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GI Pathophysiology Flashcards

1
Q

True or false: this was the worst lecture all year

A

True

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2
Q

What is responsible for vasoconstriction of arterial blood flow to the G.I. tract?

A

Sympathetic nervous system

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3
Q

What two things enhance mechanical activity of the GI tract?

A

Distention and parasympathetic nervous system stimulation

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4
Q

What is the normal pH range for gastric fluid?

A

1-3.5

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5
Q

What are some symptoms of vagal stimulation during an abdominal procedure?

A 
Bradycardia
Decrease contractility
Vasodilation
Decreased blood pressure
Increased bowel mobility
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6
Q

What can you do when there is vagal stimulation during an abdominal procedure?

A

Tell the surgeon to quit dicking around

Give glycopyrrolate

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7
Q

What two things put the patient at high risk for aspiration pneumonitis?

A

Volume > 25 mL

pH < 2.5

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8
Q

What is the relationship between the pH and volume and severity of aspiration pneumonitis?

A

Dose-dependent relationship in the severity of AP for both volume and acidity that reaches the lung

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9
Q

What are some potential reasons for reduced airway reflexes and thus increased risk for perioperative AP?

A

Pregnancy, obesity, GERD, MS, MD, MG, ALS, (Stroke)

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10
Q

What are some methods for reducing the risk of regurgitation and pulmonary aspiration?

A 
RSI
Increase emptying
Decrease volume and acidity
NG/OG tube
H1 and H2-blockers
Minimize intake
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11
Q

What are the fasting guidelines for clear liquids in adults and children?

A

Adults >3 hours

Kids >2 hours

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12
Q

What are the ASA fasting recommendations for breastmilk and nonhuman milk/light meals preoperatively?

A

Breast milk >4 hrs

Light meals >6 hrs

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13
Q

Why is gum not allowed preoperatively?

A

It increases gastric volume and decreases pH

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14
Q

How could gum potentially be helpful post-op?

A

Prevent post-op ileus

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15
Q

What is peristalsis?

A

Wavelike movements of the bowel in a forward direction

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16
Q

How long is the average adult esophagus?

A

8 inches or 20 cm

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17
Q

What is the purpose of the upper esophageal sphincter?

A

Prevents aspiration of gastric contents into the lung and swallowing of air

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18
Q

What effect do most anesthetic agents have on UES tone?

What is the exception?

A

Most anesthetic agents decrease you UES tone

Ketamine increases

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19
Q

What is zenker’s diverticulum?

A

Diverticulum of the mucosa of the pharynx just above the cricopharyngeal muscle

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20
Q

What type of maneuver cannot be performed on patients with a zenker’s diverticulum?

A

Selleck (cricoid pressure)

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21
Q

What leads to gastroesophageal reflux?

A

Decrease in lower esophageal sphincter tone

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22
Q

What is the resting pressure of lower esophageal sphincter tone?
At what point is LES pressure problematic?

A

Normal: 15-30 mmHg
Problem: <10 mmHg

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23
Q

What is barrier pressure?

A

Difference between gastric pressure and LES pressure

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24
Q

What effect does cricoid pressure have on LES tone?

A

Decreases

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25
List some factors that decrease LES tone
``` Inhaled anesthetics Opioids Anticholinergic Propofol Beta blocker Hiatal hernia Pregnancy Obesity ```
26
List some factors that increase LES tone
``` Anti-cholinesterase Cholinergic Acetylcholine Metoclopramide Histamine Serotonin Metoprolol ```
27
What is an EGD?
Esophagogastroduodenoscopy
28
What is heartburn?
Incompletely closed lower esophageal sphincter allows acidic stomach contents to reflux into the esophagus
29
What is gastroesophageal reflux disease (GERD)?
When reflux occurs frequently or is bothersome
30
What is Barrett's esophagus?
Regular reflux of stomach acids irritates the esophagus, which may lead to histological changes and progress to malignancy
31
What is achalasia?
The LES does not relax properly
32
What is true of all general anesthetics in patients with achalasia?
RSI
33
What is esophageal stricture?
A narrowing of the esophagus
34
What are the risk factors for esophageal cancer?
Smoking, heavy drinking, chronic reflux
35
What is esophageal varices?
Dilated veins in the distal esophagus are at risk for serious bleeding
36
What is the main cause of esophageal varices?
Portal hypertension
37
What is the treatment for portal hypertension and hepatic encephalopathy?
TIPS Transjugular intrahepatic portosystemic shunt
38
In the event of an upper G.I. perforation early diagnosis and surgical management within what timeframe is best?
Within 12 hours
39
Upper GI perforation is associated with what mortality if delayed 24 hours? ....48 hours?
24 hrs --> 50% | 48 hrs --> 90%
40
What is the function of the stomach?
Food storage and initial digestion | NOT Nutrient absorption
41
How is the stomach innervated?
Vagus
42
What is the pyloric sphincter?
Opening from the stomach into the small intestine
43
What is the surgical treatment option for GERD and hiatal hernias?
Nissen fundoplication
44
What is a nissen fundoplication?
When the upper portion (fundus) of the stomach is wrapped around the lower esophagus
45
What happens to FRC, PIP, PaCO2, and PaO2 during Laparoscopic procedures?
Decrease FRC Increase PIP Increase PaCO2 Decrease PaO2
46
At what intra-abdominal pressure is there a decrease in venous return?
>15
47
Why is there a potential for shoulder pain during laparoscopic procedures?
Referred pain from stimulation to the phrenic nerve
48
Where does most digestion and absorption occur?
Small intestine
49
Parasympathetic simulation will have what effect on small intestine activity?
Increased activity
50
How much chyme is produced on a daily basis?
1 to 2 L/day
51
What effect do hypokalemia, peritonitis and laparotomy have on small intestine activity
All decrease activity for up to 48 hours
52
What is celiac disease?
Autoimmune disorder that destroys the villi in the small intestines Causes a reaction to eating gluten
53
What is Crohn's disease?
Autoimmune inflammatory bowel disease
54
How much can the gallbladder store?
50mL
55
Opioid effect what structure in the gallbladder? | How can this affect be reversed?
Sphincter of oddi | Reversed with glucagon or narcan
56
What is cholelithiasis?
Gallstones can lead to rupture
57
What are some potential causes of pancreatitis?
Alcohol abuse, blockage, trauma, autoimmune, hyperparathyroidism cystic fibrosis Propofol can cause at high doses
58
What is one of the most common causes of emergency abdominal surgery?
Appendicitis
59
What is an ERCP?
Endoscopic retrograde cholangiopancreatography | -View the entrance of the common bile duct
60
Where are water and electrolytes absorbed? | Where is feces stored?
The colon
61
Colonic secretions have what type of pH?
Alkaline
62
What type of inflammatory bowel disease usually begins in the rectal area and may involve the entire large intestine?
Ulcerative colitis
63
What is diverticulosis?
Small pouches in the lining off the colon, or large intestine, that bulge outward through weak spots
64
What is diverticulitis?
When the patches of diverticulosis become inflamed
65
What are some complications associated with diverticulosis?
Bleeding, abscess, perforation, peritonitis, fistula, obstruction
66
What is important to know about carcinoid tumors?
They secrete hormones
67
60% of carcinoid syndrome cases present as what?
Carcinoid heart disease | -Right sided involvement (Tricuspid regurge and pulmonary valve involvement)
68
What is important for the management of carcinoid syndrome?
``` Block histamine and serotonin receptors Avoid histamine releasing drugs Fluid resuscitation Monitor electrolytes and glucose Octreotide-somatostatin infusion ```
69
What are the life-threatening causes of agitation during a MAC case?
Hypoxemia Hypovolemia Local toxicity Cerebral hypoperfusion
70
What are the four categories used to gauge the depth of a MAC case?
Responsiveness Airway Spontaneous ventilation Cardiovascular
71
What effect does glucagon have on the sphincter of oddi?
Relaxes it
72
What are some of the pros and cons for using ketamine during MAC anesthesia?
Pros: Analgesia, CV stability Cons: Patient may move, hallucinate, drool
73
Why might glycopyrrolate be given in conjunction with ketamine?
To control secretions

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