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Anesthesia Basics > Ch. 29 Nutritional and Gastrointestinal Disease > Flashcards

Ch. 29 Nutritional and Gastrointestinal Disease Flashcards

1
Q

What is the unit for BMI?

A

kg/m^2

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2
Q

What is a desirable BMI?

A

18-25kg/m^2

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3
Q

What is morbid obesity?

A

40kg/m^2

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4
Q

What is superobesity?

A

50kg/m^2

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5
Q

What is super-superobesity?

A

60kg/m^2

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6
Q

What are respiratory conditions associated with obesity?

A

OSA, restrictive lung disease, decreased residual volume

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7
Q

What side of the heart is most affected by obesity? Why?

A

right; OSA and/or obesity-related hypotension syndrome cause pulmonary hypertension

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8
Q

Nondiabetic obese patients have a _______ volume of gastric contents at a _______ pH than nondiabetic lean patients.

A

smaller; higher

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9
Q

What are places other than the upper arm that a blood pressure cuff can be applied?

A

lower arm; calf

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10
Q

What conditions does bariatric surgery improve?

A

HTN, DM II, OSA

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11
Q

Feeding enteral and parenteral - what routes are these?

A

enteral - nasogastral or directly into jejunum; parenteral - IV

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12
Q

What route is preferred - enteral or parenteral? Why?

A

enteral utilizes the villi of the GI tract to prevent bacterial transfer

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13
Q

What is an anesthetic concern for a patient on TPN?

A

How long should they be off TPN and be NPO for induction?

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14
Q

What lab should be checked when a patient is off TPN? Why?

A

glucose; insulin is a component of TPN

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15
Q

What are the two categories of inflammatory bowel disease?

A

ulcerative colitis (UC) and Crohn’s Disease (CD)

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16
Q

Which category of IBD is restricted to the large intestine?

A

ulcerative colitis

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17
Q

How is the presence of IBD confirmed?

A

endoscopy and biopsy

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18
Q

Which anesthetics are contraindicated for patients with IBD?

A

none

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19
Q

What barriers must gastric contents pass in order to become aspiration?

A

lower esophageal sphincter and upper esophageal sphincter

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20
Q

What percent of the general population have heartburn at least once a week?

A

20%

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21
Q

How do histamine (H2) blockers work?

A

decrease gastric acid secretion

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22
Q

What adverse side effects do H2 blockers have in the elderly?

A

cause confusion, agitation, psychosis

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23
Q

Sulfonureas work in what way?

A

stimulate beta cells to release insulin

24
Q

Meformin works in what way?

A

inhibit gluconeogenesis (inhibit hepatic production of glucose)

25
Q

How might diabetes mask an MI?

A

if the patient has cardiac autonomic neuropathy they may not get angina pectoris

26
Q

What DM drugs should not be taken the morning of surgery? Why?

A

sulfonureas because they may cause hypoglycemia due to the absence of breakfast

27
Q

What is the difference between hyperthyroidism and thyrotoxicosis?

A

hyperthyroidism is the secretion of too much thyroid; thyrotoxicosis is the state of having elevated serum thyroid hormone

28
Q

Elevated serum levels of what characterize hyperthyroidism/thyrotoxicosis

A

thyroid hormones T3 & T4

29
Q

What is the most common cause of thyrotoxicosis?

A

Grave’s disease

30
Q

Why might HTN and tachycardia be seen in patients with hyperthyroidism?

A

thyroid hormone increases cardiac sensitivity to catecholamines

31
Q

What is the most severe form of thyrotoxicosis?

A

thyroid storm

32
Q

What method is used to treat hypothyroidism initially?

A

decrease thyroid hormone synthesis

33
Q

What advantage does propanolol have vs other beta blockers for the treatment of thyroid storm?

A

blocks conversion of T4 to T3

34
Q

What condition does thyroid storm appear like?

A

MH

35
Q

Is dantrolene beneficial for treating thyroid storm?

A

yes

36
Q

What does Hashimoto’s thyroiditis cause?

A

hypothyroidism

37
Q

Which nerve do you absolutely not want to injure during thyroidectomy and why?

A

(bilateral) recurrent laryngeal because it controls separation of vocal cords during breathing

38
Q

How does a NIMs tube work?

A

the tube has electrodes next to the vocal cords that send a signal to a receiver whenever the vocal cords contract; if the surgeon stimulates a larengeal nerve by retracting it or from nearby electrocautery, an audible warning sounds occurs

39
Q

What is a tumor on the adrenal gland called?

A

pheochromocytoma

40
Q

What is a tumor of the SNS ganglia called?

A

paraganglioma

41
Q

What is MEN?

A

When two or more endocrine tumor types occur in the same patient

42
Q

What are the principal hormones secretes by the adrenal cortex?

A

cortisol and aldosterone

43
Q

What is chronic insufficiency of cortisol referred to as?

A

Addison’s disease

44
Q

Cortisol has what effect on catecholamines?

A

potentiates the effect of catecholamines

45
Q

Cortisol has what effect on vascular permeability?

A

reduces permeability

46
Q

Circulatory shock can be caused by a deficiency of cortisol. Why?

A

Cortisol reduces vascular permeability and without it, fluid leaves the vasculature at a higher rate. It also causes a loss of vascular tone and myocardial contractility. This leads to hypovolemic circulatory shock

47
Q

Cortisol has what effect on vascular tone?

A

maintains vascular tone

48
Q

Cortisol has what effect on contractility?

A

maintains contractility

49
Q

What induction drug can suppress adrenal cortical function?

A

etomidate

50
Q

What is normal daily cortisol production?

A

20-30mg/day

51
Q

What symptoms are associated with pituitary apoplexy?

A

severe HA, meningeal irritation, cardiovascular collapse

52
Q

How is pituitary apoplexy confirmed?

A

MRI or computed tomograpy

53
Q

What is Cushing’s syndrome?

A

elevated cortisol levels in the blood

54
Q

What causes Cushing’s syndrome?

A

hyperfunctioning adrenal gland or adenoma

55
Q

Cushing’s can be caused by cancers of which organs? Which is the most common?

A

pituitary (most common), lung, thyroid, prostate, pancreas, or intrathoracic neuroendocrine tumors

56
Q

Can Cushings be caused by exogenous cortisol-like medications?

A

yes

57
Q

What physical changes are associated with elevated cortisol?

A

moon-face, buffalo hump, truncal obesity/thin extremities, purple abdominal striae, thinning skin

Anesthesia Basics (13 decks)

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