Esophagus, Stomach, Spleen and Pancreas Flashcards
Both the ____ esophageal sphincter and ___ esophageal sphincter are closed at rest
upper and lower
Achalasia
Failure of the Lower esophageal sphincter tone to relax during swallowing accompanied with a lack of peristalsis
Barrett Esophagus
Normal squamous epithelium changes to metaplastic columnar epithelium
Chronic exposure to acidic gastric contents – GERD
Chronic alcohol abuse
Smoking
Types of hiatal hernia
Sliding / Type I
Paraesophageal / Type II
Mixed / Type III
Type IV
Acid release in the stomach is mediated by:
Vagal stimulation (acetylcholine)
Gastrin release – G cells in response to gastric distention
Histamine
Peptic Ulcer Disease causes:
Helicobacter pylori bacterium is the major etiologic factor
Overuse of medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS), and corticosteroids
Excessive alcohol consumption, tobacco use, stress, and receiving radiation therapy can increase one’s risk for peptic ulcers
Most common complications of peptic ulcer disease are
hemorrhage> perforation> obstruction
What are the most effective antisecretory agents for PUD?
Proton pump inhibitors
Most frequent complication of gastric ulceration is _______
perforation
PUD most common cause of ________
hemorrhage
Increased gastric mucosal acidosis is common in :
Critically ill patients
Pt. undergoing prolonged, complex surgical procedure
Pt. undergoing cardiopulmonary bypass
Insulin is eliminated by the _____ and ___ and has an elimination half-life of ____ minutes.
kidneys and liver
5 minutes
Whipple procedure / Pancreatoduodenectomy
complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.
Small intestine section lengths:
Duodenum ~ 20cm
Jejunum ~ 100cm
Ileum ~150cm
The three major classes of nutrients that undergo digestion in the small intestine are :
proteins, lipids (fats), and carbohydrates
Anesthesia Considerations for Intestinal Surgery
Aspiration Risk
Fluid and electrolyte status
History of steroid use ~ perioperative coverage
Avoid Nitrous Oxide
TPN
Bowel prep
Malnutrition and anemia
Thermoregulation – SCIP 36*C
Post op ileus
The spleen is a non-vital organ located in the ______ ______ quadrant of the abdominopelvic region.
left upper
______ is the largest lymphatic organ, acting as a site of lymphocyte proliferation and in immune surveillance and response.
In the fetus, it is a hematopoietic organ.
The Spleen
Most effective treatment to reverse obesity?
Bariatric surgery
-can lead to the resolution of HTN and DM2
Common signs of anastomotic leak:
- tachycardia (72%)
- fever (63%)
- abdominal pain (54%)
______ _____ is the most sensitive sign of an anastomotic leak.
Unexplained tachycardia
_____ shoulder pain common with anastomotic leak.
Left
Examples of procedures for Malabsorption issues
Jejunoileal bypass
Biliopancreatic diversion
Duodenal switch
Examples of procedures for Restriction issues
Gastric band
Sleeve gastrectomy
Combo restriction/malabsorption procedure
Roux-en-Y gastric bypass
What weight loss procedure yields the most improvement in comorbidities and weight loss
