Ch. 29 Nutritional and Gastrointestinal Disease Flashcards
What is the unit for BMI?
kg/m^2
What is a desirable BMI?
18-25kg/m^2
What is morbid obesity?
40kg/m^2
What is superobesity?
50kg/m^2
What is super-superobesity?
60kg/m^2
What are respiratory conditions associated with obesity?
OSA, restrictive lung disease, decreased residual volume
What side of the heart is most affected by obesity? Why?
right; OSA and/or obesity-related hypotension syndrome cause pulmonary hypertension
Nondiabetic obese patients have a _______ volume of gastric contents at a _______ pH than nondiabetic lean patients.
smaller; higher
What are places other than the upper arm that a blood pressure cuff can be applied?
lower arm; calf
What conditions does bariatric surgery improve?
HTN, DM II, OSA
Feeding enteral and parenteral - what routes are these?
enteral - nasogastral or directly into jejunum; parenteral - IV
What route is preferred - enteral or parenteral? Why?
enteral utilizes the villi of the GI tract to prevent bacterial transfer
What is an anesthetic concern for a patient on TPN?
How long should they be off TPN and be NPO for induction?
What lab should be checked when a patient is off TPN? Why?
glucose; insulin is a component of TPN
What are the two categories of inflammatory bowel disease?
ulcerative colitis (UC) and Crohn’s Disease (CD)
Which category of IBD is restricted to the large intestine?
ulcerative colitis
How is the presence of IBD confirmed?
endoscopy and biopsy
Which anesthetics are contraindicated for patients with IBD?
none
What barriers must gastric contents pass in order to become aspiration?
lower esophageal sphincter and upper esophageal sphincter
What percent of the general population have heartburn at least once a week?
20%
How do histamine (H2) blockers work?
decrease gastric acid secretion
What adverse side effects do H2 blockers have in the elderly?
cause confusion, agitation, psychosis
Sulfonureas work in what way?
stimulate beta cells to release insulin
Meformin works in what way?
inhibit gluconeogenesis (inhibit hepatic production of glucose)
How might diabetes mask an MI?
if the patient has cardiac autonomic neuropathy they may not get angina pectoris
What DM drugs should not be taken the morning of surgery? Why?
sulfonureas because they may cause hypoglycemia due to the absence of breakfast
What is the difference between hyperthyroidism and thyrotoxicosis?
hyperthyroidism is the secretion of too much thyroid; thyrotoxicosis is the state of having elevated serum thyroid hormone
Elevated serum levels of what characterize hyperthyroidism/thyrotoxicosis
thyroid hormones T3 & T4
What is the most common cause of thyrotoxicosis?
Grave’s disease
Why might HTN and tachycardia be seen in patients with hyperthyroidism?
thyroid hormone increases cardiac sensitivity to catecholamines
What is the most severe form of thyrotoxicosis?
thyroid storm
What method is used to treat hypothyroidism initially?
decrease thyroid hormone synthesis
What advantage does propanolol have vs other beta blockers for the treatment of thyroid storm?
blocks conversion of T4 to T3
What condition does thyroid storm appear like?
MH
Is dantrolene beneficial for treating thyroid storm?
yes
What does Hashimoto’s thyroiditis cause?
hypothyroidism
Which nerve do you absolutely not want to injure during thyroidectomy and why?
(bilateral) recurrent laryngeal because it controls separation of vocal cords during breathing
How does a NIMs tube work?
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
What is a tumor on the adrenal gland called?
pheochromocytoma
What is a tumor of the SNS ganglia called?
paraganglioma
What is MEN?
When two or more endocrine tumor types occur in the same patient
What are the principal hormones secretes by the adrenal cortex?
cortisol and aldosterone
What is chronic insufficiency of cortisol referred to as?
Addison’s disease
Cortisol has what effect on catecholamines?
potentiates the effect of catecholamines
Cortisol has what effect on vascular permeability?
reduces permeability
Circulatory shock can be caused by a deficiency of cortisol. Why?
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
Cortisol has what effect on vascular tone?
maintains vascular tone
Cortisol has what effect on contractility?
maintains contractility
What induction drug can suppress adrenal cortical function?
etomidate
What is normal daily cortisol production?
20-30mg/day
What symptoms are associated with pituitary apoplexy?
severe HA, meningeal irritation, cardiovascular collapse
How is pituitary apoplexy confirmed?
MRI or computed tomograpy
What is Cushing’s syndrome?
elevated cortisol levels in the blood
What causes Cushing’s syndrome?
hyperfunctioning adrenal gland or adenoma
Cushing’s can be caused by cancers of which organs? Which is the most common?
pituitary (most common), lung, thyroid, prostate, pancreas, or intrathoracic neuroendocrine tumors
Can Cushings be caused by exogenous cortisol-like medications?
yes
What physical changes are associated with elevated cortisol?
moon-face, buffalo hump, truncal obesity/thin extremities, purple abdominal striae, thinning skin
