APA 2 - GI Disturbances and Anesthesia Flashcards
1
Q
The process of digestion begins with __________
A
mastication
2
Q
Local and general anesthesia depress sensation of the _____ ______ innervation
A
upper airway
3
Q
Trigeminal nerve
A
nasopharynx
4
Q
glossopharyngeal nerve
A
posterior third of tongue and oral pharynx
5
Q
SLN
A
tongue base and inferior epiglottis to the vocal cords
6
Q
RLN
A
vocal cords distally
7
Q
Branches of vagus nerve
A
remaining larynx and trachea
8
Q
Pathology such as pharyngeal tumor, CVA and metabolic toxins increase the reisk of periopertive inability to handle ________ and puts the patient at risk for aspiration pneumonia
A
secretions
9
Q
Originates at the pharynx at approximately the level of the 6th cervical vertebra and extends to the stomach
A
esophagus
10
Q
3 functional zones of esophagus
A
Upper Esophageal Sphincter, Esophageal body, Lower Esophageal sphincter
11
Q
Typically, the sphincters hold tight but with _______ _______ can cause sphincter relaxation and higher risk of aspiration
A
anesthesia induction
12
Q
Cricoid cartilage is at about
A
C6
13
Q
Esophageal wall consists of outer longitudinal layer, inner circular ______ ______, and ______ lining
A
muscular layer / mucosal
14
Q
Inner circular muscular layer consists of ____ and ______ muscle
A
smooth and striated
15
Q
Mucosal lining has _______ epithelium, except for distal 1-2cm which is composed of _________ epithelium
A
squamous / columnar
16
Q
The esophagus passes through a space creagted by the ____ _____ of the diaphragm
A
right crus
17
Q
The esophageal wall is ______ absorptive
A
highly
18
Q
The myenteric plexus of Auerbach is mainly a __________ (vagus nerve) plexus along with some postganglionic ______ nerves
A
parasympathetic / sympathetic
19
Q
The inferior thyroid arteries supply the _____ ______
A
cervical esophagus
20
Q
Aorta esophageal branches of bronchial arteries supply the ______ _______
A
thoracic esophagus
21
Q
Intrinsic innervation is provided by the myenteric or _______ plexus and the submucosal or ________ plexus
A
Auerbach / Meissner
22
Q
The intrinsic innervation extends from the esophagus to the _______
A
anus
23
Q
Extrinsic innervation is provided by the ________, _______ and _______
A
sympathetic / parasympathetic / somatic
24
Q
Extrinsic sympathetic innervation acts on _______ plexus to modulate rather than control motor activity
A
myenteric
25
Extrinsic parasympathetic innervation involves cranial nerves ___, ____, _____ and causes esophatgeal muscular relaxation as well as relaxation of the ______
IX / X / XI / LES
26
Both the UES and LES are _____ at rest
closed
27
Excitatory stimulation of the UES occurs due to (5)
inspiration, esophageal distention ,gagging, valsalva maneuver, acidity of gastric contents
28
UES tone is reduced by (3)
distention, belching, vomiting
29
Swallowing initiates peristalsis that has average velocity of ____ cm/sec and a maximum pressure of _____mmHg
3-4 cm/sec AND 150 mmHg
30
Swallowing decreases _______ within 1.5-2.5 sec, this decrease in tone is maintained for the duration of the peristaltic wave
LES
31
ingestion of meal or increased abdominal pressure _________ LES tone via _______ afferent pathways
increases / vagal
32
Normal LES tone is ______mmHg and can be _________
20 / overcome
33
Normal LES is mediated by intrinsicc ____ and excitatory nerual mechanisms. __________ innervation is predominant
myogenic / vagal
34
With chronic alcoholism you will see what 4 things
impaired esophageal peristalsis, LES HYPOTONIA, Degeneration of the auerbach plexus, mallory weis tear
35
Failure of the LES tone to relax during swallowing accompanied with a lack of perstalsis
achalasia
36
Achalasia develops secondary to what chronic diseases
diabetes, stroke,amyotrophic lateral sclerosis, connective tissue diseases (amyloidosis and scleroderma)
37
With Barrett Esophagus, normal squamous epithelium changes to ________ __________ epithelium
metaplastic columnar epithelium
38
Barrett esophagus causes
chronic exposure to acidic gastric contents (GERD), chronic alcohol abuse, smoking
39
Barret esophagus is closely associated with eventual development of _______ ________
esophageal carcinoma
40
GERD is from failure of the _______ to function properly permitting stomach contents to reflux into the esophagus and possibly the pharynx
LES
41
Current mangagment modality for GERD
PPIs and H2 antagonists
42
This happens due to a weakness in the diaphragm that allows a portion of the stomach to migrate upward into the thoracic cavity
hiatal hernia
43
Primary symptoms of hiatal hernia include ________ pain of a burning quality that commonl occurs after meals, peptic esophagitis and it is treated _______
retrosternal / surgically
44
Review types of hiatal hernia on slides
27 and 28
45
Most common surgical procedure for hiatal hernia
nissen fundoplication
46
Esophageal diverticula are classified according to ______
location
47
Epiphrenic
locared near the LES
48
Traction
located mid-esophagus
49
Zenker
locared upper esophagus
50
Esophageal diverticula place the patient at risk for pulmonary aspiration of regurgitated food and also from food/fluids ingested but sequestered within ________
pouch
51
With Esopahgeal malignancy, the patient may have had preoperative radiation which can result in bone marrow suppression, intrathoracic and pulmonary ________ and increased friability of tissues
fibrosis
52
Daunorubicin and doxorubicin/adriamycin both can cause chemotherapyy induced _________
cardiomyopathy
53
Bleomycin can cause ________ _______ which results in a restrictive defect and increased potential for ____________ toxicity
pulmonary fibrosis / oxygen
54
A history of GERD with active reflux symptoms warrants a plan for _________ prophylaxis during _________ and __________ from general anesthesia
aspiration / induction / emergence
55
Esophageal disease mandates use of a ___________ _________ to create a sealed airway to prevent risk from passive regurgitation and aspiration
endotracheal tube
56
Someone with esophageal disease should be fully _______ and have demonstrated conscious control of the airway prior to extubation
awake
57
Esophageal cancer surgery Ivor-Lewis Repair
Anterior abdominal incision and right thoracotomy
58
Esophageal cancer surgery Ivor-Lewis McKeown - type
right neck incision, excision of diseased esophagus, anastamosis of stomach to cervical esophagus
59
If weight loss has exceeded ____%, enteral nutrition comprising of at least ________kcal/day of a high protein liquid diet should be administerd at least _____ days before surgery
10 / 2000 / 10
60
_______ ___________ should always be corrected preoperatively
aspiration pneumonia
61
Esophageal resection is associated with various inratoperative complications (3)
hemorrhage, injury to the tracheobronchial tree, RLN injury
62
Esophagela resection postopervie complications
anastomotic leak, mediastinitis, respiratory problems, pleural effusion, pneumonia, and ARDS, cardiac and functional complications
63
Postoperative _____ ______ is not uncommon in patients undergoing curative resection for esophageal cancer and can be categorized as either locoregional or distant.
tumor recurrence
64
______ _________ most commonly involve the liver, lungs and bones followed by the adrenal glands, brain and kidneys and may involve multiple organs simultaneously
hematogenous metastases
65
Intraoperative complications include ________ and ____________, hemorrhage, injury to the tracheobronchial tree and injury to the RLN
arrhythmias and hypotension
66
Injuries to the RLN can imparit the ability of the patient to _______ and can cause aspiration pneumonia.
cough
67
With the recent advancement of extended lymphadenectomy in esophageal cancer surgery, accurate disection of lymph nodes along the _______ chains and preseration of these nerves are important surgical issues
RLN
68
Look at slide
49 (RLN)
69
Regardless of surgical technique used, esophageal resection is a high-risk procedure associated with considerable _______ and ________. With improvements in techniques, there has been a decrease from 12% in the 1970s to ____% in the late 1980s and 1990s.
morbidity and mortality / 3%
70
Morbidity and mortality rates vary greatly depending on the surgical volumes, hospital size and degree of ________ specialization
cancer
71
Most serious complications of esophageal resection
anastomotic leak, mediastinitis, sepsis and respiratory failure
72
Two sections of the stomach
fundus and distal stomach
73
Fundus of stomach is _____walled, distendable, located in the _______ abdomen and primary function is ________ (4hrs)
thin / upper / storage
74
The distal stomach is ______ wallled, this is where mixing of food occurs, and slow relesase of _____ through _____ ______ into the duodenum
thick / chyme / pyloric sphincter
75
The stomach is located in the uppr part of the abdomen just beneath the ______
diaphragm
76
An empty stomach is roughly the size of an ______ _____. It can fill much of the upper abdomen when distended with food and may descend into the _____ _____ or pelvis upon standing
open hand / lower abdomen
77
The duodenum extends from the _______ to the ligament of ______ in a sharp curve that almost completes a circle
pylorus / treitz
78
The duodehum is eaual in length to the breadth of 12 fingers or about _____ cm
25 cm
79
The duodenum is largely __________ and the position is relatively _______. The stomach and duodenum are closely related in function and in pathogenisis and manifestation of disease
retroperitoneal / fixed
80
The serosa is the ______ _______ of the gastric wall and. The three smooth muscle layers are?
external layer / outer longitudinal, middle circular, inner oblique
81
The anatomy of the gastric wall from exgternal to internal
Serosa -> muscularis mucosae (smooth muscle) -> submucosa -> mucosa
82
acid secretion of _____ ______ requires a hydrogen/potassium exchange pump pwered by _____
parietal cells / ATP
83
Acid release is mediated by vagal stimulation (Ach), _______ release (in response to gastric distension) and histamine
gastrin
84
Many of our reversal medications will increase the amount of ______ available at all receptor sites, resulting in lots of GI stimulation (salivation, urination, defecation, gastric contents)
Acteylcholine
85
Within the gastric mucosa reside the glands responsible for the physiologic role of the stomach during digestion. The fundic mucosa has mucus-secreting glands that provide a protective barrier to the acid outflow of ______ ______
parietal cells
86
The sight and smell of food stimulates ____ and ______ production
acid / pepsinogen
87
Gastrin is released by __ cells in response to ______ ________ which stimulates parietal-cell acid secretion
G / gastric distension
88
_______ acid suppresses gastric fedback (negative feedback)
luminal
89
Anticholinergic agents have a minor (not therapeutic) effect on ______ ______ secretion
parietal cell
90
What surgery can be done to control gastric acid secretion
Vagotomy
91
A vagaotomy diminishes parietal cell response to ______ and _______
gastrin and histamine
92
The stomach or gastric acts as a barrier against ingested pathogens by providing an acidic environment and ________
immunosurveilance
93
The stomach can ___ or cool ingested substances
heat
94
Parietal cells secrete ______ ________ which fascilitates ileal vitamin b12 ________
intrinsic factor / absorption
95
Blood supply of stomach is primarily from ___ arteries. Right and left _______ arteries AND the right and left _______ arteries
4 / gastric / gastroepiploic
96
Major innervation of the stomach is ________. Two branches of the vagus nerve including the _____ ______ (celiac) branch and the ____ _______ (hepatic) branch.
autonomic / right posterior / left anterior
97
______ is caused by erosion of protective muscous layer of the stomach and duodenum
PUD
98
Associated causes of PUD
H. Pylori, overuse of medications like NSAIDS, ASA, corticosteroids, excessive alcohol consumption, tobacco use, stress, and receiving radiation therapy
99
___ _______ is the major etiologic factor for PUD
H. Pylori
100
If the LES is incompetent, ulcerative involvement of the ________ may also occur
esophagus
101
Subsequent ulceration over time result in lesions of _____ ______
varying depth
102
Oral antacids may produce an ____ _____ in which gastric acid secretion may increase after existing acids are neutralized by calcium-containing antacids.
acid rebound
103
Milk-alkali sundrom is characterized by what and manifests as what?
Characterized: hypercalcemia, alkalosis, elevated BUN Manifests: as skeletal muscle weakness and polyuria
104
You can have _____ ________ secondary to large amounts of aluminum-containing antacids
acute hypophosphatemia
105
Acute hypophasphatemia manifests as skeletal muscle weakness, _______ fractures, and _________
pathological / osteoporosis
106
H2 antagonists blocks secretion of ____ _____
hydrochloric acid
107
H2 antagonists promotes healing of duodenal ulcers but can alter the __________ enzyme activity in the liver
CYP450
108
If taking H2 antagonists and knowing that it alters the CYP450 system, you also know that it may cause ________ of the effects of concurrently administered drugs that rely on hepatic metabolism and eliminaton
prolong
109
________ is the least likely H2 antagonist to slow down the CYP450 system
famotidine
110
________ is the most likely H2 antagonist to slow down the CYP450
cimetidine
111
Most effective antisecretory agent
PPIs
112
Omeprazole and rabeprazole how much and how often
20 mg once daily
113
Esomeprazole and pantoprazole how much and how often
40 mg once daily
114
Lansoprazole how much and how often
30 mg once daily
115
_____ ______ produce hydrochloric acid
parietal cells
116
Aluminum salt of sulfated sucrose, binds to ulcer, increases the gastric mucous layer, promotes healing process, devoid of side effects
sucralafate
117
synthetic prostaglandin, secondary therapy to prevent ulcers in patients requiring NSAIDS
misoprostol
118
Look at slide
77
119
1st line therapy for eradication of H. Pylori
PPI Bid + clarithromycin 500 mg BID + Amox 1G BID OR Metronidazole 400-500 mg BID instead of AMOX
120
Parietal cell vagotomy is where there is selective sectioning of ______ fibers of the gastric _____ and parietal cells
vagal / fundus
121
Antrectomy with pyloroplasty and vagotomy AKA
Bilroth I
122
Majority of gastric neoplasms are _______
malignant / 95% adenocarcinoma, 4% lymphoma, 1% leiomyosarcoma
123
Lates S/S of gastric neoplasm
anorexia and weight loss
124
Surgical treatment of gastric carcinoma includes total or subtotal _______. Or, omenectomy, lymph node dissection and spleenectomy based on the _____ of disease
gastrectomy / extent
125
Bilroth II AKA
Gastrojejunostomy
126
Increased gastric mucosal acidosis is commin in (3)
critically ill patients, pt. undergoing prolonged and complex surgical procedure, pt undergoing CABG
127
Gastritis associated with gastric mucosal acidosis is associated with increased peri-operative _________ and _________
morbidity and mortality
128
The ________ _________ is particularly at risk to diminshed blood flow (ischemia) and break down of the intestinal barrier may occur. This leads to translocation of ________ and endotoxins into the blood stream causing sepsis
abdominal viscera / bacteria
129
Exocrine function of the pancreas, it secretes _____ to ______ ml of pancreatic juice daily
1500ml-3000ml
130
Pancreatic juice is clear, colorless liquid with a ph of _____ and ionic composition of Na, K, bicarb and chloride. Principle function is to adjust ______ pH and promotes optimal function of ______ enzymes.
8.3 / duodenal / pancreatic
131
Direct endocrine function (non-ductal) of pancreas is production of _____ and _______
insulin and glucagon
132
Acinar cells secrete _______ enzymes
digestive
133
islets of langerhans is considered the ______ portion of pancreas
endocrine
134
Presence of acid in duodenum causes release of
secretin
135
Presence of fats in duodenum cause release of ________
cholecystkinin
136
Vagal stimulation of pancreas causes release of ________ _______
pancreatic enzymes
137
Secretin causes release of _______
bicarb
138
Sphincter of Oddi is located in the _______
pancreas
139
Delta-cell causes _______ secretion
somatostatin
140
Acute pancreatitis is characterized by extremely ill patients with severe abdominal pain, fever, nausea, vomiting, jaundice, hypotension, ileus, and external distortion of stomach on radiographs. What are some common causes?
alcohol abuse, direct or indirect trauma, infections process, biliary tract disease, metabolic disorders, drug side effect, and ulcerative penetration from adjacent structures
141
Management of acute pancreatitis
NGT suction, maintain intravascular volume, anticipation of respiratory insufficiency, analgesia, nutritional support, common bile duct exploration
142
Chronic pancreatits is characterized by incapacitating upper abdominal pain radiating to the back, pancreatic calcification, steatorrhea and 40% have DIABETES from loss of pancreatic function. What are some common causes?
chronic alcoholism, chronic and significant biliary tract disesase, long term effects of pancreatic injury
143
Surgical therpay for pancreatitis
drainage of pseudocyst, pancreatojejunostomy, Puestow procedure
144
Curative rate for pancreatic cancer
<5%
145
Pancreatic cancer has vague and general symptoms prior to onset of ________. By the time the diagnosis is made, lesion may be _______
jaundice / unresectable
146
Pancreatic surgery is extensive and cause considerable ________
morbidity
147
Post op complications of pancreas surgery
hemorrhage, coagulopathy, hepatic, renal, pulmonary and cardiovascular failure
148
Pancreatoduodenectomy AKA
Whipple Procedure
149
Biliary tract disease is a symptomatic expression of the presence of ________ or inflammatory process attributable to infection or ischemia
gallstones
150
Gallstone formation is caused by physiochemical derangements in the formation of _______
bile
151
90% of gallstones will appear as ________ structures on x-ray
radiolucent
152
Composition of gallstones
hydrophobic cholestrol crystals and calcium bilirubinate
153
The biliary tract is considered the _______ conduit for the liver
excretory
154
The biliary tract is composed of the intrahepatic ducts, coalescence of the intrahepatic ducts and the right and left hepatic ducts, the common hepatic duct, the gallbladder, the cystic duct and the _____ ____ duct
common bile
155
The gall bladder is a pear shaped organ capable of holding ___ to ____ cc of bile
30 to 50
156
After food is ingested, the gallbladder ______, emptying bile into the duodenum to assist in digestion
contracts
157
Regulation of gallbladder contraction is primarily hormonal through the action __________ which is released from the duodenum and mediated by the presence of intraluminal amino acids and fats. _______ stimulation also plays a role secondary to cholecystkinin
cholecystkinin / vagal
158
Three main functions of bile is to emulsify and enhance absorption of ingested fasts and soluble vitamins, provide an excretory pathway for _____, _____, _____ and ______ as well as maintain duodenal _______
bilirubin, drugs, toxins and IGA / alkalization
159
Acute obstruction of the cystic duct
cholecystitis
160
Cholecysitits presents as acute, severe, ___________ pain that often radiates to the RIGHT abdomen, with a postive ________ sign (inspiratory effort accentuates pain)
midepigastric / Murphy's
161
With Cholecystits, labs may demonstrate increase in plasma
bilirubin , alk phos, amylase, and WBCs
162
Gallbladder perforation may cause _________, localized tenderness or an _______
periotnitis / ileus
163
_______ suggests complete obstruction of the CYSTIC duct
jaundice
164
Patients who present with symptoms of Cholecystitis are often confused with ______ ______
myocardial infarction
165
With suspicion of cholecysitis, you should first rule out ____ _____ with serial enzymes and EKGs. Gallbladder ________ or contrast study may assist with clinical confirmation of diagnosis.
cardiac event / ultrasound
166
Other differential diagnosis to consider when evaluating someone suspected of cholecysitis
volume depletion/dehydration, Ileus, free abdomina air from perfed gallbladder (which would require emergent exp lap)
167
_______ is done when there is an obstruction in the CBD
ERCP
168
Acute obstruction of the COMMON BILE DUCT
Cholelithiasis / Choledocholithiasis
169
Cholelithiasis symptoms are similar to ________
cholecysitis
170
Recurrent episodes of cholecystitis causes fibortic changes in gallbladder structure, ultimately impending the gallbladder to effectively _____ bile
expel
171
Charcot triangle
Fever, chills, upper quadrant pain
172
Charcot triange is indicative of acute ______ _______. Patients may also have wt loss, anorexia, and fatigue.
ductal obstruction
173
Diagnostic studies of cholelithiasis will demonstrated a ______ biliary tree
dilated
174
Anesthesia considerations with a cholecystectomy
post op pain, N/V, peritoneal irritation from C02, intravascular volume restoration
175
Referred pain in upper right ______ from C02 insufflation. ________ is good for this pain but opiates are not.
shoulder / toradol
176
Bad livers like to _____
bleed
177
Laparoscopic Surgery Considerations - Abnormal gastroesophageal junction competence from high intra-abdominal pressure creates risk for __________
aspiration
178
Laparoscopic Surgery Considerations - Altered ventilatory dynamic caused by large volume of intra-abdominal carbon dioxide can cause ________
hypercapnia
179
Laparoscopic Surgery Considerations - Decreased venous return from increased intra-abdominal pressure can be caused by ______ ______
patient position
180
Laparoscopic Surgery Considerations - Manipulation of abdominal viscera may cause cardiovascular compilcations such as _______ and _______
bradycardia and hypotension
181
Laparoscopic Surgery Considerations - Bleeding at trocar insertion site/inadvertent breech of large vessel may result in ___________
hemorrhage
182
Laparoscopic Surgery Considerations - Could have a venous C02 ________
embolism
183
Laparoscopic Surgery Considerations - Can have vagal stimulation that result in bradycardia and _________ with insufflation
asystole
184
The small intestine contains the duodenum, __________, and _______ which are all tethered by the mesentery
jejunum, ileum
185
Duodenum length
20 cm
186
Jejunum length
100 cm
187
Ileum length
150 cm
188
Composition of small bowel from inner to outer
Villi, mucosa, submucosal plexus, submucosa, mesenteric plexus, muscular layer, serosa
189
Food from the stomach is allowed into the duodenum via the _______, or pyloric sphincter, and then is pushed through the small intestine by a process of wave-like contractions called ________
pylorus / peristalsis
190
The small intestine is where most chemical digestion takes place. Most of the digestive enzymes that act in the small intestine are secreted by the _________ and enter the intestine via the ______ duct. The enzymes enter small intesting in response to the hormone _________ - ________, which is produced in the small intestine in response to the presence of nutrients. The hormone __________ also causes bicarbonate to be released into the small intestine from the pancreas in order to neutralize potentially harmful acid coming from the stomach.
pancreas / pancreatic / cholecystkinin-pancreozymin / secretin
191
The three major classes of nutrients that undergo digestion in the small intestine are _______, _______ and ______.
proteins / lipids / carbohydrates
192
In the small intestine, proteins and peptides are degraded into ______ ______. Chemical breakdown begins in the stomach and continues to the small intestine. Proteolytic enzymes, including ______ and ______ are secreted by the pancreas and CLEAVE proteins into smaller peptides.
amino acids / trypsin and chymotrypsin
193
In the small intestine, carboxypeptidase which is a pancreatic brush border enzyme splits one amino acid at a time. Aminopeptidase and __________ free the end amino acid products.
dipeptidase
194
In the small intestine, lipids are degraded into ______ ______ and _______
fatty acids and glycerol
195
Pancreatic liipse breaks down __________ into free fatty acids and monoglycerides. Pancreatic lipase works with the help of the salts from the bile secreted by the liver and ____ ________
triglycerides / gall bladder
196
Bile salts attach to _________ to help emulsify them
triglycerides
197
The bile salts are the _______ _______ that hold the triglycerides in the watery surroundings until the LIPASE can break them into smaller components that are able to enter the villi for ________
middle man / absoroption
198
Carbohydrates are degraded into simple sugars or ____________
monosaccharides
199
Pancreatic _________ breaks down carbohydrates into OLIGOSACCHARIDES and brush border enzymes take over from there
AMYLASE
200
The most important brush border enzymes are _________ and _________
dextrinase and glucoamylase
201
Digested food passes into the blood vessels in the wall of the intestine through ________
diffusion
202
The _____ _______ is the site where most of the nutrients from ingested food are absorbed
small intestine
203
The inner wall, or mucosa, of the small intestine is lined with simple ____ ______ ______
columnar epithelial tissue
204
Structurally, the mucosa is covered in wrinkles or folds called ______ ______, which are considered permanent features in the wall of the organ. Thye are distinct from rugae which are considered non-permanent or temporary allowing for distention and contraction.
plica circulares
205
From the plica circulares project microscopic finger-like pieces of tissue called ______. The individual epithelial cells also have finger-like projections called ___________. The function of the plica circulares, the villi and the mircovilli is to increase the amount of surface area available for the __________ of nutrients.
villi / microvilli / absorption
206
Diseases of the small intestine
Malabsorption syndromes (celiac sprue/gluten-sensitive enteropathy, FAT malabsorption, Protein Malabsoprtion), Maldigestion syndromes (deficient pancreatic secretion), upper GI bleed and Small Bowel Obstruction
207
______ prior to induction would be a good idea for someone with SBO
NGT
208
The colon is __ to ___ ft long
3 to 5
209
The large intestine wall is composed of _________ muscle and numerous _______ (haustrations) throughout its length
longitudinal / outpouchings
210
Arterial supply to the large intestine
Superior mesenteric artery, inferior mesenteric artery, internal iliac artery
211
Bacteria that colonize the large intestine _______ waste products. They breakdown indigestible material by _______, releasing various gases. Vitamin K and certain B vitamins are also _______ by bacterial activity.
digest / fermentation / produced
212
Absorption in the large intestine includes vitamins B, K and some electrolytes (Na and Cl) and most of the remaining water which is up to ___ to ____ liters per day
1 to 2
213
Diseases of the Large Intestine
IBS (Chrohn's dz and UC), diverticulitis/diverticulosis, Abdominal compartment syndrome, colon polyps, colon cancer, colon volvulus, ischemic bowel, appendicitis
214
With diverticulitis, it is actually ________
inflammed
215
Crohn's disease is characterized by a __________ appearance and _____-wrapping around the intestine
cobblestoning / fat
216
UC has loss of ________ and pseudopolyps visible when scoped
haustra
217
UC starts from some point in the colon and then continues _______
onward
218
Crohn's is usually _______ and appears all throughout the colon
sporadic
219
Crohn's disease facts
walls of the intestine becaome inflammed, most common in teens and young adults, have chronic diarrhea, abdominal pain, fatigue, and treated with anti-inflammatory drugs, steroids, antibiotics and biologics, and some 66-75% will need surgery
220
In Crohn's diet ______ appear to cause or worsen the disease
doesn't
221
Anesthesia considerations for intestinal surgery
aspiration risk, fluid and electrolyte status, history of steroid use will require perioperative coverage, AVOID nitrous, do not stop TPN, bowel prep, malnutrition and anemia, thermoregulation at 36 degress celsius, may have post op ileus
222
Look at adult RSI slide on
132
223
The spleen is a non-vital organ located in the _______ of the abdominopelvic region
LUQ
224
The spleen is the largest ________ organ, acting as a site of lymphocyte _________ and in immune surveillance and response
lymphatic / proliferation
225
The fetus, the spleen is a ________ organ
hematopoietic
226
In the infant and adult, the spleen destroys old RBCs, recycles iron and globin and stores functional red blood cells, expelling them in response to _________
hermorrhage
227
The spleen periodically expels blood in non-emergency situations by contracting smooth muscle of the splenic capsule and trabeculae, moving blood to the splenic ____ or _____
artery or vein
228
Reasons for splenectomy
idiopathic thrombocytopenia purpura, thrombotic thrombocytopenia purpura, Hodgkin's disease, Lymphoma, certain leukemias, hereditary hemolytic anemia, Hypersplenism, Thalassemia, sickle cell disease, blunt or penetrating trauma
