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Flashcards in GI/Liver Deck (72)
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1

When can liberal fasting guidelines be used?

In healthy patients

2

How soon before surgery can a patient have a sip of water or oral liquid medication?

Up to 1 hour before surgery

3

People who are aspiration risks

Age extremes (70)
Ascites
Collagen vascular diseases
Metabolic disorders (DM, hypothyroid, ESRD)
Mechanical obstruction
Prematurity
Pregnancy
Neurologic diseases

4

People with greatest aspiration risk

Pregnant
Morbidy obese
Hiatal hernia
Pre-op anxiety

5

Medications for aspiration prophylaxis

Anxiolytics
H2 receptor antagonists
Sodium citrate (Bicitra)-- acts as a buffer
Metoclopramide (Reglan) - increase gastric motility and increases sphincter tone
Omeprazole (Prilosec)-- will decrease acidity

6

H2 Antagonist that gives the best result

Famotodine (Pepcid)

7

Examples of H2 antagonists

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotodine (Pepcid)

8

How do H2 antagonists work?

Reduce acid secretion by competitively binding to H2 receptors on parietal cells.

9

When should H2 antagonists be given?

Night before surgery and repeated 45-60 minutes before surgery

10

How does metoclopramide (Reglan) prevent aspiration?

By preventing and alleviating nausea

MOA: Dopamine antagonist which increases lower esophageal sphincter tone and increases gastric emptying

11

When is metoclopramide (Reglan) contraindicated?

In a bowel obstruction

12

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

13

When before surgery to you give bicitra?

15 minutes before surgery, and it lasts 1-3 hours.
Increases gastric volume and can cause nausea.

14

When would we do Sellick's maneuver?

During RSI (for someone at high risk of aspiration and we can't do an awake intubation)

15

Complications of Sellick's maneuver

Esophageal rupture and cricoid ring fracture

16

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).

17

Risk factors for aspiration pneumonitis (Mendelson Syndrome)

Gastric volume > .4mL/kg (about 25mL for a 70kg patient)
Gastric pH < 2.5

18

Severity of aspiration pneumonitis depends on

pH
Volume
Contents of the gastric material aspirated

19

S/S of aspiration pneumonitis

Resp distress with bronchospasm
Dyspnea
Cyanosis
Tachycardia

20

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.

21

S/S of hiatal hernia

Retro-sternal discomfort
Burning after meals

22

Where does peptic ulcer disease most commonly occur?

Antrum of stomach
or
Duodenal bulb

23

Causes/risk factors for peptic ulcers
Also s/s of peptic ulcers

H. Pylori
Age 45-60
Chronic NSAID use
Steroid use

S/S:
Epigastric pain
Vomiting
Hematemesis or melena in acute hemorrhage
Perforation
Abdominal tenderness/rigidity

24

S/S of malabsorption syndromes

Unexplained weight loss****
Diarrhea
Steatorrhea
Vit. K deficiency
Bleeding dyscrasias
Anemia
Fatigue
Edema/ascites

25

Differences between Crohn's and UC

Crohn's
- Vit/mineral deficiencies (B12, mag, folic acid, zinc, iron, and potassium)
- protein loss (decreased serum albumin)
- anemia

UC
- Intermittent blood diarrhea (hooray!)
- fever/malaise
- Abd pain
- Risk of colon CA

26

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.

S/S:
Flushing
Diarrhea
Bronchospasm
Dyspnea
Hypo/hypertenion
Orthostatic hypotension)
Palpitations

27

Substances released by carcinoid tumors in carcinoid syndrome

Bradykinin
Histamine
Serotonin
Dopamine

28

Malnutrition is associated with these complications

Prolonged hospital stay
Wound infection/abcess
Resp failure
Death

29

Albumin level less than ___ in the general surgical population is indicative of malnutrition

3.5

Also weight loss greater than 10% in 6 months is also indicative of malnutrition

30

Albumin level less than ___ is a major predictor of morbidity

2.1