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APA 2 > APA 2 - GI Disturbances and Anesthesia > Flashcards

APA 2 - GI Disturbances and Anesthesia Flashcards

1
Q

The process of digestion begins with __________

A

mastication

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2
Q

Local and general anesthesia depress sensation of the _____ ______ innervation

A

upper airway

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3
Q

Trigeminal nerve

A

nasopharynx

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4
Q

glossopharyngeal nerve

A

posterior third of tongue and oral pharynx

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5
Q

SLN

A

tongue base and inferior epiglottis to the vocal cords

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6
Q

RLN

A

vocal cords distally

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7
Q

Branches of vagus nerve

A

remaining larynx and trachea

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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

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9
Q

Originates at the pharynx at approximately the level of the 6th cervical vertebra and extends to the stomach

A

esophagus

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10
Q

3 functional zones of esophagus

A

Upper Esophageal Sphincter, Esophageal body, Lower Esophageal sphincter

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11
Q

Typically, the sphincters hold tight but with _______ _______ can cause sphincter relaxation and higher risk of aspiration

A

anesthesia induction

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12
Q

Cricoid cartilage is at about

A

C6

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13
Q

Esophageal wall consists of outer longitudinal layer, inner circular ______ ______, and ______ lining

A

muscular layer / mucosal

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14
Q

Inner circular muscular layer consists of ____ and ______ muscle

A

smooth and striated

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15
Q

Mucosal lining has _______ epithelium, except for distal 1-2cm which is composed of _________ epithelium

A

squamous / columnar

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16
Q

The esophagus passes through a space creagted by the ____ _____ of the diaphragm

A

right crus

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17
Q

The esophageal wall is ______ absorptive

A

highly

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18
Q

The myenteric plexus of Auerbach is mainly a __________ (vagus nerve) plexus along with some postganglionic ______ nerves

A

parasympathetic / sympathetic

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19
Q

The inferior thyroid arteries supply the _____ ______

A

cervical esophagus

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20
Q

Aorta esophageal branches of bronchial arteries supply the ______ _______

A

thoracic esophagus

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21
Q

Intrinsic innervation is provided by the myenteric or _______ plexus and the submucosal or ________ plexus

A

Auerbach / Meissner

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22
Q

The intrinsic innervation extends from the esophagus to the _______

A

anus

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23
Q

Extrinsic innervation is provided by the ________, _______ and _______

A

sympathetic / parasympathetic / somatic

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24
Q

Extrinsic sympathetic innervation acts on _______ plexus to modulate rather than control motor activity

A

myenteric

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25
Q

Extrinsic parasympathetic innervation involves cranial nerves ___, ____, _____ and causes esophatgeal muscular relaxation as well as relaxation of the ______

A

IX / X / XI / LES

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26
Q

Both the UES and LES are _____ at rest

A

closed

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27
Q

Excitatory stimulation of the UES occurs due to (5)

A

inspiration, esophageal distention ,gagging, valsalva maneuver, acidity of gastric contents

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28
Q

UES tone is reduced by (3)

A

distention, belching, vomiting

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29
Q

Swallowing initiates peristalsis that has average velocity of ____ cm/sec and a maximum pressure of _____mmHg

A

3-4 cm/sec AND 150 mmHg

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30
Q

Swallowing decreases _______ within 1.5-2.5 sec, this decrease in tone is maintained for the duration of the peristaltic wave

A

LES

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31
Q

ingestion of meal or increased abdominal pressure _________ LES tone via _______ afferent pathways

A

increases / vagal

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32
Q

Normal LES tone is ______mmHg and can be _________

A

20 / overcome

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33
Q

Normal LES is mediated by intrinsicc ____ and excitatory nerual mechanisms. __________ innervation is predominant

A

myogenic / vagal

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34
Q

With chronic alcoholism you will see what 4 things

A

impaired esophageal peristalsis, LES HYPOTONIA, Degeneration of the auerbach plexus, mallory weis tear

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35
Q

Failure of the LES tone to relax during swallowing accompanied with a lack of perstalsis

A

achalasia

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36
Q

Achalasia develops secondary to what chronic diseases

A

diabetes, stroke,amyotrophic lateral sclerosis, connective tissue diseases (amyloidosis and scleroderma)

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37
Q

With Barrett Esophagus, normal squamous epithelium changes to ________ __________ epithelium

A

metaplastic columnar epithelium

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38
Q

Barrett esophagus causes

A

chronic exposure to acidic gastric contents (GERD), chronic alcohol abuse, smoking

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39
Q

Barret esophagus is closely associated with eventual development of _______ ________

A

esophageal carcinoma

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40
Q

GERD is from failure of the _______ to function properly permitting stomach contents to reflux into the esophagus and possibly the pharynx

A

LES

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41
Q

Current mangagment modality for GERD

A

PPIs and H2 antagonists

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42
Q

This happens due to a weakness in the diaphragm that allows a portion of the stomach to migrate upward into the thoracic cavity

A

hiatal hernia

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43
Q

Primary symptoms of hiatal hernia include ________ pain of a burning quality that commonl occurs after meals, peptic esophagitis and it is treated _______

A

retrosternal / surgically

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44
Q

Review types of hiatal hernia on slides

A

27 and 28

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45
Q

Most common surgical procedure for hiatal hernia

A

nissen fundoplication

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46
Q

Esophageal diverticula are classified according to ______

A

location

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47
Q

Epiphrenic

A

locared near the LES

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48
Q

Traction

A

located mid-esophagus

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49
Q

Zenker

A

locared upper esophagus

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50
Q

Esophageal diverticula place the patient at risk for pulmonary aspiration of regurgitated food and also from food/fluids ingested but sequestered within ________

A

pouch

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51
Q

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

A

fibrosis

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52
Q

Daunorubicin and doxorubicin/adriamycin both can cause chemotherapyy induced _________

A

cardiomyopathy

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53
Q

Bleomycin can cause ________ _______ which results in a restrictive defect and increased potential for ____________ toxicity

A

pulmonary fibrosis / oxygen

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54
Q

A history of GERD with active reflux symptoms warrants a plan for _________ prophylaxis during _________ and __________ from general anesthesia

A

aspiration / induction / emergence

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55
Q

Esophageal disease mandates use of a ___________ _________ to create a sealed airway to prevent risk from passive regurgitation and aspiration

A

endotracheal tube

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56
Q

Someone with esophageal disease should be fully _______ and have demonstrated conscious control of the airway prior to extubation

A

awake

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57
Q

Esophageal cancer surgery Ivor-Lewis Repair

A

Anterior abdominal incision and right thoracotomy

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58
Q

Esophageal cancer surgery Ivor-Lewis McKeown - type

A

right neck incision, excision of diseased esophagus, anastamosis of stomach to cervical esophagus

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59
Q

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

A

10 / 2000 / 10

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60
Q

_______ ___________ should always be corrected preoperatively

A

aspiration pneumonia

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61
Q

Esophageal resection is associated with various inratoperative complications (3)

A

hemorrhage, injury to the tracheobronchial tree, RLN injury

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62
Q

Esophagela resection postopervie complications

A

anastomotic leak, mediastinitis, respiratory problems, pleural effusion, pneumonia, and ARDS, cardiac and functional complications

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63
Q

Postoperative _____ ______ is not uncommon in patients undergoing curative resection for esophageal cancer and can be categorized as either locoregional or distant.

A

tumor recurrence

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64
Q

______ _________ most commonly involve the liver, lungs and bones followed by the adrenal glands, brain and kidneys and may involve multiple organs simultaneously

A

hematogenous metastases

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65
Q

Intraoperative complications include ________ and ____________, hemorrhage, injury to the tracheobronchial tree and injury to the RLN

A

arrhythmias and hypotension

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66
Q

Injuries to the RLN can imparit the ability of the patient to _______ and can cause aspiration pneumonia.

A

cough

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67
Q

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

A

RLN

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68
Q

Look at slide

A

49 (RLN)

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69
Q

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.

A

morbidity and mortality / 3%

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70
Q

Morbidity and mortality rates vary greatly depending on the surgical volumes, hospital size and degree of ________ specialization

A

cancer

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71
Q

Most serious complications of esophageal resection

A

anastomotic leak, mediastinitis, sepsis and respiratory failure

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72
Q

Two sections of the stomach

A

fundus and distal stomach

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73
Q

Fundus of stomach is _____walled, distendable, located in the _______ abdomen and primary function is ________ (4hrs)

A

thin / upper / storage

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74
Q

The distal stomach is ______ wallled, this is where mixing of food occurs, and slow relesase of _____ through _____ ______ into the duodenum

A

thick / chyme / pyloric sphincter

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75
Q

The stomach is located in the uppr part of the abdomen just beneath the ______

A

diaphragm

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76
Q

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

A

open hand / lower abdomen

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77
Q

The duodenum extends from the _______ to the ligament of ______ in a sharp curve that almost completes a circle

A

pylorus / treitz

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78
Q

The duodehum is eaual in length to the breadth of 12 fingers or about _____ cm

A

25 cm

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79
Q

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

A

retroperitoneal / fixed

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80
Q

The serosa is the ______ _______ of the gastric wall and. The three smooth muscle layers are?

A

external layer / outer longitudinal, middle circular, inner oblique

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81
Q

The anatomy of the gastric wall from exgternal to internal

A

Serosa -> muscularis mucosae (smooth muscle) -> submucosa -> mucosa

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82
Q

acid secretion of _____ ______ requires a hydrogen/potassium exchange pump pwered by _____

A

parietal cells / ATP

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83
Q

Acid release is mediated by vagal stimulation (Ach), _______ release (in response to gastric distension) and histamine

A

gastrin

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84
Q

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)

A

Acteylcholine

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85
Q

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 ______ ______

A

parietal cells

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86
Q

The sight and smell of food stimulates ____ and ______ production

A

acid / pepsinogen

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87
Q

Gastrin is released by __ cells in response to ______ ________ which stimulates parietal-cell acid secretion

A

G / gastric distension

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88
Q

_______ acid suppresses gastric fedback (negative feedback)

A

luminal

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89
Q

Anticholinergic agents have a minor (not therapeutic) effect on ______ ______ secretion

A

parietal cell

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90
Q

What surgery can be done to control gastric acid secretion

A

Vagotomy

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91
Q

A vagaotomy diminishes parietal cell response to ______ and _______

A

gastrin and histamine

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92
Q

The stomach or gastric acts as a barrier against ingested pathogens by providing an acidic environment and ________

A

immunosurveilance

93
Q

The stomach can ___ or cool ingested substances

A

heat

94
Q

Parietal cells secrete ______ ________ which fascilitates ileal vitamin b12 ________

A

intrinsic factor / absorption

95
Q

Blood supply of stomach is primarily from ___ arteries. Right and left _______ arteries AND the right and left _______ arteries

A

4 / gastric / gastroepiploic

96
Q

Major innervation of the stomach is ________. Two branches of the vagus nerve including the _____ ______ (celiac) branch and the ____ _______ (hepatic) branch.

A

autonomic / right posterior / left anterior

97
Q

______ is caused by erosion of protective muscous layer of the stomach and duodenum

A

PUD

98
Q

Associated causes of PUD

A

H. Pylori, overuse of medications like NSAIDS, ASA, corticosteroids, excessive alcohol consumption, tobacco use, stress, and receiving radiation therapy

99
Q

___ _______ is the major etiologic factor for PUD

A

H. Pylori

100
Q

If the LES is incompetent, ulcerative involvement of the ________ may also occur

A

esophagus

101
Q

Subsequent ulceration over time result in lesions of _____ ______

A

varying depth

102
Q

Oral antacids may produce an ____ _____ in which gastric acid secretion may increase after existing acids are neutralized by calcium-containing antacids.

A

acid rebound

103
Q

Milk-alkali sundrom is characterized by what and manifests as what?

A

Characterized: hypercalcemia, alkalosis, elevated BUN Manifests: as skeletal muscle weakness and polyuria

104
Q

You can have _____ ________ secondary to large amounts of aluminum-containing antacids

A

acute hypophosphatemia

105
Q

Acute hypophasphatemia manifests as skeletal muscle weakness, _______ fractures, and _________

A

pathological / osteoporosis

106
Q

H2 antagonists blocks secretion of ____ _____

A

hydrochloric acid

107
Q

H2 antagonists promotes healing of duodenal ulcers but can alter the __________ enzyme activity in the liver

A

CYP450

108
Q

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

A

prolong

109
Q

________ is the least likely H2 antagonist to slow down the CYP450 system

A

famotidine

110
Q

________ is the most likely H2 antagonist to slow down the CYP450

A

cimetidine

111
Q

Most effective antisecretory agent

A

PPIs

112
Q

Omeprazole and rabeprazole how much and how often

A

20 mg once daily

113
Q

Esomeprazole and pantoprazole how much and how often

A

40 mg once daily

114
Q

Lansoprazole how much and how often

A

30 mg once daily

115
Q

_____ ______ produce hydrochloric acid

A

parietal cells

116
Q

Aluminum salt of sulfated sucrose, binds to ulcer, increases the gastric mucous layer, promotes healing process, devoid of side effects

A

sucralafate

117
Q

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

A

misoprostol

118
Q

Look at slide

A

77

119
Q

1st line therapy for eradication of H. Pylori

A

PPI Bid + clarithromycin 500 mg BID + Amox 1G BID OR Metronidazole 400-500 mg BID instead of AMOX

120
Q

Parietal cell vagotomy is where there is selective sectioning of ______ fibers of the gastric _____ and parietal cells

A

vagal / fundus

121
Q

Antrectomy with pyloroplasty and vagotomy AKA

A

Bilroth I

122
Q

Majority of gastric neoplasms are _______

A

malignant / 95% adenocarcinoma, 4% lymphoma, 1% leiomyosarcoma

123
Q

Lates S/S of gastric neoplasm

A

anorexia and weight loss

124
Q

Surgical treatment of gastric carcinoma includes total or subtotal _______. Or, omenectomy, lymph node dissection and spleenectomy based on the _____ of disease

A

gastrectomy / extent

125
Q

Bilroth II AKA

A

Gastrojejunostomy

126
Q

Increased gastric mucosal acidosis is commin in (3)

A

critically ill patients, pt. undergoing prolonged and complex surgical procedure, pt undergoing CABG

127
Q

Gastritis associated with gastric mucosal acidosis is associated with increased peri-operative _________ and _________

A

morbidity and mortality

128
Q

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

A

abdominal viscera / bacteria

129
Q

Exocrine function of the pancreas, it secretes _____ to ______ ml of pancreatic juice daily

A

1500ml-3000ml

130
Q

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.

A

8.3 / duodenal / pancreatic

131
Q

Direct endocrine function (non-ductal) of pancreas is production of _____ and _______

A

insulin and glucagon

132
Q

Acinar cells secrete _______ enzymes

A

digestive

133
Q

islets of langerhans is considered the ______ portion of pancreas

A

endocrine

134
Q

Presence of acid in duodenum causes release of

A

secretin

135
Q

Presence of fats in duodenum cause release of ________

A

cholecystkinin

136
Q

Vagal stimulation of pancreas causes release of ________ _______

A

pancreatic enzymes

137
Q

Secretin causes release of _______

A

bicarb

138
Q

Sphincter of Oddi is located in the _______

A

pancreas

139
Q

Delta-cell causes _______ secretion

A

somatostatin

140
Q

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?

A

alcohol abuse, direct or indirect trauma, infections process, biliary tract disease, metabolic disorders, drug side effect, and ulcerative penetration from adjacent structures

141
Q

Management of acute pancreatitis

A

NGT suction, maintain intravascular volume, anticipation of respiratory insufficiency, analgesia, nutritional support, common bile duct exploration

142
Q

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?

A

chronic alcoholism, chronic and significant biliary tract disesase, long term effects of pancreatic injury

143
Q

Surgical therpay for pancreatitis

A

drainage of pseudocyst, pancreatojejunostomy, Puestow procedure

144
Q

Curative rate for pancreatic cancer

A

<5%

145
Q

Pancreatic cancer has vague and general symptoms prior to onset of ________. By the time the diagnosis is made, lesion may be _______

A

jaundice / unresectable

146
Q

Pancreatic surgery is extensive and cause considerable ________

A

morbidity

147
Q

Post op complications of pancreas surgery

A

hemorrhage, coagulopathy, hepatic, renal, pulmonary and cardiovascular failure

148
Q

Pancreatoduodenectomy AKA

A

Whipple Procedure

149
Q

Biliary tract disease is a symptomatic expression of the presence of ________ or inflammatory process attributable to infection or ischemia

A

gallstones

150
Q

Gallstone formation is caused by physiochemical derangements in the formation of _______

A

bile

151
Q

90% of gallstones will appear as ________ structures on x-ray

A

radiolucent

152
Q

Composition of gallstones

A

hydrophobic cholestrol crystals and calcium bilirubinate

153
Q

The biliary tract is considered the _______ conduit for the liver

A

excretory

154
Q

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

A

common bile

155
Q

The gall bladder is a pear shaped organ capable of holding ___ to ____ cc of bile

A

30 to 50

156
Q

After food is ingested, the gallbladder ______, emptying bile into the duodenum to assist in digestion

A

contracts

157
Q

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

A

cholecystkinin / vagal

158
Q

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 _______

A

bilirubin, drugs, toxins and IGA / alkalization

159
Q

Acute obstruction of the cystic duct

A

cholecystitis

160
Q

Cholecysitits presents as acute, severe, ___________ pain that often radiates to the RIGHT abdomen, with a postive ________ sign (inspiratory effort accentuates pain)

A

midepigastric / Murphy’s

161
Q

With Cholecystits, labs may demonstrate increase in plasma

A

bilirubin , alk phos, amylase, and WBCs

162
Q

Gallbladder perforation may cause _________, localized tenderness or an _______

A

periotnitis / ileus

163
Q

_______ suggests complete obstruction of the CYSTIC duct

A

jaundice

164
Q

Patients who present with symptoms of Cholecystitis are often confused with ______ ______

A

myocardial infarction

165
Q

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.

A

cardiac event / ultrasound

166
Q

Other differential diagnosis to consider when evaluating someone suspected of cholecysitis

A

volume depletion/dehydration, Ileus, free abdomina air from perfed gallbladder (which would require emergent exp lap)

167
Q

_______ is done when there is an obstruction in the CBD

A

ERCP

168
Q

Acute obstruction of the COMMON BILE DUCT

A

Cholelithiasis / Choledocholithiasis

169
Q

Cholelithiasis symptoms are similar to ________

A

cholecysitis

170
Q

Recurrent episodes of cholecystitis causes fibortic changes in gallbladder structure, ultimately impending the gallbladder to effectively _____ bile

A

expel

171
Q

Charcot triangle

A

Fever, chills, upper quadrant pain

172
Q

Charcot triange is indicative of acute ______ _______. Patients may also have wt loss, anorexia, and fatigue.

A

ductal obstruction

173
Q

Diagnostic studies of cholelithiasis will demonstrated a ______ biliary tree

A

dilated

174
Q

Anesthesia considerations with a cholecystectomy

A

post op pain, N/V, peritoneal irritation from C02, intravascular volume restoration

175
Q

Referred pain in upper right ______ from C02 insufflation. ________ is good for this pain but opiates are not.

A

shoulder / toradol

176
Q

Bad livers like to _____

A

bleed

177
Q

Laparoscopic Surgery Considerations - Abnormal gastroesophageal junction competence from high intra-abdominal pressure creates risk for __________

A

aspiration

178
Q

Laparoscopic Surgery Considerations - Altered ventilatory dynamic caused by large volume of intra-abdominal carbon dioxide can cause ________

A

hypercapnia

179
Q

Laparoscopic Surgery Considerations - Decreased venous return from increased intra-abdominal pressure can be caused by ______ ______

A

patient position

180
Q

Laparoscopic Surgery Considerations - Manipulation of abdominal viscera may cause cardiovascular compilcations such as _______ and _______

A

bradycardia and hypotension

181
Q

Laparoscopic Surgery Considerations - Bleeding at trocar insertion site/inadvertent breech of large vessel may result in ___________

A

hemorrhage

182
Q

Laparoscopic Surgery Considerations - Could have a venous C02 ________

A

embolism

183
Q

Laparoscopic Surgery Considerations - Can have vagal stimulation that result in bradycardia and _________ with insufflation

A

asystole

184
Q

The small intestine contains the duodenum, __________, and _______ which are all tethered by the mesentery

A

jejunum, ileum

185
Q

Duodenum length

A

20 cm

186
Q

Jejunum length

A

100 cm

187
Q

Ileum length

A

150 cm

188
Q

Composition of small bowel from inner to outer

A

Villi, mucosa, submucosal plexus, submucosa, mesenteric plexus, muscular layer, serosa

189
Q

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 ________

A

pylorus / peristalsis

190
Q

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.

A

pancreas / pancreatic / cholecystkinin-pancreozymin / secretin

191
Q

The three major classes of nutrients that undergo digestion in the small intestine are _______, _______ and ______.

A

proteins / lipids / carbohydrates

192
Q

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.

A

amino acids / trypsin and chymotrypsin

193
Q

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.

A

dipeptidase

194
Q

In the small intestine, lipids are degraded into ______ ______ and _______

A

fatty acids and glycerol

195
Q

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 ____ ________

A

triglycerides / gall bladder

196
Q

Bile salts attach to _________ to help emulsify them

A

triglycerides

197
Q

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 ________

A

middle man / absoroption

198
Q

Carbohydrates are degraded into simple sugars or ____________

A

monosaccharides

199
Q

Pancreatic _________ breaks down carbohydrates into OLIGOSACCHARIDES and brush border enzymes take over from there

A

AMYLASE

200
Q

The most important brush border enzymes are _________ and _________

A

dextrinase and glucoamylase

201
Q

Digested food passes into the blood vessels in the wall of the intestine through ________

A

diffusion

202
Q

The _____ _______ is the site where most of the nutrients from ingested food are absorbed

A

small intestine

203
Q

The inner wall, or mucosa, of the small intestine is lined with simple ____ ______ ______

A

columnar epithelial tissue

204
Q

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.

A

plica circulares

205
Q

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.

A

villi / microvilli / absorption

206
Q

Diseases of the small intestine

A

Malabsorption syndromes (celiac sprue/gluten-sensitive enteropathy, FAT malabsorption, Protein Malabsoprtion), Maldigestion syndromes (deficient pancreatic secretion), upper GI bleed and Small Bowel Obstruction

207
Q

______ prior to induction would be a good idea for someone with SBO

A

NGT

208
Q

The colon is __ to ___ ft long

A

3 to 5

209
Q

The large intestine wall is composed of _________ muscle and numerous _______ (haustrations) throughout its length

A

longitudinal / outpouchings

210
Q

Arterial supply to the large intestine

A

Superior mesenteric artery, inferior mesenteric artery, internal iliac artery

211
Q

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.

A

digest / fermentation / produced

212
Q

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

A

1 to 2

213
Q

Diseases of the Large Intestine

A

IBS (Chrohn’s dz and UC), diverticulitis/diverticulosis, Abdominal compartment syndrome, colon polyps, colon cancer, colon volvulus, ischemic bowel, appendicitis

214
Q

With diverticulitis, it is actually ________

A

inflammed

215
Q

Crohn’s disease is characterized by a __________ appearance and _____-wrapping around the intestine

A

cobblestoning / fat

216
Q

UC has loss of ________ and pseudopolyps visible when scoped

A

haustra

217
Q

UC starts from some point in the colon and then continues _______

A

onward

218
Q

Crohn’s is usually _______ and appears all throughout the colon

A

sporadic

219
Q

Crohn’s disease facts

A

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
Q

In Crohn’s diet ______ appear to cause or worsen the disease

A

doesn’t

221
Q

Anesthesia considerations for intestinal surgery

A

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
Q

Look at adult RSI slide on

A

132

223
Q

The spleen is a non-vital organ located in the _______ of the abdominopelvic region

A

LUQ

224
Q

The spleen is the largest ________ organ, acting as a site of lymphocyte _________ and in immune surveillance and response

A

lymphatic / proliferation

225
Q

The fetus, the spleen is a ________ organ

A

hematopoietic

226
Q

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 _________

A

hermorrhage

227
Q

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 _____

A

artery or vein

228
Q

Reasons for splenectomy

A

idiopathic thrombocytopenia purpura, thrombotic thrombocytopenia purpura, Hodgkin’s disease, Lymphoma, certain leukemias, hereditary hemolytic anemia, Hypersplenism, Thalassemia, sickle cell disease, blunt or penetrating trauma

APA 2 (7 decks)

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