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ARCHIVED: Assessment > Exam 2: GI and Liver > Flashcards

Exam 2: GI and Liver Flashcards

1
Q

Pre-op restriction on clear liquids:

A

2 hours

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2
Q

Pre-op restriction on breast milk:

A

4 hours

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3
Q

Pre-op restriction on light meals, milk, or formula:

A

6 hours

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4
Q

Pre-op restriction on heavy meals:

A

8 hours

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5
Q

Pre-op restriction on sips of water for meds:

A

1 hour

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6
Q

Patients who are aspiration risks (8):

A 
Age extremes ( 70)
Ascites
Hiatal hernia/GERD/esophageal surgery
Mechanical obstruction
Metabolic disorders
Neurologic diseases
Pregnancy
Prematurity

AAHMMNPP

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7
Q

Four greatest risks for aspiration:

A

Pregnant
Morbidly obese
Hiatal hernia
Preoperative anxiety

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8
Q

Aspiration prophylaxis:

A

H2 receptor antagonists
Sodium citrate/Bicitra
Metoclopramide/Reglan
PPI (i.e. omeprazole)

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9
Q

Use of H2 blockers pre-op:

A

Best given night before & 45-60 minutes pre-op
Famotidine: best result
Also cimetidine, ranitidine

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10
Q

Indications, MoA, and contraindications for pre-op metoclopramide:

A

Dopamine antagonism ↑ pressure on LES which speeds gastric emptying
Prevents/alleviates N/V
CONTRAINDICATED in obstruction!!

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11
Q

MoA, dose, and timing of sodium citrate pre-op:

A

30mL, 15 minutes before surgery to raise gastric pH (also raises volume, though)

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12
Q

Mendelson Syndrome characterized by:

A

Aspiration of > 25ml of gastric material at

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13
Q

Manifestations of Mendelson Syndrome:

A 
Respiratory distress
Bronchospasm
Cyanosis
Tachycardia
Dyspnea
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14
Q

Tx for Barrett’s esophagus:

A

H2 blockers and PPIs

Nissen fundoplication

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15
Q

S/s of hiatal hernia:

A

Retrosternal discomfort
Burning after meals
+/- reflux

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16
Q

Tx of hiatal hernia:

A

Surgery

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17
Q

Risk factors for PUD:

A 
H. pylori
Age 45-60
Chronic NSAIDs
ETOH
Steroids
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18
Q

S/s of PUD:

A 
Epigastric pain
Vomiting
Hematemesis/melena
Abdominal tender/rigid
Perforation
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19
Q

Tx of PUD:

A

H2 blockers and PPIs
Abx
Antacids

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20
Q

Tx of PUD:

A

H2 blockers and PPIs
Abx
Antacids

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21
Q

S/s of gastric ulcers:

A

Pain
Anorexia
Weight loss
Metabolic derangements

22
Q

Important pre-op considerations for malabsorption syndromes:

A

Fluids and electrolytes

Vitamin K levels!

23
Q

Important pre-op considerations for malabsorption syndromes:

A

Fluids and electrolytes

Vitamin K levels!

24
Q

S/s of malabsorptions syndromes:

A 
Weight loss
Steatorrhea
Diarrhea
Anemia
Fatigue
Vitamin deficiency
Dyscrasias
Edema/ascites
25
Q

Lab abnormalities in Crohn’s disease:

A

Deficiencies in magnesium, B12, phosphorus, folic acid, zinc, iron, postassium, albumin
Anemia

26
Q

Carcinoid syndrome is:

A

Mild, non-metastatic cancer originating in the GI tract

27
Q

Substances secreted by carcinoid cancers:

A

Bradykinin
Histamine
Serotonin
Dopamine

28
Q

Skin signs of GI problems:

A 
Jaundice
Small veins
Cracked lips
Turgor
(mostly fluid-related)
29
Q

Useful GI labs:

A

Hgb/hct (fluid status)
Electrolytes
BUN/Cr
Serum albumin

30
Q

Serum albumin range:

A

Should be > 4

31
Q

Liver’s blood reservoir %:

A

10-15%

32
Q

Risk factors for chronic liver disease:

A 
Blood transfusions
Jaundice
Drugs/ETOH
Meds/fish oil
Travel hx
Occupational hx
33
Q

S/s of liver disease:

A 
Bruising
Anorexia
Weight changes
N/V
Pain
Itching
GI bleeding
34
Q

Two grading scales for liver dysfunction:

A

MELD

Child-Turcotte-Pugh

35
Q

Factors in the Child-Turcotte-Pugh scoring system:

A 
ABE APP:
Ascites
Bilirubin
Encephalopathy
Albumin
PT/INR
Primary biliary cirrhosis
36
Q

Lab tests for liver function:

A 
AAAA B CC NP:
Ammonia
AST/ALT
Alk phos/GGT
Albumin
Bilirubin
CBC
Coags
5' Nucleotidase
Prothrombin
37
Q

Physical assessment for liver function:

A 
Look for:
Jaundice
Ascites
Dependent edema
Asterixis
38
Q

Anesthetic considerations for liver disease:

A

Often have enzyme induction and need ↑ sedatives
Hyperdynamic circulatory state
↑ levels of endogenous vasodilators like VIP

39
Q

Liver disease effects on respiratory status:

A

Ascites impairs diaphragm movement and ↓ FRC

40
Q

Factors dependent on Vitamin K:

A

II, VII, IX, X

2, 7, 9, 10

41
Q

Absorption of Vitamin K depends on:

A

Bile salt excretion into the GI tract

42
Q

Treatment of Hep B/C:

A

Interferon, ribavirin

43
Q

Treatment of AI hepatitis:

A

Corticosteroids, AZT

44
Q

Anesthetic considerations for hepatitis:

A

Aspiration precautions!

Look for s/s of encephalopathy, bleeding, ascites, etc.

45
Q

Hours after ETOH withdrawal that tremors may be seen:

A

6-8 hours

46
Q

Hours after ETOH withdrawal that seizures may be seen:

A

24 hours

47
Q

Hours after ETOH withdrawal that DTs may be seen:

A

72 hours (but preceded by tremors, hallucinations, seizures)

48
Q

Anesthetic considerations for cirrhosis:

A

Hyperdynamic circulation
↑ CO
↓ PVR

49
Q

Clotting factors reduced in liver failure:

A

II, V, VII, IX, X

2, 5, 7, 9, 10

50
Q

Factors dependent on Vitamin K:

A

II, VII, IX, X (2, 7, 9, 10)

Protein C, Protein S

51
Q

Clotting factors reduced in liver failure:

A

II, V, VII, IX, X (2, 5, 7, 9, 10)

52
Q

Mechanism of platelet dysfunction in liver failure:

A

Thrombopoietin is produced by the liver and signals for platelet production in the bone marrow

ARCHIVED: Assessment (11 decks)

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