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Mar: Sem 2 - Health Assessment > Exam 4 GI Assessment Part 1 [Bri] > Flashcards

Exam 4 GI Assessment Part 1 [Bri] Flashcards

1
Q

The GI tract constitutes approximately ____% of the total human body mass

A

5%

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2
Q

what are the main functions of the GI system?

A
  • motility
  • digestion
  • absorption
  • excretion
  • circulation

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3
Q

what are the layers of the GI tract from outer most to inner most?

A

the serosa, longitudinal muscle layer, circular muscle layer, submucosa, and mucosa

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4
Q

within the mucose (outermost to innermost) is what 3 things?

A
  • muscularis mucosae
  • lamina propria
  • epithelium

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5
Q

The ____ is a smooth membrane of thin connective tissue and cells that secrete serous fluid to enclose the cavity and reduce friction between muscle movements

A

serosa

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6
Q

The ____ muscle layer contracts to shorten the length of the intestinal segment

A

longitudinal

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7
Q

The ____ muscle layer contracts to decrease the diameter of the intestinal lumen

A

circular

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8
Q

what 2 layers work together to propagate gut motlility?

A

longitudinal muscle layer and circular muscle layer

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9
Q

Innervation of the GI organs up to the proximal transverse colon is supplied bythe ____.

A

celiacplexus

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10
Q

Innervation of the descending colon and distal GI tract comes from the inferior____.

A

hypogastricplexus

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11
Q

what different approaches can be used to block the celiac plexus?

A
  • Transcrural
  • Intraoperative
  • endoscopic ultrasound-guided
  • peritoneallavage

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12
Q

The____lies btwthe smooth muscle layers and regulatesthesmoothmuscle

A

myenteric plexus

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13
Q

The____ transmits information from the epithelium to the entericand central nervoussystems

A

submucosal plexus

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14
Q

what is the mucosa composed of?

A
  • muscularis mucosa
  • lamina propria
  • immune and inflammatory cells
  • epithelium

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15
Q

what is the muscularis mucosa and what does it do?

A

a thin layer of smooth muscle which functions to move the vili

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16
Q

what does the lamina propria contain?

A

blood vessels and nerve endings

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17
Q

what happens in the epithelium?

A
  • Gi contents are sensed
  • enzymes are secreted
  • nutrients are absorbed
  • waste is excreted

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18
Q

what is the GI tract innervated by?

A

autonomic nervous system

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19
Q

what does the GI ANS consist of?

A
  • extrinisic nervous system
  • enteric nervous system

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20
Q

what are the components of the GI ANS extrinsic nervous system and how do they effect GI motility?

A
  • has SNS and PNS components)
    • The extrinsic SNS is primarily inhibitory anddecreases GI motility
    • The extrinsic PNS is primarily excitatory and activates GI motility

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21
Q

____ is the independent nervous system, which controls motility, secretion, and blood flow

A

enteric nervous system

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22
Q

what is the enteric system comprised of?

A

myenteric plexus and submucosal plexus

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23
Q

how does the myenteric plexus control motility?

A

carried out by enteric neurons,interstitial cells of Cajal (aka ICC cells, GI pacemakers), andsmooth musclecells

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24
Q

the myenteric plexus and submucosal plexus respont to what kind of stimulation?

A

sympathetic and parasympatheticstimulation

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25
Q
  • This procedure may be diagnostic or therapeutic.
  • It is performed by endoscope placed into esophagus, stomach, pylorus, and duodenum
  • May be done with or w/o anesthesia but has anesthesia challenges of sharing airway with endoscopist and/or procedure performed outside of the main OR
A

Upper Gastrointestinal Endoscopy:

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26
Q
  • This procedure may be diagnostic or therapeutic/interventional
  • May be done with or w/o anesthesia and has anesthesia challenges of pt dehydration d/t bowel prep & NPO status
A

Colonoscopy:

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27
Q

this procedure is wherea pressure cathetermeasures pressuresalong entire esophageal length and is generally used to dx motility disorders

A

High Resolution Manometry (HRM)

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28
Q

what procedure uses radiologic assessment of swallowing function and GI transit

A

GI series with ingested barium

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29
Q

What procedure haspatient fasts for at least 4 hours, then consumes a meal with a radiotracer. Continuous or frequent imaging occurs for the next 1-2 hrs

A

Gastric emptying study

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30
Q
  • This procedure uses acatheter to measure contraction pressures andmotility of the small intestine
  • evaluatescontractions during three periods: fasting, during a meal, and post-prandial.
  • Normally the recording time consists of 4 hrs fasting, followed by ingestion of a meal, and 2 hrs post-meal
  • Abnormalresults are grouped into myopathic and/or neuropathic causes
A

Small intestine manometry

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31
Q

This procedure involves the administration of a barium enema to a patient. The barium outlines the intestines and it is visible on radiograph. This allows for detection of colon and rectal anatomical abnormalities

A

lower GI series

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32
Q

diseases of the esophagus are grouped into:

A
  • Anatomical
  • Mechanical
  • Neurologic

although many disease states overlap

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33
Q

Anatomical causes of esophageal disease include:

A
  • diverticula
  • hiatal hernia
  • change assoc w/ chronic acid reflux.

These abnormalities interrupt the normal pathway of food,which changes the pressure zones of the esophagus

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34
Q

mechanical causes of esophageal disease include:

A
  • achalasia
  • esophageal spasms
  • hypertensive LES

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35
Q

neurologic causes of esophageal disease include:

A

caused by neurologic disorders such as:
* stroke
* vagotomy
* hormone deficiencies

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36
Q

what are the most common symptoms of esophageal disease?

A
  • dysphagia
  • heartburn
  • GERD

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37
Q

what is dysphagia and what are the differnt types?

A
  • difficulty swallowing
  • orpharyngeal or esophageal

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38
Q

when is oropharryngeal dysphagia commonly seen?

A

after head and neck surgeries

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39
Q

what are the 2 different types of esophageal dysphasia?

A

Classified based on physiology
* Esophageal dysmotility: sx occur w/ both liquids & solids
* Mechanical esophageal dysphasia: sx only occur w/solid food

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40
Q

what is gastroesophageal reflux disease (GERD), and what is normal s/s?

A
  • effortless return of gastric contents into pharynx d/t Incompetence of the gastro-esophageal junction, leading to reflux
  • S/S: Heartburn, nausea, “lump in throat”, dysphagia, and mucosal injury

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41
Q

what is achalasia?

A

neuromuscular disorder of the esophagus consisting of an outflow obstruction d/t inadequate LES tone and a dilated hypomobile esophagus

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42
Q

what are the causes of achalasia?

A
  • Theoretically c/b loss of ganglionic cells of the esophageal myenteric plexus
  • Followed by absence of inhibitory neurotransmitters of the LES
  • Unopposed cholinergic LES stimulation (LES can’t relax)
  • Esophageal dilation with food unable to pass into stomach

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43
Q

s/s of achalasia?

A
  • dysphagia
  • regurgitation
  • heartburn
  • chest pain

Long term increased rx of esophageal cancer

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44
Q

how is achalasia diagnosed?

A

w/esophageal manometry and/or esophagram

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45
Q

what are the 3 classes of achalasia?

A
  • 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

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46
Q

what is the treatment for achalasia?

A
  • all treatments are palliative
  • Medications
  • Endoscopic botox injections
  • Pneumatic dilation
  • Laparoscopic Hellar Myotomy
  • Peri-oral endoscopic myotomy (POEM)
  • Esophagectomy

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47
Q

why would we do RSI or awake intubation with pts who have achlasia?

A

increased risk for aspiration

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48
Q

what medications can be used for achalasia?

A

nitrates & CCBs to relax LES

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49
Q

whats the most effective nonsurgical treatment for achalasia?

A

Pneumatic dilation

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50
Q

what is the best surgical treatment for achalasia?

A

Laparoscopic Hellar Myotomy

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51
Q
  • What is peri-oral endoscopic myotomy (POEM)?
  • how many pt develop pneumothorax or pneumoperitoneum?
A
  • endoscopic division of LES muscle layers
  • 40% develop pneumothorax or pneumoperitoneum

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52
Q

when is esophagectomy considered for achalasia?

A

only considered in the most advanced dz states

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53
Q
  • what is diffuse esophageal spasms?
  • most common in?
  • diagnosed with?
  • pain mimics ____.
  • treatment?
A
  • Spasms that usually occur in distal esophagus; likely d/t autonomic dysfunction
  • More common in elderly
  • Dx on esophagram
  • Pain mimics angina
  • Tx: NTG, antidepressants, PD-I’s

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54
Q

what is esophageal diverticula?

A

outpouchings in the wall of the esophagus

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55
Q

what type of esophageal diverticula has bad breath d/t food retention

A

Pharyngoesophageal (Zenker diverticulum)

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56
Q

what type of esophageal diverticula may be caused by old adhesions or inflamed lymph nodes

A

Midesophageal:

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57
Q

what type of esophageal diverticula have pts that may experience achalasia

A

Epiphrenic (supradiaphragmatic)

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58
Q

for esophageal diverticula all are aspiration risk so what should we do?

A

removal of particles and RSI indicated

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59
Q
  • What is hital hernia?
  • What is it caused by?
  • may be ____
  • often associated with ____
A
  • Herniation of stomach into thoracic cavity, occurs through the esophageal hiatus in the diaphragm
  • c/b weakening in anchors of GE junction to the diaphragm
  • May be asymptomatic
  • often associated with GERD

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60
Q

this happens in 4-5 out of 100,000 people in US

A

esophageal cancer

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61
Q

Esophageal Cancer

  • Presents w/
  • Poor survival rate bc
  • Most are adenocarcinomas, located in ____.
  • ____ accounts for the rest of esophageal cancers
A
  • progressive dysphagia and weight loss
  • abundant lymphatics leads to lymph node metastasis
  • lower esophagus
  • Squamous cell carcinoma

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62
Q
  • These are r/t GERD, Barretts, Obesity
A

adenocarcinomas located in the lower esophagus

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63
Q

what can be curative or palliative for esophageal cancer?

A
  • esophagectomy and may be performed transthoracic, transhiatal, or minimally invasive

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64
Q

____ has a high risk of recurrent laryngeal nerve injury; of which ____% resolve spontaneously.

A
  • esophagectomy
  • 40%

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65
Q

things to keep in mind for pts recieving esophgectomies for cancer

A
  • Pts often malnourished preop, and many months after
  • If h/o chemo/radiation -pancytopenia & dehydration may present
  • Post-esophagectomy pts are very high aspiration risk for life

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66
Q

GERD occurs in ____% of adults.

A

15

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67
Q

in GERD reflux contents include

A
  • HCL
  • pepsin
  • pancreatic enzymes
  • bile

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68
Q

bile reflux in GERD is associated with ____ and ____.

A

Barrett metaplasia & adenocarcinoma

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69
Q

3 mechanisms of GE incompetence

A
  1. Transient LES relaxation, elicited by gastric distention
  2. LES hypotension
  3. Autonomic dysfunction of GE junction

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70
Q
  • normal LES pressure:
  • avg GERD pressure:
A
  • 29 mmhg
  • 13 mmhg

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71
Q

treatment for GERD

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

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72
Q

Preop interventions for GERD

A
  • Cimetidine & Ranitidine-↓acid secretion & ↑pH
  • PPI’s generally given night before and morning of
  • Sodium Citrate- PO nonparticulate antacid
  • Metoclopramide- gastrokinetic; often reserved for diabetics, obese, pregnant
  • Aspiration precautions!
  • RSI indicated. Cricoid pressure has become controversial

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73
Q

what factors increase intraoperative risk of aspiration?

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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74
Q

the stomach is a____ sac that serves as a reservoir for large volumes of food, mixes and breaks down food to form ____, and slows emptying into the ____.

A
  • J-shaped
  • chyme
  • small intestine

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75
Q

Solids must be broken down into ____ particles before entering the duodenum

A

1-2 mm

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76
Q

The motility of the stomach is controlled by?

A

intrinsic and extrinsic neural regulation

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77
Q
  • ____ stimulation to the vagus nerve increases the number and force of contractions
  • ____ stimulation inhibits these contractions via the splanchnic nerve
  • The ____ nervous system provides coordination for motility
A
  • Parasympathetic
  • Sympathetic
  • intrinsic

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78
Q

Neurohormonal control also occurs with:
* gastrin & motilin which does ….?
* and gastric inhibitory peptide does…?

A
  • increase the strength and frequency of contractions
  • inhibits contractions

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79
Q

What disease is this?

  • Most common cause of non-variceal upper GI bleeding
  • Lifetime prevalence= 10% women, 12% men
  • 15,000 death per year
  • may be associated with Helicobacter Pylori
A

peptic ulcer disease

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80
Q

s/s of peptic ulcer disease

A

burning epigastric pain exacerbated w/fasting and improved w/meals

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81
Q

Peptic Ulcer Disease

  • ____% risk of perforation in those who do not receive treatment
  • Perforation s/s?
  • Mortalityis d/t shock or perforation >____h
A
  • 10%
  • sudden/severe epigastric pain c/b acidic secretions into peritoneum
  • 48H

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82
Q

The submucosal plexus controls what?

A
  • absorption
  • secretion
  • mucosal bloodflow

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Mar: Sem 2 - Health Assessment (32 decks)

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