15. Digestive system Flashcards
Vagus innervation
Innervates the esophagus,
stomach, pancreas, small intestine and proximal half of the large intestine
B12 absorption
Ileum
Scoline and digestive system
Using scoline increases intragastric pressure which may lead to reflux and aspiration
The effect of opiates on the digestive system?
Reduces gastric motility
Inhibits gastric emptying
Increases fluid absorption from the intestine
Post operative Ileus
1 Manipulation of the intestine is the main cause of postoperative ileus. Additional contributors -
Immobility, electrolyte disturbances from fluid shifts, swelling of the intestine
2 There are 2 phases to postoperative ileus. The first is neurogenic, which lasts several hours and the second phase is inflammatory and lasts several days.
3 During a normal postoperative course, without complications, ileus is expected to continue for about 3-4 days
4 Due to pain an manipulation
Liver innervation
Celiac plexus. T5- T10
Celiac plexus innervation
Stomach, liver, pancreas, spleen, small intestine, proximal part of the colon
Esophagus innervation
From C6 to T 11
Opiates and digestive system
Activation of Mu receptors in the Myenteric plexus causes a decrease in intestinal activity and increases rectal muscle tone
Action of Duodenum
Chemical digestion
Promote gastric distention (hormones)
Gastrin and NO
Neostigmine vs sugamadex
Neostigmine can produce contraction that can lead to dehiscence. Sugam no
Opioid preferred for the GI
Transdermal patches of fentanyl (much better than morphine)
Complications of celiac plexus block
Hypotension
Diarrhea
Renal injury
Pneumothorax
Chylothorax
Paraplegia
Peritonitis and abscess
Retroperitoneal hematoma
ERAS protocol
Regional anesthesia
Avoidance of opioids
Multimodal analgesia
Preoperative nutrition
Bowel preparation
Fluid optimization
Temp control
Early removal of drains, mobilization, oral intake
