Exam 4- GI Flashcards
Parietal
HCl, IF,
Chief cells
Pepsin
G cells
Gastrin
Production of intrinsic factor –
Essential for the absorption of vitamin B12 in ileum
Parasympathetic nervous system (stimulatory_
– Primarily through
vagus (CN X)
- Increased motility
- Increased secretions
Sympathetic nervous system is
inhibitory
________Maintain continuous flow of saliva in mouth
C.N. VII & IX –
Gastrin
– Secreted by stomach in response to distention
• Increases gastric secretions & motility, relaxes pyloric and ileocecal sphincters – promotes stomach emptying
Histamine(H2 receptor)
– Increased secretion of hydrochloric acid
Secretin
– Decreases gastric secretion
Cholecystokinin (CCK)
Inhibits gastric emptying; stimulates contraction of gallbladder
Fat-soluble vitamins
Vitamins A, D, E, K
Absorbed with fats
Water
-soluble vitamins
–
Vitamins B and C –
Neuroendocrine cells of G.I. tract
• Enterochromaffin Cells
• Use tryptophan hydroxylase-1 to________
•______% of serotonin store in body
• Stimulates secretory, peristaltic and vagal reflexes
via___________
• Important in generating__________
• Ondansetron mechanism: 5-HT 3 receptor antagonist
• (Ginger)
synthesize Serotonin (5-HT) 90%
5-HT 3 receptor
nausea/vomiting
Neuroendocrine cells, they release
_________stimulates parietal cells
via H2 receptors HCl production
Histamine
Small intestine
Duodenum -Jejunum - Ilium
Anorexia and vomiting
– Can cause serious complications
• Dehydration, acidosis, malnutrition
Vomiting
Vomiting center located in the medulla
Increased intracranial pressure
– Sudden projectile vomiting without previous
nausea
Hematemesis
“Coffee grounds” –
brown granular material indicates action of HCl on hemoglobin
– Frank blood –
acute esophageal or gastric Hemorrhage
Fat soluble
Be careful
Prolonged diarrhea may lead to
dehydration,
electrolyte imbalance, acidosis, malnutrition,
weight loss
Steatorrhea – “fatty diarrhea”
** Characteristic of malabsorption syndromes
– Frequent bulky, greasy, loose stools
– Foul odor
Upper GI bleeding
•
Esophagus, stomach, or duodenum –
Lower GI bleeding
• Below the ligament of Treitz: bleeding from the
jejunum, ileum, colon, or rectum
_______ and _______are common
complications of GI tract disorders.
Electrolytes
–
Dehydration and hypovolemia
Lost in vomiting and diarrhea
• Acid-base imbalances
• Diarrhea causes loss of bicarbonate.
Metabolic alkalosis
• Results from loss of HCl w/ vomiting
Metabolic acidosis
Severe vomiting causes a change to metabolic acidosis
due to the loss of bicarbonate of duodenal secretions.
Types of abdominal pain
- Visceral
- Somatic
- Referred
VISCERAL: Burning sensation –
Inflammation and ulceration in upper GI tract
VISCERAL :Dull, aching pain –
Typical result of stretching of liver capsule
VISCERAL:Cramping or diffuse pain –
Inflammation, distention, stretching of intestines
VISCERAL: Colicky, often severe pain –
Recurrent sooth muscle spasms or contraction
Response to severe inflammation or obstruction
Somatic pain receptors directly linked to spinal
nerves –
May cause reflex spasm of overlying abdominal
muscles
Steady, intense, often well-localized pain
Rebound tenderness” – over area of involvement / inflammation of peritoneum
Malnutrition:
2 types
Vitamin B12 deficiency = pernicious anemia
– Iron deficiency = iron deficient anemia
Antacids
•
– To relieve pyrosis
• Antiemetics
– To relieve vomiting
• Laxatives or enemas
– Treatment of acute constipation
Antidiarrheals
– Reduction of peristalsis
– Relieve cramps
Sulfasalazine
•
- Anti-inflammatory and antibacterial
– For acute episodes of inflammatory bowel disease
• ABX
- Clarithromycin Clarithromycin or azithromycin azithromycin
– Effective against Heliobacter pylori infection
• Usually combined with a proton pump inhibitor
Sucralfate
Coating agent
– Enhance gastric mucosal barrier against irritants
such as NSAIDs
Anticholinergic drugs
Reduce secretions &motility
H2 blockers
Useful in gastric reflux
• PPIs
Reduce gastric secretion
Disorder: Cleft lip palate: Intubation
May require intubation with RAE endotracheal tube for
surgical repair
Fistula complicates airway because
airway connected to esophagus
Dilation may
cause airway impingement
GERD
Anesthesia concenrs is aspration
Anesthesia concerns: Aspiration
• Possible related respiratory concerns with GERD:
• Laryngitis
• Recurrent pneumonia
• Asthma (50% of pt.s have endoscopic evidence of
esophagitis)
Hemorrhage
- Due to erosion of blood vessels
- Common complication
- May be the first sign of a peptic ulcer
Obstruction
• May result later due to the formation of scar tissue
Perforation
- Ulcer erodes completely through the wall.
- Chyme can enter the peritoneal cavity.
- Results in chemical peritonitis
DUMPING syndrome
Hyperosmolar chyme draws what?
fluid from vascular compartment into intestine. – Intestinal distention – Increased intestinal motility – Hypotension, Tachycardia, Diaphoresis, Pallor
Hypoglycemia __________
–
2-3 hours after meal
High glucose levels in chyme stimulate
increased insulin secretion → hypoglycemia
Acute pancreatitis
Pancreas lacks a fibrous capsule
***** Hypovolemia and circulatory collapse may follow
– Destruction may progress into tissue surrounding the
pancreas
– Substances released by necrotic tissue lead to
widespread inflammation
– Adult respiratory distress syndrome and acute renal
failure occur in
25% of patients
– GI hemorrhage & DIC may also occur
Gastrinoma
• Large volumes of gastric fluid usually present at
time of anesthesia induction = ↑risk of reflux / aspiration.
• Profuse watery diarrhea = hypokalemia & metabolic
alkalosis.
• IV ranitidine (H2 blocker) useful for preventing acid
hyper-secretion intra-op
Appendicitis – Signs and Symptoms
• “Boardlike” abdomen, tachycardia,
hypotension
Intestinal obstruction
Mesenteric thrombosis (Dehydration in HHS)
