Flashcards in GI/Liver Deck (57)
What are the guidelines for NPO status pre-operatively in a healthy patient?
no chewing gum or candy after midnight
clear liquids up to 2 hours before
breast milk up to 4 hours before
light meal, milk or formula up to 6 hours before
(only really applicable in ASA class 1 or 2 patients)
What are some factors that make a patient at high risk for aspiration?
ascites or ESLD
metabolic disorders like DM, ESRD or hypothyroid
mechanical obstruction like intestinal obstructions or pyloric stenosis
What kinds of patients are at the GREATEST risk of aspiration?
high anxiety pre-op
pregnancy (esp after 14 weeks)
What are some common treatments for aspiration prophylaxis?
sodium citrate (bicitra)
H2 Antagonists -- special considerations?
act as competitive antagonists at the H2 receptors at the gastric parietal cells to decrease acid secretion
best if given the night before surgery and then repeated 1 hour before surgery
ex. cimetidine and famotidine
metoclopramide -- special considerations
acts as a dopamine antagonist to increase pressure at the lower esophageal sphincter to speed up gastric emptying
prevent or alleviates N/V
CONTRAINDICATED in intestinal obstruction
sodium bicitrate (bicitra) -- special considerations
its a non-particulate antacid used to raise gastric pH (30 mL of volume which may contribute to aspiration risk)
give it 15 minutes before surgery and it will last for 3 hours
not indicated if the patient has no risk factors for aspiration, per ASA
What are some physiologic risk factors for aspiration pneumonitis?
pH 25 mL in 70 kg patient
What are the manifestations of aspiration pneumonitis?
potentially the only sign intra-op might be a persistent desat with the tube definitely in the right place
bronchospasm, cyanosis, tachycardia, dyspnea
how are aspiration syndromes characterized?
by volume aspirated, type of material aspirated, pH of the material
What is the treatment for Barrett's Esophagus?
H2 blockers, PPIs, nissen fundoplication
what are S&S of barrett's esophagus?
dysphagia, reflux esophagitis, heartburn, LES dystonia, weight loss
How would you modify the anesthetic plan in the case of a patient with Barrett's Esophagus?
prepare for an RSI
What are the S&S of a hiatal hernia?
reflux after meals
What is the usual cause of peptic ulcer disease?
What are some typical treatments for peptic ulcer disease?
H2 antagonists, PPIs, antimicrobial therapy, antacids
Who is at high risk for a peptic ulcer?
chronic NSAID use, age 45-60, ETOH
What are the S&S of peptic ulcer disease?
abdominal tenderness and rigidity
What are some examples of malabsorption syndromes?
protein malabsorption syndromes
fat malabsorption syndromes
small bowel perforation or obstruction
What is the clinical significance of malabsorption syndromes?
metabolic disturbances that change electrolytes and fluid status
What are some S&S of malabsorption syndromes?
unexplained weight loss
Vit K deficient
What is the clinical significance of Crohn's disease pre-anesthetically?
deficient in multiple vitamins and minerals such as B12, phosphorous, folic acid, zinc, iron, K+
What are the S&S of ulcerative colitis?
intermittent bloody diarrhea
What are some anesthetic considerations for a patient with large colon dysfunction, such as Crohn's and uclerative colitis?
patient may be on chronic steroids and would require a stress dose pre or intra op
prepare for immune suppression r/t meds and higher infection risk
What is carcinoid syndrome?
a small tumor that has originated in the GI tract or bronchi and will produce hormones that can be secreted in the blood and cause systemic effects
What are some S&S of carcinoid syndromes?
cutaneous flushing, diarrhea, palpitations, bronchospasm, dyspnea, hypotension, hypertension, orthostasis
*may want to consider a 12 lead EKG if there are S&S of a dysrhythmia
What is the problem with having a carcinoid syndrome?
the tumors secrete hormones such as bradykinin, serotonin, dopamine and and histamine
What are some helpful lab values when taking care of a patient with severe GI or liver disease?
Hct, albumin, serum electolytes, BUN
Nutritional deficiencies are associated with what poor outcomes?
prolonged hospital stays
poor wound healing
higher infection rate