hepatobiliary/GI Flashcards by Sarah Horvath

what are the 4 layers of the esophagus

outer longitudinal layer
inner circular muscular layer(smooth and striated muscle)
mucosal lining (squamous epithelium, distal 1-2cm is columnar epithelium)

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What is the concern with esophageal surgery?

close proximity to aorta

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achalasia

failure of the lower esophageal sphincter tone to relax during swallowing accompanied with a lack of peristalsis

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what causes achalasia

DM
stoke
Amyotrophic lateral sclerosis
connective tissue diseases

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what happens to the epithelium in barret esophagus

normal squamous epithelium changes to metaplastic columnar epithelium

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what causes barrett esophagus

chronic exposure to acidic gastric contents - GERD, chronic etoh, smoking

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Barrett esophagus is closely associated with ____?

esophageal cancer

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What medications are used to manage GERD?

PPI’s & H2 blockers

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Failure of the LES to function properly, permitting stomach contents to reflux into the esophagus and possibly the pharynx is what condition

GERD

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Weakness in the diaphragm that allows a portion of the stomach to migrate upward into the thoracic cavity is what condition

hiatal hernia

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retrosternal pain of a burning quality that commonly occurs after meals is a characteristic of what condition?

Hiatal Hernia

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What are two surgical tx for hiatal hernia

nissen & fundoplication

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Where is a epiphanic diverticula located

near the LES

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where is a traction diverticula located

mid esophagus

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where Is a zenker diverticula located

upper esophagus

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what is the risk of esophageal diverticula?

places the pt at risk for pulm aspiration of regurgitated food and also from food/fluids ingested but sequestered within the pouch

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what do chemo drugs such as danunorubicin and doxorubicin cause

chemotherapy induced cardiomyopathy

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what can bleomycin cause

pulmonary fibrosis, restrictive defect, increased potential for O2 toxicity.

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anesthetic consideration for extubating a patient with esophageal disease

Patient must be fully awake and have demonstrated conscious control of the airway prior to extubation.

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anesthetic consideration for intubating a patient with esophageal disease

ETT to create a sealed airway to prevent the risk from passive regurg and aspiration
RSI with cricoid pressure

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what types of intraop complications are associated with esophageal cancer?

hemorrhage
injury to the tracheobronchial tree
RLN injury

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what types of post-op complications are associated with esophageal cancer

anastomic leak; mediastinities; 
pleural effusion, 
pneumonia,
ARDs,
cardiac and functional complications

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Post-op tumor recurrence in patients with esophageal cancer:

not uncommon in patients undergoing curative resection for esophageal cancer - can be characterized as either loco regional (loco regional lymph node metastases, anastomic recurrence) or distant (hematogenous metastases, pleural or peritoneal seeding).

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hematogenous metastases most commonly involve which organs

liver, lungs, bones. followed by adrenal glands, brain, and kidneys.

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injury to the RLN places a patient at higher risk for?

aspiration pneumonia. impairs the ability of the patient to cough.

Mortality rates for esophageal resection have dropped from __% in the 1970s and early 1980s to __% in the late 1980s and early 1990s.

12 3

what are the most serious complications of esophageal resection?

anastomotic leak, mediastinitis and sepsis, and respiratory failure.

acid secretion of patietal cells depends on which energy pump

hydrogen/potassium (H+/K+) powered by ATP

acid release in the stomach is mediated by which three things

- vagal stim (ach) - gastrin release (g cells in response to gastric distention) - histamine

examples of H2 antagonists

cimetidine, ranitidine,

examples of H+/K+ ATP inhibitors

omeprazole, prostaglandins

what does vagotomy surgery do

diminishes parietal-cell response to gastrin and histamine

How is the gastric system a barrier against ingested pathogens

acidic environment, immunosurveillance

how is the gastric system a thermoregulator

heats or cools ingested substances

how does vitamin B12 play a role in the gastric system

parietal cells secrete intrinsic factor, facilitates ideal vitamin B12 absorption

the stomach is innervated by which nerve

vagus (X)

which disease is caused by erosion of protective mucous layer of the stomach and duodenum?

peptic ulcer disease

what causes peptic ulcer disease

- helicobacter pylori - overuse of NSAIDS, ASA, and corticosteroids - excessive etoh, tobacco, stress, radiation therapy

associated diseases with PUD

cirrhosis, chronic renal failure, zollinger ellison syndrome, hyperparathyroidism, chronic lung disease, chronic pancreatitis

what are the 3 components of milk-alkali syndrome

hypercalcemia, alkalosis, elevated BUN

how does milk-alkali syndrome manifest

skeletal muscle weakness and polyuria

oral antacids - how does acid rebound happen

gastric acid secretion may increase after existing acids are neutralized by calcium containing antacids

what do large amounts of aluminum containing antacids do to phosphorus levels

cause acute hypophosphatemia which manifests as skeletal muscle weakness and fatigue, pathologic fractures, osteoporosis

what drugs are given for PUD?

h2's and PPI's

how do H2 receptors work

block secretion of hydrochloric acid, promotes healing of duodenal ulcers.

how do h2's interact w CYP450

may cause prolongation of the effects of concurrently administer drugs that rely on hepatic metabolism and elimination. famotidine is the least likely H2 antagonist offender

which drug binds to the ulcer, increases the gastric mucous layer, promotes the healing process, and is devoid of side effects?

sucralfate

what is Misoprostol used for

synthetic prostaglandin, secondary therapy to prevent ulcers in patients requiring NSAIDs

s/s of gastric neoplasms

anorexia and weight loss

majority of gastric neoplasms are classified as?

adenocarcinoma (95%)

which patients is increased gastric mucosal acidosis common in ?

critically ill, | pt undergoing prolonged, complex surgical procedure, pt undergoing CPB

gastritis associated with gastric mucosal acidosis is associated with

increased peri-operative morbidity and mortality

The abdominal viscera is particularly at risk to diminished blood flow (ischemia) and break down of the intestinal barrier may occur. Why is this concerning?

leads to translocation of bacteria and endotoxins into the bloodstream (sepsis)

what is the principle function of the pancreas

adjust duodenal pH

presence of acid in duodenum cause release of ___

secretin

presence of fats in duodenum causes release of ____

cholecystokinin

vagal stim to the pancreas causes release of

pancreatic enzymes

common causes of acute pancreatitis

- alchohol abuse - direct or indirect traume - ulcerative penetration from adjacent structures - infectious processes - biliary tract disease - metabolic disorders - drug side effect

pancreatitis s/s

extremely ill with severe abd pain, fever, nausea, vomiting, jaundice, hypotension, ileus, and external distortion of stomach on radiographs

acute pancreatitis management

- NG suction - maintenance of intravascular volume - anticipation of resp insufficiency - analgesia - nutritional support - common bile duct exploration

s/s of chronic pancreatitis

incapacitating upper abd pain radiating to the back (continuous or intermittent in nature)

what condition causes steatorrhea

chronic pancreatitis

40% of patients with chronic pancreatitis have ___ From loss of pancreatic function

diabetes

common causes of chronic pancreatitis

- chronic alcoholism - chronic, significant biliary tract disease - long term effects of pancreatic injury

pancreatic cancer usually presents with

jaundice

what do gallstones look lik eon x-ray

radiolucent structures

regulation of gallbladder contraction is primarily hormonal thru the action of ______ which is released from dudenum and mediated by presence of intraluminal amino acids and fats

cholecystokinin

what are the three main functions of bile?

- emulsify and enhance absorption of ingested fats and fat-soluble vitamins - provide an excretory pathway for bilirubin, drugs, toxins, and IgA - maintain duodenal alkalization

how do patients present with cholecystitis

acute, severe, mid-epigastric pain that often radiates to the right abdomen

what is murphys sign

inspiratory effort accentuates cholecystitis pain

what would you expect labs to look like in someone with cholecystitis?

increase in plasma bilirubin, alkaline phosphatase, amylase, and WBC's

gallbladder perforation may cause what 3 things

peritonitis, localized tenderness, or ileus

complete obstruction of the cystic duct will present as

jaundice

what is free abdominal air suggestive of

ruptured viscus with perf of gallbladder - requires emergency exp lap

charcot triangle is indicative of?

acute ductal obstruction.

charcot triangle symptoms

fever, chills, upper quadrant pain, weight loss, anorexia, fatigue.

cholecystitis is an acute obstruction of the ___ duct, while cholelithiasis is obstruction of ___ duct

cystic , common bile duct

increased intra-abdominal pressure causes ____ venous return

decreased

manipulation of abdominal visera may cause ___Cardia and ____tension

brady, hypo

laparoscopic surgery's affect on ventilation

altered ventilatory dynamic caused by large volume of intra-abdominal carbon dioxide/hypercapnia

what type of embolism does laparoscopic surgery place pt at risk for

venous CO2 embolism

how does laparoscopic surgery increase risk of aspiration

abnormal gastroesophael junction competence from high intra-abdominal pressure

where does most digestion take place

small intestine

proteins and peptides are degraded into

amino acids

lipids are degraded into

fatty acids and glycerol

which disease is characterized by "cobble stoning"

crohn's

which disease is characterized by pseudopolyps

Chrons primary effects which part of the digestive track

SI and colon

which GI disease has a higher risk for smokers

chrons

which GI disease has a greater cancer risk

UC effects which part of GI track

lower colon and rectum

intestinal surgery - avoid which gas

nitrous oxide

in the fetus, the spleen is a ____ organ

hematopoietic

hepatobiliary/GI Flashcards

(93 cards)