Flashcards in GI/Liver Deck (72)
When can liberal fasting guidelines be used?
In healthy patients
How soon before surgery can a patient have a sip of water or oral liquid medication?
Up to 1 hour before surgery
People who are aspiration risks
Age extremes (70)
Collagen vascular diseases
Metabolic disorders (DM, hypothyroid, ESRD)
People with greatest aspiration risk
Medications for aspiration prophylaxis
H2 receptor antagonists
Sodium citrate (Bicitra)-- acts as a buffer
Metoclopramide (Reglan) - increase gastric motility and increases sphincter tone
Omeprazole (Prilosec)-- will decrease acidity
H2 Antagonist that gives the best result
Examples of H2 antagonists
How do H2 antagonists work?
Reduce acid secretion by competitively binding to H2 receptors on parietal cells.
When should H2 antagonists be given?
Night before surgery and repeated 45-60 minutes before surgery
How does metoclopramide (Reglan) prevent aspiration?
By preventing and alleviating nausea
MOA: Dopamine antagonist which increases lower esophageal sphincter tone and increases gastric emptying
When is metoclopramide (Reglan) contraindicated?
In a bowel obstruction
When do we give meds like H2 blockers, reglan, and bicitra?
If the person has risk factors for aspiration****
We do not give these meds to patients routinely
When before surgery to you give bicitra?
15 minutes before surgery, and it lasts 1-3 hours.
Increases gastric volume and can cause nausea.
When would we do Sellick's maneuver?
During RSI (for someone at high risk of aspiration and we can't do an awake intubation)
Complications of Sellick's maneuver
Esophageal rupture and cricoid ring fracture
How to perform Sellick's maneuver
Apply light downward and cephalad pressure (10N) in the awake pressure, and increase pressure as the patient drifts to sleep (20-44N).
Risk factors for aspiration pneumonitis (Mendelson Syndrome)
Gastric volume > .4mL/kg (about 25mL for a 70kg patient)
Gastric pH < 2.5
Severity of aspiration pneumonitis depends on
Contents of the gastric material aspirated
S/S of aspiration pneumonitis
Resp distress with bronchospasm
Why does Barrett's esophagus place a person at risk for aspiration?
Because the esophagus becomes less functional, causing dysphagia. Person also obviously has very bad GERD, as this is what caused the disease in the first place.
S/S of hiatal hernia
Burning after meals
Where does peptic ulcer disease most commonly occur?
Antrum of stomach
Causes/risk factors for peptic ulcers
Also s/s of peptic ulcers
Chronic NSAID use
Hematemesis or melena in acute hemorrhage
S/S of malabsorption syndromes
Unexplained weight loss****
Vit. K deficiency
Differences between Crohn's and UC
- Vit/mineral deficiencies (B12, mag, folic acid, zinc, iron, and potassium)
- protein loss (decreased serum albumin)
- Intermittent blood diarrhea (hooray!)
- Abd pain
- Risk of colon CA
What is carcinoid syndrome?
Carcinoid tumors (which release hormones), arising from the appendix, pancreas, or bronchi, secrete substances into the GI tract and systemic circulation, causing an array of symptoms.
Substances released by carcinoid tumors in carcinoid syndrome
Malnutrition is associated with these complications
Prolonged hospital stay
Albumin level less than ___ in the general surgical population is indicative of malnutrition
Also weight loss greater than 10% in 6 months is also indicative of malnutrition