RED ONLY GI Flashcards by Linsay AugustinCRNA

What do Parietal cells secrete ?

HCl, IF

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What do Chief cells secrete?

Pepsin

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What do G cells secrete?

(Gastrin)

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Parasympathetic nervous system Stimulatory/inhibitory

(stimulatory)

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Parasympathetic stimulate through which nerve

– Primarily through vagus CN X

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Sympathetic nervous system Stimulatory/inhibitory

Inhibitory

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SNS on cells reduce what?

Reduced secretions & regeneration epithelial cells

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What are the 2 CN for neural controls in mouth

CN VII and IX

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Role of CN VII and IX

Maintain continuous flow of saliva in the mouth

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Secreted by stomach in response to distention

Gastrin

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Increases gastric secretions & motility

Gastrin

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relaxes pyloric and ileocecal sphincters –

Gastrin

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promotes stomach emptying

Gastrin

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Gastrin (SIRP)

Secreted in response to distention
Increases gastric secretions and motility
Relaxes pyloric and ileocecal sphincters
Promotes stomach emptying.

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Gastrin vs Cholecytokinin

Gastrin Promote gastrin emptying

Cholecystokinin : Decrease gastrin emptying

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Secretin (tone in down)

Decrease gastric secretions

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Increased secretion of hydrochloric acid

Histamine(H2 receptor)

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Stimulates contraction of gallbladder

Cholecystokinin

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Enterochromaffin cells use _____to synthesize

Use tryptophan hydroxylase-1 to synthesize Serotonin (5-HT)

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Neuroendocrine cells Stimulates those reflexes SPV

via

Secretory, peristaltic and vagal reflexes ;5-HT 3 receptor

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Important in generating nausea/vomiting

5 HT3 receptors

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Neuroendocrine Cells of GI Release

Histamine stimulates parietal cells via H2 receptors HCl production

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Anorexia and vomiting

– Can cause serious complications (MAD)

Dehydration, acidosis, malnutrition

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Can cause dehydration, acidosis, malnutrition

Anorexia/vomiting

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2 roles of medulla

Coordinates activities involved in vomiting | Protects airway during vomiting

Vomiting center located in the

medulla

Vomiting Center Activation: ICP

Increased intracranial pressure | Sudden projectile vomiting without previous nausea

What is “Coffee grounds”? What does it indicate?

brown granular material indicates action of HCl on hemoglobin

Steatorrhea – “fatty diarrhea

Characteristic of malabsorption syndromes

Steatorrhea : Characteristic of malabsorption syndromes such as

• i.e., celiac disease or cystic fibrosis

Upper GIB is (DES)

• Esophagus, Stomach, or duodenum

Lower GI bleeding (JICR)

Below the ligament of Treitz: bleeding from the jejunum, ileum, colon, or rectum

2 common complications of GI tract disorders

Dehydration and hypovolemia

Acid-base imbalances

– Metabolic alkalosis

– Metabolic acidosis how?

• Severe vomiting causes a change to metabolic acidosis due to the loss of bicarbonate of duodenal secretions. • Diarrhea causes loss of bicarbonate

Why metabolic alkalosis

• Results from loss of HCl w/ vomiting

3 types of abdominal pain

Visceral • Somatic • Referred

Visceral pain BDCC

Burning sensation Dull, aching pain Cramping or diffuse pain Colicky, often severe pain

Inflammation and ulceration in upper GI tract

Burning Sensation

Typical result of stretching of liver capsule

Dull, aching pain

Inflammation, distention, stretching of intestines

Cramping or diffuse pain

Recurrent sooth muscle spasms or contraction

Colicky often severe pain

Response to severe inflammation or obstruction

Recurrent sooth muscle spasms or contraction

Somatic pain receptors directly linked to____ | What do they benefit from?

spinal nerves – May cause reflex spasm of overlying abdominal muscles

Steady, intense, often well-localized pain

Somatic pain

Over area of involvement / inflammation of peritoneum

“Rebound tenderness”

Results when visceral and somatic nerves converge | at one spinal cord level.

Referred pain

To relieve pyrosis

• Antacids

To relieve vomiting

• Antiemetics

Treatment of acute constipation

• Laxatives or enemas

Reduction of peristalsis | Relieve cramps

• Antidiarrheals

What is Sulfasalazine?:

– Anti-inflammatory and antibacterial | – For acute episodes of inflammatory bowel disease

ABX what are they? What are they effective against | Combined with ?

- Clarithromycin or azithromycin – Effective against Heliobacter pylori infection • Usually combined with a proton pump inhibitor

Sucralfate What are they and what do they do?

– Coating agent – Enhance gastric mucosal barrier against irritants such as NSAIDs

Anticholinergic drugs: What do they do?

Reduce secretions &motility

H2 blockers useful for ?

Useful in gastric reflux

PPIs

Reduce gastric secretion

(Dysphasia) –

Inability to speak

GERD Anesthesia concerns:

Aspiration

• Possible related respiratory concerns with GERD: RAL

• Recurrent pneumonia • Asthma (50% of pt.s have endoscopic evidence of esophagitis) • Laryngitis

Peptic Ulcers – Gastric & Duodenal • Complications: – Hemorrhage (DCM ) – Perforation

* Due to erosion of blood vessels * Common complication * May be the first sign of a peptic ulcer

Peptic Ulcers – Gastric & Duodenal | • Complications: CUR

* Chyme can enter the peritoneal cavity. * Ulcer erodes completely through the wall. * Results in chemical peritonitis

Peptic Ulcers – Gastric & Duodenal | • Complications: – Obstruction

• May result later due to the formation of scar tissue

Treatment of Peptic ulcer: Gastric & Duodenal

Combination of antimicrobial & PPI to eliminate H. pylori

Dumping syndrome Pathophysiology

Hyperosmolar chyme draws fluid from vascular compartment into intestine leading to – Intestinal distention – Increased intestinal motility

Dumping syndrome Signs and symptoms?

Hypotension Tachycardia Diaphoresis Pallor

Dumping and glucose

Hypoglycemia 2 to 3 hours after meal:

Why does dumping syndrome cause HYPOGLYCEMIA?

High glucose levels in chyme stimulate increased insulin secretion → hypoglycemia

Acute Pancreatitis

Pancreas lacks fibrous capsule. Destruction may progress into tissue surrounding the pancreas – Substances released by necrotic tissue lead to widespread inflammation – Hypovolemia and circulatory collapse may follow

– Hypovolemia and circulatory collapse may follow

Acute pancreatitis

in Acute Pancreatitis: Chemical peritonitis results in

bacterial peritonitis | Septicemia may result

Acute Pancreatitis resp and renal

Adult respiratory distress syndrome and acute renal | failure occur in 25% of patients

May also occur with pancreatitis

GI hemorrhage & DIC may also occur

What is GASTRINOMA? • IV ranitidine (H2 blocker) useful for preventing acid hypersecretion intra-op.

Gastrin secreting tumor in Pancreas or Duodenum causing GASTRIC HYPERSECRETION

Anesthesia consideration for Gastrinoma?

• Large volumes of gastric fluid usually present at | time of anesthesia induction = ↑risk of reflux / aspiration.

Gastrinoma is associated with _________

Profuse watery diarrhea

GastriNOMA associated with Profuse watery diarrhea leading to what kind of ACID BASE DISTURBANCES

Hypokalemia and METABOLIC ALKALOSIS

Appendicitis – Signs and Symptoms BATH

“Boardlike” abdomen, tachycardia, hypotension

Appendicitis As peritonitis develops____/. Toxins lead to

abdominal wall muscles spasm. | Toxins lead to reduced blood pressure.

Intestinal Obstruction functional obstruction can lead to

Mesenteric thrombosis (Dehydration in HHS)