precautions–> possibly RSI
  • ETT warranted–> protects airway
  • Emergence just as important as induction for risk of aspiration–> fully awake
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17
Q

During Esophageal Surgery what Intraoperative Complications can occur?

A
  • Arrythmias
  • Hypotension
  • hemmorhage
  • RLN injury–> affect ability to cough and increases risk of aspiration pna
  • Tracehobronchial tree injury
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18
Q

Anatomical Parts of the Stomach

A
  • Fundus
           uppper abdomen/ primary job is storage (4 hours)
  • Distal Stomach
           thick walled, mixing of food, slow release of chyme through pyloric sphincter into duodenum
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19
Q

Acid Release Cascade

A

G-cell (located in the submucosa) is activated by stretch receptors–> secretes Gastrin into circulating system

This mobilizes ECL cells to release histamine

Histamine stimulates parietal cells to secrete HCL acid

**This whole process is vagally mediated** (acetylcholine)

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20
Q

Pharmacologic Gastric Acid Control

A

H2 antagonists- Shut down histamin preventing release of HCL via parietal cells

  • Cimetidine
  • Ranitidine

PPIs- directly block the proton pump (parietal cell)

  • Omeprazole
  • Prostaglandin
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21
Q

Other Functions of the Stomach

A

Barrier against pathogens

Thermoregulation

Vitamin B12 absorption (intrinsic factor)

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22
Q

Blood Supply of Stomach

A

4 Major Arteries

R/L gastric arteries

R/L gastroepiploic

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23
Q

Innervation of the Stomach

A

Major is Autonomic

Two branches of the vagus nerve

  • Right posterior (celiac) branch
  • Left anterior (hepatic) branch
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24
Q

Peptic Ulcer Disease

A

Erosion of the protective mucous layer of the stomach and duodenum

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25
Most associated cause of PUD
Helicobacter Pylori * overuse of NSAIDS, steroids * Excessive etoh consumption * Stress * smoking \*originates from the imbalances of the aggressive forces and the mucosal defense forces
26
Treatment of PUD
* Erradication of H. Pylori * High dose PPI's * Sucralfate * Endoscopy * Surgery \*Surgical treatment no longer considered primary
27
Milk Alkali Syndrome
Occurs with treatment of PUD with antacids * Hypercalcemia * Alkalosis * Elevated BUN Manifests as skeletal muscle weakness and polyuria Also hyophosphatemia secondary to large amounts of aluminum containing anatacids
28
Adverse effects of H2 Antagonists
Can alter CYP-450 system and prolong the effects of meds that depend on this system H2 works on ECL cell PPI works on Parietal cell
29
Gastric Neoplastic Disease- what type is most common
Majority is malignant, and 95% of them are adenocarcinoma, 4% lymphoma
30
S/S of Gastric Neoplastic Disease
* Anorexia * Weight loss
31
Surgical Treatment of Gastric Carcinoma
Total or subtotal gastrectomy Omentectomy, lymph node dissection, and splenectomy depending on extent * Gastrectomy * Billroth II (Gastrojejunostomy)
32
Pancreas General Facts
* Secretes 1500-3000ml of pancreatic juice daily * pH 8.3 * Principle fuction is to adjust duodenal pH * Promotes function of pancreatic enzymes * Acid and Fats stimulate release of secretin causing HCO3- to neutralize acidic chyme
33
Acute Pancreatitis
Patient are extremely ill with severe abdominal pain, fever, nausea, vomiting, jaundice, hypotension, ileus Common causes ETOH abuse Direct or indirect Trauma Infection Perforation
34
Management of Acute Pancreatitis
* NG suction * MIVF * Anticipate respiratory problems/ ARDS * Analgesia * Nutrition * expect calcium imbalances
35
Surgical Therapy for Pancreatitis
Drainage of pseudocyst Pancreatojejunostomy Puestow Procedure \*\*Severe major surgery\*\*
36
Cure Rate of Pancreatic CA
5%
37
Procedure for Pancreatic CA
Whipple Procedure/ Pancreatoduodenectomy
38
Gall Bladder
Pear Shaped, holds 30-50cc of bile
39
Bile 3 Main Functions
1. Emulsify and enhance fat and fat soluble vitamin absorption 2. Provide an excretory pathway for bilirubin, drugs, toxins, IgA 3. Maintain duodenal alkalization
40
Cholecystitis
Acute obstruction of the Cystic Duct * Severe midepigastric pain, often radiates to right abdomen * Murphy sign- inspiration accentuates the pain * Jaundice suggests complete obstruction of the cystic duct] \*s/s often mimic MI so r/o cardiac event with serial enzymes and ECG
41
Cholelithiasis
Acute obstruction of the common bile duct * symptoms simliar to cholecystitis * charcot triangle- fever, chills, upper quadrant pain
42
Cholecystectomy anesthetic considerations
* Post-op pain * Nausea and vomiting * Pain in upper left shoulder from CO2 * High aspiration risk * Decreased venous return from increased intraabdominal pressure secondary to CO2 insufflation
43
Length of Portions of the Intestinal Tract
Duodenum ~20cm Jejunum ~100cm Ileum~ 150cm
44
What breaks down proteins
enzymes (trypsin and chymotrypsin)
45
What breaks down lipids
Lipase (pancreatic lipase)
46
What breaks down carbohydrates
amylase
47
Absorption of food occurs through what process
Diffusion \*\*Villi have a very large surface area\*\*
48
Diseases of the Small Intestine
Malabsorption Syndromes * celiac * fat/ protein malabsorption Maldigestion * Deficient pancreatic secretion Upper GI bleed Small bowel obstruction
49
How long is the Large Intestine
Colon 3-5 feet long
50
What are haustrations
Numerous outpouchings found in the colon wall
51
Blood supply of the Large Instestine
Superior Mesenteric Artery Infererior Mesenteric Artery Internal Iliac Artery
52
How many Liters of water does your colon absorb daily
1-2 liters
53
Differences of Crohns and Ulcerative Colitis
Crohns can happen all throughout colon large family history link Inflammatory disease (antiinflammatories, steroids) Multiple surgeries Ulcerative Colitis typically in descending and small part of transverse ulcerative disease, loss of haustria
54
Anesthesia Considerations of Intestinal Surgery
* Aspiration risk * Fluid and electrolyte imbalance * History of steriod use (pre-op coverage, adrenal insufficiency) * Aviod Nitrous oxide * TPN * Bowel prep- dehydrated further * Discern NG vs. OG * RSI- consider full belly
55
Splenectomy
* ITP, TTP * Hodgkins disease * Lymphoma * Sickle cell disease
56
3 Important Things for Laparascopic Abdominal Surgery
1. Foley or void prior 2. Drop OG to decompress stomach 3. Antibiotics
57
Drugs that decrease LES increasing the risk of aspiration
* anticholinergics * dopamine * thiopental * opioids * propofol * trycyclic antidepressants * sodium nitroprusside
58
Drugs that increase LES and decrease the risk of aspiration
* metoclopramide * prochlorperazine * edrophonium * neostigmine * pancuronium * alpha-adrenergic agents * antacids \*Succ increases LES but also increases gastric pressure during fasiculations\*
59
Gold Standard method of airway management
ETT
60
Hallmark manifestations of cholelithiasis
* fatty food intolerance * right upper quadrant pain (formation of gall stones)
61
Symptoms of cholecystitis
Inflammation of cystic duct or gall bladder * pain that resembles cholelithiasis * leukocytosis * fever * abdominal muscle guarding * rebound tenderness
62
Two most common causes of Acute Pancreatitis
Cholelithiasis and alcohol abuse accounts for 60-80% of all cases
63
What acid base balance is typically seen with pyloric stenosis
Metabolic Alkalosis (vomiting all their acid out, along with electrolyte disturbances)
64

Foundations II (2 decks)

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