EXAM 4 GI Flashcards
learn about the ole poop chute
Five basic layers of the GI tract
the serosa, longitudinal muscle layer, circular muscle layer, submucosa, and mucosa
Three layers of the mucosa
muscularis mucosae, lamina propria, and epithelium
What is the serosa?
smooth membrane of thin connective tissue and cells that secrete serous fluid to enclose the cavity and reduce friction between muscle movements
Compare longitudinal muscle to circular muscle layer
Longitudinal= short
Circular= decreased diameter
What are the two plexi of the GI tract?
Celiac and Hypogastric
Name the four blocks of the celiac plexus.
Transcrural
Intraoperative
endoscopic ultrasound-guided
peritoneallavage
Which plexus controls the smooth muscle layers of the GI tract?
Myenteric plexus.
The submucosal plexus is linked to what portion of the nervous system?
Enteric and CNS
The GI tract is controlled by the ANS, what functions to the SNS and PNS provide?
SNS= inhibition
PNS= excitatory
This portion of our nervous system is linked to that gut feeling and what neurotransmitter is associated with?
Enteric nervous system &
5-HT
What is the other name of the pace maker cells of the myenteric nervous system?
Interstitial Cells of Cajal (ICC)
Name the seven diagnostic procedures for the GI tract.
Endoscopy
Barium Swallow
Colonoscopy
Gastric emptying
High resolution manometry
Lower GI series
Small intestine Manometry
Name the three categories of esophageal disorders.
Anatomical, mechanical, and neurologic
what are some anatomical esophageal disorders?
diverticula, hiatal hernia, and changes associated w/ chronic acid reflux
Name some mechanical esophageal disorders
achalasia, esophageal spasms, and ahypertensive LES
what are some neurological esophageal disorders?
stroke, vagotomy, or hormone deficiencies
Common symptoms associated with esophageal disorders?
dysphagia, heartburn, GERD
Dysphagia can be classified two ways, differentiate them.
Mechanical Dysphagia- the inability to swallow solid food.
Dysmotility- The inability to swallow liquids or solids.
Soft ball question, what is GERD?
gastric esophageal reflux disease. This is when food leaves the stomach and refluxes into the esophagus causing pain. aka heartburn.
What is achalasia? How many classes does it have.
neuromuscular disorder of the esophagus consisting of an outflow obstruction d/t inadequate LES tone and a dilated hypomobile esophagus
Three classes
Type 1: minimal esophageal pressure, responds well to myotomy
Type 2: entire esophagus pressurized; responds well to treatment, has best outcomes
Type 3: esophageal spasms w/premature contractions; has worst outcomes
List treatment options for achalasia
Medications: nitrates & CCBs to relax LES
Endoscopic botox injections
Pneumatic dilation * most effective nonsurgicaltx
Laparoscopic Hellar Myotomy *best surgical tx
Peri-oral endoscopic myotomy (POEM)- endoscopic division of LES muscle layers
40% develop pneumothorax or pneumoperitoneum
Esophagectomy- only considered in the most advanced dz states
This esophageal disorder has resemblance to angina, what is it and how do we treat?
Diffuse Esophageal Spasms
Nitroglycerin, antidepressants, and Phosphodiesterase inhibitors.
An outpouching disorder that are at high risk for aspiration and linked to bad breath.
Esophageal Diverticula
can be upper, mid, or supradiaphragmatic.
Another softball, what is it called when the stomach protrudes through the esophageal aperture?
Hiatal hernia.
Alot of these patients experience GERD.
Dysphagia, weight loss, and lymph node involvement.
what am I?
Esophageal cancer. Poor outcomes, an esophagectomy can be performed to relieve symptoms.
Anesthetic considerations in the setting of esophageal cancer?
Hi risk for recurrent laryngeal nerve injury, dehydration, electrolyte imbalance, and pancytopenia if receiving cancer treatment.
Transient LES relaxation, elicited by gastric distention
LES hypotension,
Autonomic dysfunction of GE junction are associated with?
GERD
Normal LES tone?
29 mmHg
Common medical treatments for GERD?
H2 antagonist, PPIs, Reglan, antacids (sodium citrate preferred for anesthesia.
Surgical treatments for GERD?
Nissen Fundoplication, Toupet, LINX
all essentially return “tone” through wrapping. LINX uses magnets, so that’s dope.
Aspiration risk factors?
its a long list yall.
Emergent surgery
Full Stomach
Difficult airway
Inadequate anesthesia depth
Lithotomy
Autonomic Neuropathy
Gastroparesis
DM
Pregnancy
↑ Intraabdominal pressure
Severe Illness
Morbid Obesity
Parasympathetic stimulation increases rate and force of contraction of the stomach, what nerve is it?
The vagus nerve.
What nerve inhibits the stomach?
splanchnic nerve
These two hormones cause contraction
gastrin and motilin
Peptic ulcer disease symptoms are relieved by this everyday activity.
Eating.
Why do people die from PUD?
untreated perforation leading to hemorrhage or peritonitis.
Your patient is extremely dehydrated, alkalotic, and is continuously vomiting. What are you suspicious of?
gastric outlet obstruction.
Ngt tube, bowel rest, and IV resuscitation. This can be recurrent if there is a stenosis.
This is related ETOH and NSAID use?
Gastric ulcers.
what are the five types of gastric ulcers?
What syndrom of the GI tract is associated with a disruption of a negative feeback loop?
Zollinger Ellison Syndrome
Anesthetic considerations for Zollinger Ellison Syndrome?
pre op/ induction
Correct lytes,↑gastric pH w/meds, RSI
Treatment for Zollinger Ellison Syndrome?
PPIs and surgical resection of gastrinoma
Why is segmentation so important for the small intestines?
The contractions slow the food down within the tract, giving it more time to be absorbed by the mucosa.
What are reversible causes of small bowel dysfucntion?
mechanical obstruction such as hernias, malignancy, adhesions, and volvuluses
bacterial overgrowth leading to alterations in absorptive function
ileus, electrolyte abnormalities, and critical illness
Irreversible causes of small bowel dysfunction?
Structural: scleroderma, connective tissue disorders, IBD
Neuropathic:pseudo-obstruction in which the intrinsic and extrinsic nervous systems are altered and the intestines can only produce weak, uncoordinated contractions
distention of ______ allows the _________ to open, thus permitting entrance into the colon.
ileum and ileocecal valve.
These are produced to allow mass movement of contents within the colon.
Giant migrating complexes.
complexes occur approximately 6-10x a day
What are two categories of colonic dysmotility?
IBS and IBD
What typically relieves IBS?
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
What are the two common forms of IBD?
Chron’s and Ulcerative colitis
Giant migrating complexes still occur in IBD, what is missing?
smooth muscle contractions due to the inflammation of the mucosa.
Because of the increased frequency of giant migrating complexes, what can occur in IBD?
their pressure-effect further compresses the inflamed mucosa, which can lead to hemorrhage, thick mucus secretion, and significant erosions
Ulcerative colitis is defined as ?
Mucosal disease of the rectum and part or all of the colon
Common lab findings in UC?
↑plts,↑erythrocyte sedimentation rate, ↓H&H, ↓albumin
How many units of blood warrant a colectomy?
6 plus
This disease can effect a person anywhere in the gut and comes in two forms?
Crohn’s
penetrating-fistulous, or obstructing
Complications of Crohn’s
solid list
Diarrhea decreases and is replaced by chronic bowel obstruction
Extensive inflammation leads to loss of absorptive surfaces, resulting in malabsorption & steatorrhea
Colonic dz may fistulize into stomach/duodenum, causing fecal vomitus
1/3 Crohn’s pts have an additional symptoms s/a arthritis, dermatitis, kidney stones
Common IBD treatments?
5-Acetylsalicylic acid (5-ASA)- mainstay for IBD
PO/IV Glucorticoids during flares
Antibiotics: Rifaximin, Flagyl, Cipro
Purine analogues
Why is surgery not ideal for crohn’s?
can lead to short gut syndrome and the need for TPN.
Common symptoms of carcinoid tumors?
flushing, diarrhea, HTN/HoTN, bronchoconstriction
Pre op measures for carcinoid tumors?
Octreotide before surgery and prior to tumor manipulation to attenuate volatile hemodynamic changes
carcinoid tumors excrete an excess of what?
gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, serotonin, other biological actives
Differentiate the different carcinoid manifestations based on location
What has increased ten fold since the 1960s?
Acute pancreatitis, most likely to due to better diagnostic capabilities.
What is typically elevated in acute pancreatitis?
↑serum amylase & lipase
Typical causes of acute pancreatitis?
Gallstones obstruct ampulla of vater, causing pancreatic ductal HTN
Pancreatitis is also seen in immunodeficiency syndrome, hyperparathyroidism/↑Ca²
Acute pancreatitis treatment?
Aggressive IVF, NPO to rest pancreas, enteral feeding (preferred over TPN), opioids
ERCP
What is more common, upper of lower GI bleeding?
upper GI
Dosage for neostigmine and what to watch out for in the setting of ileus?
2-2.5mg over 5 min
watch for bradycardia.
Inhibition of the GI tract is proportional to what?
Norepinephrine levels. Keep your patients chill, and anxiety at a minimum.
Name the sections of the GI tract that recover first to last post op?
small intestine, stomach, followed by large intestine.
large intestine takes about a day and a half to fully recover.
Why is nitrous oxide an issue with the gut?
will dissolve into air filled compartments, increased volume and pressure. can cause abdominal or bowel distention.
What reversal agent has no effect on GI motility.
sugammadex.
