Bowel Procedures

Question 1

3 major concerns of a CRNA during bowel surgery

Answer 1

Keep Warm
Keep Hydrated
Keep and. wall relaxed

Question 2

Length of the small bowel

what are the landmarks of the beginning and ending of the small bowel

And why are the 3 parts in order

Answer 2

5 M

pyloric spinctor to the ileocecal valve

Dudoenum Jejunum Ileum (don’t jump in)

Question 3

How long is the Large Bowel

What is the sphincter at the end

What is the major artery that supplies blood to the Large Bowel?

Answer 3

1.5 M

The sphincter of O’Beirne admits waste from sigmoid colon to rectum

Mesentery Circulation

Question 4

How many hours of acute and pain is required for the dx of Acute ABD?

Answer 4

> 6 hours

Question 5

How is Acute And. best treated?

Answer 5

Surgery

Question 6

What pre op evals are needed for an Acute Abd.?

Answer 6

CBC, lytes, X-ray looking for free air, CT, Ultra Sound

Question 7

What are some possible causes of Acute Abd.

Answer 7

appendicitis
AAA
Urological
GYN procedures

Question 8

What are some clear signs for surgery?

Answer 8

Peritonitis

And pain and sepsis without an apparent cause

Surgery may be differed if pt is stable with vague s/s (this is potentially dangerous)

Question 9

What is peritonitis and what are some common causes?

Answer 9

Infectious irritation of peritoneum usually die to intra-abdominal source such as

Perforation
Infection
Gangrene

Question 10

What are some reasons for Small Bowel Surgery?

Answer 10

Obstruction
Crohn’s Disease
Diverticular disease (esp. Meckels Diverticulum)
Malignancy (rare)

Question 11

What is strangulated bowel compared to an obstruction of a bowel?

Answer 11

Strangulated means the blood flow is also stopped and not just the closing of the lumen

Strangulation is an EMERGENCY

Question 12

Things to know about Crohn’s Disease

Answer 12

Affects the full thickness

Affects primarily the small bowel

Causes fistulas and can lead to CA

Treatment generally includes steroids, but leads to surgery after time

Question 13

What is the general surgery done for CA of the small bowel

Answer 13

Whipple

Question 14

How do you develop Metabolic Alkalosis?

How do you treat Metabolic Alkalosis?

Answer 14

you become alkalotic because you vomit all your Cl and your body saves bicarb.

Normally treat with 0.9 NS and K+

Question 15

How do you develop Metabolic Acidosis?

How do you treat Metabolic Acidosis?

Answer 15

Developed because..

(1) the reabsorb HCO3 poorly
(2) Ketosis from poor metabolism
(3) Sepsis

Primary treatment is correction of obstruction and you can give a dose of Na HCO3 (1 mEq/Kg)

Initially may have a high serum K due to the acidosis, but they will loose it and soon be low.

Question 16

During Surgery how do you correct Volume?

Answer 16

Use crystalloids (because most will be 3rd spaced)

difficult to estimate but generally 5-6 ml/kg/hr

Question 17

What are your anesthesia concerns with induction for a patient having bowel obstruction surgery?

Answer 17

Pt is considered a full stomach & give aspiration medications*

if obstruction is expected, no gastrokinetics

Question 18

What agents should be avoided with bowel sugary?

Answer 18

Nitrous

Can interfere with surgical exposure by aggravating bowel dissension

Question 19

why is normal temp hard to maintain

Answer 19

their core temp (stomach) is exposed

Question 20

What are some concerns for post-op

Answer 20

Pt is at risk for REGURGITATION resulting in an ASPIRATION so leave your NG in place

(small bowel takes a few hours, Stomach takes 24 hours, and colon takes 48 hours)

*KEEP the IV FLUID low
(the 3rd space fluid will come out of interstitial space and increase Myocardial workload)

Question 21

What are some indications for cool-rectal surgery?

Answer 21

Obstruction / Perforation 
Diverticular Disease
Ulcerative colitis
Anal pathology 
Colo-rectal CA
Appendicitis

Question 22

Diverticular Disease

Answer 22

An acquired disease from a low fiber diet and results in adhesions of the bowel.

Question 23

Ulcerative Colitis

Answer 23

An Autoimmune disease that commonly leads to CA and generally treated with STEROIDS.

Primarily stays in the Large Bowel and a Colonectomy is considered curative.

Question 24

Appendicitis

Answer 24

grows out of the cecum and can be obstructed by forgein body (poop) leading to a bacterial overgrowth and inflammation.

Treat like a Full Stomach and give all Aspiration medications

Generally not perforated

Can become attached to the bottom of the cecum making surgery difficult.

Question 25

Colo-Rectal Cancer

Answer 25

2 CA in US and it is preventable with a colonoscopy

Disease takes 10 years to develop so give your colonoscopy every 10 years after age 50.

Generally occurs in the Rectum.

Question 26

What are some preoperative concerns in colonic surgery?

Answer 26

Bowel Prep is CRITICAL

ABX: neomycin, Flagl, metronidazole 1d pre-op
-Will prolong NDNMR-