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Health Assessment Exam 4 > Exam 4 - Gastrointestinal > Flashcards

Exam 4 - Gastrointestinal Flashcards

1
Q

What are the 5 functions of the GI system?

A

motility, digestion, absorption, excretion and circulation

GI tract is 5% of total body mass :)

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2
Q

Name the layers of GI system from outer to inner (5 layers)
(3 within layers in mucosa)

A

the serosa, longitudinal muscle, circular muscle, submucosa, mucosa
~Within mucosa is muscularis mucosae, lamina propia and epithelium

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3
Q

How do the longitutional muscle and circular muscle layers propagate gut motility?

A
  • longitudinal muscle contracts to shorten the length
  • circular muscle contracts to decrease the diameter
  • They work together and propagate motility

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4
Q

What does the celiac plexus innervate?

A

the GI organs up to the proximal transverse colon

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5
Q

What does the inferior hypogastric plexus innervate?

A

descending colon and distal GI tract

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6
Q

Where do the submocosal plexus transmit information to?

What is the role of myenteric plexus?

A

submucosal plexus transmits info from epithelium to the enteric & CNS

-myenteric plexus lies btw smooth muscle layers and regulates smooth muscle

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7
Q

The mucosa is made up of muscularis mucosa, lamina propia and epithelium. What are their functions?

A
  • muscularis mucosa -thin layer; moves the villi
  • lamina propria -contains blood vessels & nerve endings
    immune and inflammatory cells
  • epithelium- senses GI contects, secretes enzymes,absorbs nutrients, exretes waste

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8
Q

The mucosa is made up of muscularis mucosa, lamina propia and epithelium. What are their functions?

A
  • muscularis mucosa -thin layer; moves the villi
  • lamina propria -contains blood vessels & nerve endings
    immune and inflammatory cells
  • epithelium- senses GI contects, secretes enzymes,absorbs nutrients, excretes waste

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9
Q

GI is innervated by ANS

The GI tract ANS consits of extrinsic and enteric nervous systems. What are their functions?

A
  • extrinsic nervous system
    The extrinsic SNS -inhibitory and decreases GI motility
    extrinsic PNS - excitatory and activates GI motility
  • enteric nervous system independent nervous system; controls motility, secretion, and blood flow

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10
Q

The enteric system is comprised of myenteric plexus and submucosal plexus. What are the functions of these?

A
  • myenteric plexus controls motility-(carried out by enteric neurons,interstitial cells of Cajal, and smooth muscle cells)
  • submucosal plexus controls absorption, secretion, and mucosal blood flow

Both these respond to sympathetic and parasympathetic stimualtion

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11
Q

Upper Gastrointestinal Endoscopy: may be diagnostic or therapeutic. Endoscope placed into what 4 structures

A
  • esophagus
  • pylorus
  • stomach
  • duodenum

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12
Q

High Resolution Manometry is a pressure catheter; measures pressures along _______?

Used to diagnose ______ _______

11

A

the entire esophageal lenght
motility disorder

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13
Q

GI series with ingested barium is a _______ assessment of _______ function and GI transit.

A
  • radiologic
  • swallowing

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14
Q

What is gastric empting study?

A

Pt fasts for 4 hours; then consumes a meal. There is continous imaging for 2 hours.

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15
Q

Lower GI Series involves the administration of a _____ enema to a patient. This outlines the ________ . This allows for the detection of ______ and _____ anatomical abnormalities.

A
  • barium enema
  • intestines
  • colon
  • rectal

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16
Q

Anatomical causes of Esophageal Disease include _______, ____ hernia, and changes associated with _____ acid reflux.

A
  • diverticula
  • Hiatal
  • chronic

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17
Q

Mechanical causes of Esophageal Disease include achalasia, _______ spasm and a ______ LES

A
  • Esophageal
  • Hypertensive

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18
Q

Neurologic causes of Esophageal Disease may be stroke, ______ or hormone _________.

A
  • vagotomy
  • deficiencies

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19
Q

Oropharyngeal Dysphasia is most common after ______ and _______ surgeries.

A
  • head
  • neck

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20
Q

Esophageal Dysphasia is based on physiology. Includes Esophageal _______ and Mechanical ________ dysphasia.

A
  • Esophageal Dysmotility (occurs w liquids and solids)
  • Mechanical Esophageal (solids)

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21
Q

Gastroesphageal Reflux Disease is the effortless return of _____ contents into ________.

A
  • gastric
  • pharynx

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22
Q

What are (3) Classic symptoms of GERD

A
  • Heatburn
  • Lump in throat
  • nausea

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23
Q

Achalasia is a ________ disorder of the _________ consisting of outflow obstuction d/t an inadequate _____ tone and _____ hypomobile esophagus.

A
  • neuromuscular
  • esophagus
  • LES
  • dilated

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24
Q

Achalsia is caused by loss of _______ cells of the esophagus ______ plexus.
Followed by an absence of ______ neurotransmitters of the LES.
Causing unopposed _________ LES stimulation (LES can’t RELAX)

A
  • ganglionic
  • myenteric
  • inhibitory
  • cholinergic

This disease was referred to as a symptom of several GI disorders later

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25
Q

Achalasia causes Esophageal ____ with food ______ to pass to the stomach.

A
  • dilation
  • unable

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26
Q

Achalsia symptoms include _______, regurgitation, ________ and chest pain. Long-term can increase risk of ________ cancer.

A
  • dysphasia
  • heart burn
  • esophageal

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27
Q

Achalsia Type 1: __________ esophageal pressure, responds _______ to myotomy

A
  • minimal
  • well

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28
Q

Achalasia Type 2: _____ esophagus pressureized; responds well to treatment and has the ______ outcome.

A
  • Entire
  • Best

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29
Q

Achalasia Type 3: Esophageal ______ w/ premature contractions; has the ______ outcome.

A
  • spasms
  • worst

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30
Q

All treatments for Achalasia are __________.

A
  • Palliative.

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31
Q

Medication treatments for Achalsia include nitrates and _____ to relax LES, and Endoscopic _____ injections.

A
  • Calcium Channel Blockers (CCB)
  • Botox

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32
Q

What is the most effective non surgical tx for achalasia?

A

Pneumatic dilation

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33
Q

What is the best surgical treatment for achalasia? hint laparascopic

A
  • Laparascopic Hellar Myotomy

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34
Q

Surgical treatment for Achalasia can include Peri-oral Endoscopic Myotomy (POEM) which is the endoscopic division of the ____ muscle layers. 40% of the surgeries cause ________ or pneumoperitoneum.

A
  • LES
  • Pneumothroax

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35
Q

Esophagectomy for the treatment for Achalasia is only considered in the most _________ disease states.

A
  • advanced.

high aspiration risk! RSI or awake intubation

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36
Q

What are diffuse esophageal spasms? Why do they occur?

A

Spasms that usually occur in distal esophagus; likely d/t autonomic dysfunction

Common in elderly
Tx: NTG, antidepressants, PD-I

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37
Q

What is esophageal diverticula?

A

outpouchings in the wall of the esophagus

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38
Q

What are the (3) types of esophagela diverticula?
What are they all at risk of?

A

Pharyngoesophagelal (zenker diverticulum)
Midesophageal
Epiphrenic (supradiaphragmatic)

All are aspiration risks. Removal of particles and RSI indicated.

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39
Q

What are the signs of Pharyngoesophageal (Zenker diverticulum)?

A

bad breath d/t food retention

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40
Q

What are the causes of Midesophageal diverticula?

A

old adhesions or inflamed lymph nodes

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41
Q

What does the pain from diffuse esophageal spasms mimic? What is the treatment of diffuse esophagela spasms?

A

Pain mimics angina.
TX: NTG, antidepressants, PD-I’s

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42
Q

What can Epiphrenic (supradiaphragmatic) pts experience?

A

achalasia

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43
Q

What is Hiatal Hernia? How does it occur? What is it associated with?

A
  • Herniation of stomach into thoracic cavity, occurs through the esophageal hiatus in the diaphragm
  • c/b weakening in anchors of gastroesophageal junction to the diaphragm
  • May be asymptomatic; often associated with GERD

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44
Q

What type of cancer presents w/ progressive dysphagia and weight loss?

A

Esophageal cancer
5/100,000 ppl in US

poor survival rate :(

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45
Q

What is the most common type of esophageal cancer?

What 3 conditions does it relate to?

A

Most are adenocarcinomas, located in lower esophagus
These are r/t GERD, Barretts, Obesity

Squamous cell carcinoma accounts for the rest of esophageal cancers

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46
Q

Why does esophageal cancer have poor survival rate?

A

B/c abundant lymphatics lead to lymph node metastasis

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47
Q

What is the surgical intervention for esophageal cancer?
How is it performed?

A

Esophagectomy: May be curative or palliative
May be performed transthoracic, transhiatal, or minimally invasive.

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48
Q

What are pts at risk of when undergoing esophagectomy?

How do these pts usually present in pre-op?

If h/o of chemo and radiation, what 2 symptoms may occur?

A

High risk of recurrent laryngeal nerve injury; of which 40% resolve spontaneously.

Patients are often malnourished preop, & months after.

If h/o chemo/radiation -pancytopenia & dehydration may present

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49
Q

What are all patients post- esophagectomy at risk of?

A

High aspiration risk for life!

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50
Q

GERD

What do reflux contents include?

A

HCL, pepsin, pancreatic enzymes, bile

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51
Q

What is GERD? what are its s/s? How frequently does it occur in adults?

A

Incompetence of the gastro-esophageal junction, leading to reflux

Sx: heartburn, dysphagia & mucosal injury

Occurs in 15% of adults.

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52
Q

What diseases is bile reflux associated with?

A

Barrett metaplasia & adenocarcinoma

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53
Q

What are 3 mechanisms of GE incompetence?

A
  1. Transient LES relaxation, elicited by gastric distention
  2. LES hypotension (normal LES pressure-29mmHg, avg GERD pressure-13 mmHg)
  3. Autonomic dysfunction of GE junction

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54
Q

What is the treatment for GERD? (meds and surgery). What foods do you avoid?

A
  • Meds: Antacids, H2 blockers, PPIs
  • Surgery: Nissen Fundoplication, Toupet, LINX
  • avoidance of trigger foods

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55
Q

What are the pre-op interventions for GERD patients?

A
  • Cimetidine, Ranitidine-↓acid secretion & ↑pH
  • PPI’s generally given night before and morning of surgery.
  • Sodium Citrate- PO nonparticulate antacid
  • Metoclopramide- gastrokinetic; often reserved for diabetics, obese, pregnant

Aspirations precautions –> RSI

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56
Q

What are the factors that increase intraop aspiration risk? (long list)

A
  • Emergent surgery
  • Full Stomach
  • Difficult airway
  • Inadequate anesthesia depth
  • Lithotomy
  • Autonomic Neuropathy
  • Gastroparesis
  • DM
  • Pregnancy
  • ↑ Intraabdominal pressure
  • Severe Illness
  • Morbid Obesity

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57
Q

The stomach is ____sac that serves as a ____ for large volumes of food, mixes and breaks down food to form ____, and slows emptying into the small intestine

A

J- shaped
reservoir
chyme

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58
Q

What does gastrin and motilin do?
What does gastric inhibitory peptide do ?

A

Gastrin & motilin increase the strength and frequency of contractions
Gastric inhibitory peptide inhibits contractions

These are controlled by neurohormonal

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59
Q

What is the effect of PNS and SNS on the motility of the stomach?

A

Parasympathetic stimulation to the vagus nerve increases the number and force of contractions
Sympathetic stimulation inhibits these contractions via the splanchnic nerve

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60
Q

What does the intrinsic nervous system do for motility?

A

Provides coordination

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61
Q

What controls the motility of the stomach?

A

intrinsic and extrinsic neural regulation

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62
Q

What are solids must be broken down into before entering duodenum?

A

1-2 mm particles

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63
Q

Peptic Ulcer Disease ::

  • Most common cause of ____________________
  • Prevalence= ___ women, ___ men
    *____ death per year
  • may be associated with _______________
A

non-variceal upper GI bleeding

10% ,, 12%

15,000

Helicobacter Pylori

slide 25

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64
Q

Gastric Outlet Obstruction
What are 2 causes of acute obstructions

A

edema & inflammation in pyloric channel at beginning of duodenum

slide 26

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65
Q

Peptic Ulcer Disease ::

  • Sx :: ______ epigastric pain exacerbated w/ ______ and improved w/ _______
  • 10% risk of__________ in those who do not receive treatment

Mortalityis d/t (2 things)

A

BURNING epigastric pain exacerbated w/ FASTING and improved w/ MEALS

perforation

shock or perforation >48h

slide 25

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66
Q

PUD

Perforation is sudden/severe ______ pain from _____ secretions into ________

A

sudden/severe EPIGASTRIC pain c/b ACIDIC secretions into PERITONEUM

slide 25

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67
Q

What is the treatment for gastric outlet obstruction? (2)

Normally resolves in ___ hrs

Repetitive ______ & _____ may lead to fixed-stenosis and chronic obstruction

A

NGT + IV hydration

72 hrs

ulceration + scarring

slide 26

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68
Q

Gastric Ulcers ::

What is the treatment for H. Pylori

A

Triple therapy
2abx+ PPI x 14 days

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69
Q

What are 3 symptoms of pyloric obstruction?

A

Recurrent vomiting
dehydration
hyperchloremic alkalosis

Slide 26

70
Q

What are 3 primary causes of gastric ulcers?

A

NSAIDs, alcohol, H. Pylori

27

71
Q

What are the 5 types of gastric ulcers

Location – acid hyper secretion?

A

1 = Lesser curvature close of incisura – NO

2 = TWO ulcers : gastric body + duodenal - YES

3 = prepyloric - YES

4 = lesser curvature of gastroesophageal junction - NO

5 = anywhere - usually d/t NSAID use

27

72
Q

Zollinger Ellison Syndrome ::

_________ tumor of the pancreas, causing ______ hypersecretion
Usually, gastrin stimulates gastric acid ________.
Gastric acid ________ further gastrin release (neg feedback)
This feedback loop is ________ in ZE syndrome

A

Non B cell islet
gastrin

secretion

inhibits

absent

28

73
Q

Zollinger Ellison Syndrome ::

WHat are 2 treatments?

Pts have ↑ gastric fluid_______, ________imbalances, &________ abnormalities

Preop :: Correct ______, ↑ gastric ____ w/meds

Induction technique?

A

PPIs and surgical resection of gastrinoma

volume … electrolyte … endocrine

electrolytes … pH

RSI

28

74
Q

Zollinger Ellison Syndrome ::

  • 3 symptoms
  • Occurs in ______ of PUD pts
  • Gender affected?? Most commonly btw ages _____
    Up to 50% of pts w/gastrinomas are______ at time of dx
A

peptic ulcer dz, erosive esophagitis, diarrhea

0.1-1%

Males > females agees 30-50

metastatic

28

75
Q

Small Intestine ::

  • motility mixes contents of the stomach with _____ ________, further reducing particle___ and increasing _____
  • Major function :: _____ the contents and expose them to the ______ _____ to maximize absorption of ____, ______, and _______ before entering the large intestine
A

digestive enzymes … size …. solubility

circulate … mucosal wall …water, nutrients, vitamins

29

76
Q

Small Intestine ::

The_____ and _________ muscle layers coordinate to achieve SEGMENTATION

Segmentation occurs when two areas _______ and thereby isolate a segment of intestine
Segmentation allows the contents to remain in the _______ long enough for the essential substances to be _______ into the circulation

It is controlled mainly by the ________ nervous system with modulation of motility by the _____ nervous system

A

circular … longitudinal

contract

intestine …. absorbed

Enteric ….EXtrinisic

29

77
Q

Small bowel Dysmotility

5 Reversible Causes

2 types Nonreversible causes

A
  • Mechanical Obstruction (hernias, adhesions)
  • bacterial overgrowth
  • ileus
  • electrolyte abnormalities
  • critical illness
    Nonreversible:
  • Structural - scleroderma , IBD , connective tissue dx
  • neuropathic - intrinsic + extrinsic NS altered + produce weak contractions&raquo_space;> n/v, bloating, abd pain

29

78
Q

Large Intestine ::

The colon also exhibits giant _______ complexes
These serve to produce mass _______ across the large intestine
In the healthy state, these complexes occur approximately ______x a day

A

Migrating

movements

6-10

31

79
Q

Large Intestine ::

  • Acts as a reservoir for _____ and ______ material before elimination
    *extracts remaining ______ and water
  • _______ of the ileum will RELAX the _____ valve to allow intestinal contents to enter the colon
  • Subsequent _____ distention will CONTRACT the ileocecal valve
A

waste .. indigestible

electrolytes

Distention … ileocecal

cecal

31

80
Q

What are the most common diseases associated with Colonic dysmotility?

Large Intestine

A
  • IBS (Inflammatory Bowel Syndrome)
  • IBD (Inflammatory Bowel Disease)

32

81
Q

Rome II criteria defines IBS as having abdominal discomfort along with 2 of the following features?

there are 3 features

A
  • defecation relieves discomfort
  • pain is assoc w/abnormal frequency (> 3x per day or < 3xper week)
  • pain is associated with a change in the form of the stool

S32

82
Q

In IBD, the contractions are suppressed due to colonic wall ____ by the inflamed mucosa, but the giant ____ complexes remain

A

In IBD, the contractions are suppressed due to colonic wall compression by the inflamed mucosa, but the giant migrating complexes remain

32

83
Q

The ↑ frequency of the giant migrating complexes and their pressure effect = ↑ compression of inflamed mucosa which can lead to?

A
  • hemorrhage
  • thick mucus secretion
  • significant erosions

S32

84
Q

What is the 2nd most common inflammatory disorder (after RA)?

A

IBD

Incidence 18:100,000 ppl

33

85
Q

What is a mucosal disease of rectum and part or all of the colon?

A

Ulcerative Colitis?

33

86
Q

In severe cases of Ulcerative Colitis, what is the condition of the mucosa?

A
  • hemorrhagic
  • edematous
  • ulcerated

S33

87
Q

What are the s/s of Ulcerative Colitis?

A
  • diarrhea
  • rectal bleeding
  • crampy abdominal pain
  • N/V
  • fever
  • weight loss

33

88
Q

What are the lab results of Ulcerative Colitis?

A

↑plts
↑erythrocyte sedimentation rate
↓H&H
↓albumin

33

89
Q

What intervention to do after giving 6+ units of blood in 24-48 hours of hemorrhage of Ulcerative Colitis?

A

surgical colectomy

~ ½ cases resolve and ½ require colectomy

33

90
Q

What are 2 primary symptoms that manifests with Colonic dysmotility?

A

altered bowel habits
and/or
intermittent cramping

S32

91
Q

What is a complication of Ulcerative Colitis triggered by electrolyte disturbances?

A

Toxic megacolon

S33

92
Q

What is a dangerous complication of toxic megacolon?

A

Colon perforation

S33

93
Q

What is acute or chronic inflammatory process that may affect any/all of the bowel?

A

Crohn’s Disease

S34

94
Q

Where is the most common site of Cronh’s disease?

A

Terminal ilium

34

95
Q

What does presentation of Cronh’s disease?

A

w/ ileocolitis
w/ RLQ pain
& diarrhea

S34

96
Q

What are 2 patterns of Cronh’s disease?

A
  • penetrating-fistulous
  • obstructing

S34

97
Q

What are s/s of Cronh’s disease?

A
  • weight loss
  • fear of eating
  • anorexia
  • diarrhea

34

98
Q

What does persistent inflammation of Crohn’s disease gradually progresses to?

A
  • fibrous narrowing
  • stricture formation

34

99
Q

What replaces diarrhea with Cronh’s disease progression?

A

Chronic bowel obstruction

S34

100
Q

Colonic disease may ____ into stomach/duodenum, causing fecal ____

A

Colonic disease may fistulize into stomach/duodenum, causing fecal vomitus

S34

101
Q

What are additional symptoms of 1/3 Cronh’s patients?

A
  • arthritis
  • dermatitis
  • kidney stones

S34

102
Q

What are medical treatments of IBD?

A
  • 5-Acetylsalicylic acid (5-ASA) - for antibacterial & anti-inflammatory
  • PO/IV Glucorticoids - during flares
  • Antibiotics - Rifaximin, Flagyl, Cipro
  • Purine analogues

S35

103
Q

What intervention should be the last resort for IBD?

A

Resection surgery

S35

104
Q

What length should small intestestine resection be limited to?

A

< 1/2 length

Resected segment should be as conservative as possible

S35

105
Q

What does > 2/3 of small intestine resection leads to? And what does it require?

A

“short bowel syndrome”

requiring TPN

S35

106
Q

Where do most carcinoid tumors originate from? Where can they occur?

A

GI tract

occur in any GI tissue/segment

S36

107
Q

What kind of products are secreted by Carcinoid tumors?

A

peptides & vasoactive substances

(gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, serotonin, other biological actives)

S36

108
Q

What occurs to 10% of patients with Carcinoid tumors where large amounts of serotonin and vasoactive substances reach systemic circulation?

A

Carcinoid syndrome

S36

109
Q

What are s/s of Carcinoid syndrome?

A
  • flushing
  • diarrhea
  • HTN/HoTN
  • bronchoconstriction

S36

110
Q

Effects of Carcinoid sydrome on CV:

May acquire right heart endocardial ____
Left heart generally more ____ as the lungs clear some of the vasoactive substances

A

May acquire right heart endocardial fibrosis
Left heart generally more protected as the lungs clear some of the vasoactive substances

S36

111
Q

How to diagnose Carcinoid syndrome?

A
  • urinary or plasma serotonin levels
  • CT/MRI

S36

112
Q

What are the treatments for Carcinoid syndrome?

A
  • avoid serotonin-triggers
  • control diarrhea
  • serotonin antagonists
  • somatostatin analogues

S36

113
Q

What medication to give before surgery and prior to tumor manipulation of Carcinoid syndrome and why?

A

Ocreotide

to attenuate volatile hemodynamic change

S36

114
Q

What are the secretory characteristics in the Foregut of Carcinoid tumors?

A

↓ Serotonin secretion

secreted ACTH, 5-HTP, GRF

Atypical Carcinoid syndrome

S38 table

115
Q

What are the secretory characteristics in the Midgut of Carcinoid tumors?

A

↑ Serotonin secretion

secreted Tachykinins, rarely 5-HTP, ACTH

Typical Carcinoid syndrome

S38 table

116
Q

What are the secretory characteristics in the Hindgut of Carcinoid tumors?

A

rare Serotonin secretion

rarely 5-HTP, ACTH, other peptides

rare Carcinoid syndrome

S38 table

117
Q

What are the presentations of Carcinoid Tumors at the Small Intestines?

A
  • Abdominal pain
  • Intestinal obstruction
  • tumor
  • GI bleeding

S38 table

118
Q

What are the presentations of Carcinoid Tumors at the Rectum?

A
  • Bleeding
  • constipation
  • diarrhea

S38 table

119
Q

What is the presentation of Carcinoid Tumors at the Bronchus?

A

Asymptomatic

S38 table

120
Q

What is the presentation of Carcinoid Tumors at the Thymus?

A

Anterior mediastinal mass

S38 table

121
Q

What is the presentation of Carcinoid Tumors at the Ovary and Testicle?

A

Mass discovered on physical examination or ultrasound

S38 table

122
Q

Where do Carcinoid Tumors metastasize to and what is the presentation?

A

in the Liver
presents as Hepatomegaly

S38 table

123
Q

How is autodigestion normally prevented to prevent trigger of Pancreatitis?

A
  • Proteases packaged in precursor form
  • Protease inhibitors
  • Low intra-pancreatic calcium → decreases trypsin activity

S39

124
Q

What are the most common causes of Pancreatitis?

A
  1. Gallstones - obstruch ampula of vater → pancreatic ductal HTN
  2. Alcohol abuse

S39

125
Q

Pancreatitis is also seen in which 2 disorders?

A

immunodeficiency syndrome hyperparathyroidism (↑Ca++)

S39

126
Q

What are s/s of Acute Pancreatitis?

A
  • excruciating epigastric pain that radiates to back
  • N/V
  • abd distention
  • steatorrhea
  • ileus
  • fever
  • tachycardia
  • HoTN

S40

127
Q

What are the hallmark labs of Acute Pancreatitis?

A

↑serum amylase & lipase

S40

128
Q

what are some imaging for acute pancreatitis?

A

contrast CT or MRI, endoscopic US (EUS)

s40

129
Q

what are some complications of acute pancreatitis?

A

25% experience serious complications s/a shock, ARDS, renal failure, necrotic pancreatic abscess

s40

130
Q

What are the treatments for Acute Pancreatitis?

A
  • Aggressive IVF
  • NPO (to rest pancreas)
  • enteral feeding (preferred over TPN)
  • opioids

TPN associated w/greater risk of infectious complications

S40

131
Q

what is an ERCP? Interventions include what 4 things?

A

Fluoroscopic examination of biliary & pancreatic ducts
Interventions include
stone removal
stent placement
sphincterotomy
hemostasis

s40

132
Q

which GI bleed is more common? (upper or lower?)

A

Upper GI bleed

s41

133
Q

what vital sign changes will u see w/ >25% blood loss?

A

hypotension and tachycardia

s41

134
Q

what does orthostatic hypotension normally indicate?

A

HCT <30%

s41

135
Q

what does melena indicate?

A

GI Bleed that is above the cecum!!

(Cecum is where small intestine meets colon)

s41

136
Q

why does the BUN go up >40 mg/dL during a GI bleed?

A

because absorption of nitrogen into bloodstream

s41

137
Q

what is the therapeutic procedure of choice and also diagnostic for GI bleeds?

A

EGD (Esophagogastroduodenoscopy)
for endoscopic ulcer ligation and ligation of bleeding varices

s41

138
Q

what is the last resort for uncontrolled variceal bleeding?

A

Mechanical balloon tamponade

s41

139
Q

who usually has lower GI bleeds and what are some causes?

A

elderly

causes - diverticulosis, tumors, colitis

s42

140
Q

What procedure can be performed for Lower GI bleeding as soon as HD stabilizes?

A

Unprepped sigmoidoscopy

S42

141
Q

What procedure can be done for Lower GI bleeding if pt can tolerate prep?

A

Colonoscopy

S42

142
Q

What 2 interventions are warranted if persistent bleeding occurs with Lower Gi bleed?

A

angiography and embolic therapy

S42

143
Q

what is an adynamic ileus?

A

Colonic ileus characterized by massive dilation of the colon without mechanical obstruction

s43

144
Q

what leads to distention of colon?

A

loss of peristalsis

s43

145
Q

what is an adynamic ileus caused by?

A

electrolyte disorders, immobility, excessive narcotics, anticholinergics

s43

146
Q

what could be the neural reason for adynamic ileus?

A

thought to be due to neural-input imbalance of excessive sympathetic stimulation along with inadequate parasympathetic input to the colon

s43

147
Q

whats the tx for adynamic ileus?

A
  • Restore e-lyte balance
  • hydrate
  • mobilize
  • NG suction
  • enemas

s43

148
Q

what med and dose will u give for adynamic ileus?

and what do monitoring do u need if u give it?

A

neostigmine 2-2.5 mg over 5 min

  • produces immediate results 80-90%
  • CARDIAC MONITORING REQUIRED

s43

149
Q

what happens if u leave an adynamic ileus untreated?

A

ischemia and perforation!

s43

150
Q

what is inhibition GI activity directly proportional to?

A

amount of norepinephrine secreted from SNS stimulation, so the higher anxiety = higherinhibition

s44

151
Q

what do volatiles do to the GI system?

A

depress the spontaneous, electrical, contractile, and propulsive activity in the stomach, small intestine, and colon

s44

152
Q

whats the process of recovery of GI system?

A
  1. small intestine –> first part of GI tract to recover
  2. followed by stomach in approx 24 hrs
  3. then, colon 30-40 hours post-op

s44

153
Q

what is important about nitrous oxide and gas containing cavities?

A
  • N2O is 30x more soluble than nitrogen in blood
  • will diffuse into gas-containing cavities from the blood faster than the nitrogen can diffuse out

s45

154
Q

do NMBs affect GI motility?

A

No, NMBs only affect skeletal muscle, so GI motility remains intact

s45

155
Q

when should N2O be avoided?

A

in lengthy abdominal surgeries or when the bowel is already distended

s45

156
Q

what does gut distention correlate to?

A
  • pre-existingamount of gas in the bowel
  • duration of nitrous oxide administration
  • concentration of nitrous oxideadministered

s45

157
Q

what will neostigmine (AChE-I) cause w/ GI system?

what will offsets the cholinergic activity of neostigmine?

A

increase PNS activity and bowel peristalsis by increasing the frequency & intensity of contractions

  • concurrent admin of anticholinergics (glycopyrrolate or atropine)

s46

158
Q

What is sugammadex’s effects on motility?

A

NONE, Sugammadex does not appear to have any effect on motility

s46

159
Q

What is known to cause reduced GI motility and constipation?

How?

A

Opioids

by exerting their function on both central & peripheralmu, delta, and kappa receptors

  • and there’s a high density of peripheral mu-opioid receptors in the myenteric and submucosal plexuses!!!
  • Activation of the mu-receptors causes delayed gastric emptying and slowertransit through the intestine!!!

s47

160
Q

what are some adverse events w/ opioids and the GI system?

A
  • nausea
  • anorexia
  • delayed digestion
  • abdominal pain
  • excessive straining during bowel movements
  • incomplete evacuation

s47

161
Q

what are the 5 main functions of the GI tract?

A
  • motility
  • digestion
  • absorption
  • excretion
  • circulation

s48

162
Q

name the layers of GI tract wall from outermost to innermost

A

outermost to innermost
1. serosa
2. longitudinal muscle
3. circular muscle
4. submucosa
5. mucosa

s48

163
Q

name the layers of the mucosa from outer to inner

A
  1. muscularis mucosae
  2. lamina propria
  3. epithelium

s48

164
Q

how do the SNS and PNS act on the GI motility?

A

The extrinsic nervous system consists of:

SNS –> primarily inhibitory
PNS –> primarily excitatory on GI tract motility

s48

165
Q

what does the enteric nervous system control?

A

motility, secretion, and blood flow

s48

166
Q

what are the 2 primary movements w/in and along the GI tract?

A

mixing and propulsive movements

s49

167
Q

What can hemodynamic changes, bowel manipulation and open abdominal surgeries induce?

A

ileus, inflammatory states, mesenteric ischemia, and partial or total disruption of myogenic continuity

s49

168
Q
A
169
Q
A
170
Q
A

Health Assessment Exam 4 (7 decks)

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