Gastrointenstinal (exam 4) Flashcards
1
Q
What are the main functions of the GI tract?
A
Motility, digestion, absorption, excretion, and circulation
2
Q
List the layers of the GI tract from outermost to innermost.
A
- Serosa
- Longitudinal muscle layer
- Circular muscle layer
- Submucosa
- Mucosa
3
Q
What is the role of the longitudinal muscle layer in the GI tract?
A
Contracts to shorten the length of the intestinal segment
4
Q
What does the circular muscle layer do?
A
Contracts to decrease the diameter of the intestinal lumen
5
Q
What are the components of the mucosa (outside –> in)
A
- Muscularis mucosae
- Lamina propria
- Epithelium
6
Q
What is the function of the muscularis mucosae?
A
Moves the villi
7
Q
What does the lamina propria contain?
A
- Blood vessels
- Nerve endings
- Immune cells
8
Q
What is the enteric nervous system responsible for?
A
Controls motility, secretions, and blood flow
9
Q
What are the two main components of the GI ANS?
A
- Extrinsic nervous system
- Enteric nervous system
10
Q
How does the extrinsic SNS affect GI motility?
A
Primarily inhibitory and decreases GI motility
11
Q
How does the extrinsic PNS affect GI motility?
A
Primarily excitatory and activates GI motility
12
Q
What is the celiac plexus responsible for innervating?
A
Proximal GI organs to the transverse colon
13
Q
What is the role of the myenteric plexus?
A
Controls motility: carried out by enteric neurons, interstitial cells of Cajal, and smooth muscle cells
14
Q
What does the submucosal plexus transmit?
A
Information from the epithelium to the enteric and central nervous systems
15
Q
What is the purpose of an upper gastrointestinal endoscopy?
A
Diagnostic or therapeutic procedure for esophagus, stomach, pylorus, and duodenum
16
Q
What is a high-resolution manometry (HRM) used for?
A
Diagnosing motility disorders in the esophagus
**uses a pressure catheter to measure pressures along the entire esophageal length
17
Q
What are the three categories of esophageal diseases?
A
- Anatomical
- Mechanical
- Neurologic
18
Q
What is dysphagia?
A
Difficulty swallowing
19
Q
What are common symptoms of esophageal disease?
A
- Dysphagia
- Heartburn
- GERD
20
Q
What is achalasia?
A
Neuromuscular disorder causing outflow obstruction due to inadequate LES tone and a dilated hypomobile esophagus
21
Q
What are the treatment options for achalasia?
A
- Medications: nitrates & CCBs
- Endoscopic botox injections
- Pneumatic dilation - most effective nonsurgical treatment
- Laparoscopic Hellar Myotomy - best surgical treatment
- Esophagectomy
22
Q
True or False: Esophageal cancer has a high survival rate.
A
False
23
Q
What is GERD?
A
Incompetence of the gastro-esophageal junction leading to reflux
24
Q
What does the stomach do?
A
Serves as a reservoir for food, mixes and breaks down food to form chyme
25
What is the most common cause of non-variceal upper GI bleeding?
Peptic ulcer disease
26
What is Zollinger Ellison Syndrome?
Non B cell pancreatic tumor (gastrinoma) causing gastrin hypersecretion
27
What is the major function of the small intestine?
Circulate contents and expose them to the mucosal wall to maximize absorption
28
What are reversible causes of small bowel dysmotility (5)?
* Mechanical obstruction
* Bacterial overgrowth
* Ileus
* Electrolyte abnormalities
* Critical illness
29
What does the large intestine do?
Acts as a reservoir for waste and extracts remaining electrolytes and water
30
What are the primary symptoms of colonic dysmotility?
* Altered bowel habits
* Intermittent cramping
31
What is inflammatory bowel disease (IBD)?
Second most common inflammatory disorder after RA
32
What is the primary symptom of colonic dysmotility?
Altered bowel habits and/or intermittent cramping
33
What are the most common diseases associated with colonic dysmotility?
* IBS
* IBD
34
What happens to contractions in Inflammatory Bowel Disease (IBD)?
Contractions are suppressed due to inflammation, but giant migrating complexes remain
35
What can increased frequency of giant migrating complexes lead to in IBD?
Significant erosions and hemorrhage
36
What is the second most common inflammatory disorder after rheumatoid arthritis?
Inflammatory Bowel Disease (IBD)
37
What is the incidence rate of IBD?
18:100,000 people
38
What characterizes Ulcerative Colitis?
Mucosal disease of part or all of the colon
39
What are severe symptoms of Ulcerative Colitis (6)?
* Diarrhea
* Rectal bleeding
* Crampy abdominal pain
* Nausea/Vomiting
* Fever
* Weight loss
40
What lab findings may indicate Ulcerative Colitis?
* ↑ platelets
* ↑ erythrocyte sedimentation rate
* ↓ Hemoglobin & Hematocrit
* ↓ albumin
41
What is a surgical indication for Ulcerative Colitis?
Hemorrhage requiring 6+ units of blood in 24-48 hours
42
What complication can be triggered by electrolyte disturbances in Ulcerative Colitis?
Toxic megacolon
43
What is the mortality rate associated with colon perforation?
15%
44
What is Crohn’s Disease?
Acute or chronic inflammatory process that may affect any/all of the bowel
45
Where is Crohn’s Disease most commonly located?
Terminal ileum
46
What are common symptoms of Crohn’s Disease (4)?
* Weight loss
* Fear of eating
* Anorexia
* Diarrhea
47
What complications can arise from extensive inflammation in Crohn’s Disease?
* Loss of absorptive surfaces
* Malabsorption
48
What is the mainstay treatment for IBD?
5-Acetylsalicylic acid (5-ASA)
49
What are glucocorticoids used for in IBD?
During flares
50
What are common antibiotics used in IBD treatment?
* Rifaximin
* Flagyl
* Cipro
51
What is the last resort in IBD treatment?
Surgery
52
What percentage of carcinoid tumors originate from the GI tract?
95%
53
What substances do carcinoid tumors secrete (8)?
* Gastrin
* Insulin
* Somatostatin
* Motilin
* Neurotensin
* Tachykinins
* Glucagon
* Serotonin
54
What is carcinoid syndrome?
Occurs in 10% of patients with carcinoid tumors. Large amounts of serotonin and vasoactive substances reach systemic circulation
55
What are symptoms of carcinoid syndrome (4)?
* Flushing
* Diarrhea
* Hypertension/Hypotension
* Bronchoconstriction
56
What is the preoperative treatment for carcinoid tumors?
Octreotide before surgery
57
What is acute pancreatitis?
Inflammatory disorder of the pancreas
58
What are the most common causes of acute pancreatitis?
* Gallstones
* Alcohol abuse
59
What are hallmark laboratory findings in acute pancreatitis?
* ↑ serum amylase
* ↑ lipase
60
What is the primary treatment for acute pancreatitis?
Aggressive intravenous fluids (IVF)
61
What is the most common symptom of acute pancreatitis?
Excruciating epigastric pain that radiates to back
62
What is the difference between upper and lower GI bleeding?
Upper GI bleeding is more common than lower GI bleeding
63
What is melena indicative of?
Bleed above the cecum (where the small intestine meets the colon)
64
What is a common cause of lower GI bleeding in elderly patients?
Diverticulosis
65
What is ileus characterized by?
Massive dilation of the colon without mechanical obstruction
66
What can cause loss of peristalsis leading to ileus?
* Electrolyte disorders
* Immobility
* Excessive narcotics
* Anticholinergics
67
What is the treatment for ileus (5)?
* Restore electrolyte balance
* Hydrate
* Mobilize
* NG suction
* Enemas
68
What is a side effect of volatile anesthetics on the GI system?
Depress the electrical, contractile, and propulsive GI activity
69
What is the first part of the GI tract to recover after anesthesia?
Small intestine
70
What effect do opioids have on GI motility?
Reduce GI motility and cause constipation
71
What are the main functions of the GI tract?
* Motility
* Digestion
* Absorption
* Excretion
* Circulation
72
What are the layers of the GI tract wall from outermost to innermost?
* Serosa
* Longitudinal muscle
* Circular muscle
* Submucosa
* Mucosa
73
What controls motility, secretion, and blood flow in the GI tract?
Enteric nervous system
74
What are the two primary movements within the GI tract?
* Mixing movements
* Propulsive movements
75
True or False: Anesthesia medications can alter GI function.
True
76
What is a key point regarding the effects of surgery on GI function?
Hemodynamic changes, bowel manipulation, and open abdominal surgeries can induce ileus, inflammatory states, and mesenteric ischemia
77
The GI tract constitutes approximately _______ of total body mass
5%
78
_______ _______ _______ is the independent nervous system, which controls motility, secretions, and blood flow
Enteric nervous system
**Myenteric plexus, submucosal plexus
79
What (4) ways can the celiac plexus be blocked?
1. trans-crural
2. intraoperative
3. endoscopic ultrasound-guided
4. peritoneal lavage
80
_______ _______ controls absorption, secretion, and mucosal blood flow
Submucosal plexus
81
What are (3) anesthesia challenges with an upper gastrointestinal endoscopy?
1. sharing airway with endoscopist
2. usually done without ETT
3. procedure performed outside of main OR (limited equipment)
82
T/F: pt dehydration d/t bowel prep and NPO status are anesethesia considerations during a colonoscopy
True!
83
**GI series with ingested barium** is a radiologic assessment of _______ and _______
Swallowing and GI transit
84
In a _______ _______ study the pt fasts for 4+ hrs, then consumes a meal with a radiotracer. Frequent imaging for the next 1-2 hrs
Gastric emptying
85
_______ _______ _______: catheter measures contraction pressures and motility of the small intestine
Small intestine manometry
86
_______ _______ _______: barium enema outlines the intestines and it is visible on radiograph, allowing for detection of colon/rectal abnormalities
Lower GI series
87
These types of esophageal diseases include diverticula, hiatal hernia, and changes associated with chronic acid reflux
Anatomical
88
These types of esophageal diseases include achalasia, esophageal spasms, and a hypertensive LES
Mechanical
89
These types of esophageal diseases include disorders such as stroke, vagotomy, or hormone deficiencies
Neurologic
90
This type of dysphagia is common after head and neck surgeries
Oropharyngeal
91
With this type of dysmotility, symptoms occur with both liquids and solids
Esophageal
92
With this type of esophageal dysphasia, symptoms only occur with solid food
Mechanical
93
What are the (3) classes of achalasia?
Type 1: minimal esophageal pressure - responds well to myotomy (cutting muscle to relieve pressure/tension
Type 2: entire esophagus pressurized - has best outcomes
Type 3: esophageal spasms w/ premature contractions - has worst outcomes
94
T/F: For achalasia, an esophagectomy can be considered in mild to severe cases
False: an esophagectomy is only considered in the most advanced disease states
**Esophagectomy = removal of part or all of the esophagus
95
Endoscopic division of the LES muscle layers
Peri-oral endoscopic myotomy (POEM)
**40% develop pneumothorax or pneumoperitoneum
96
Esophageal spasms usually occur in the _______ esophagus
Distal
97
_______ diverticulum can result in bad breath due to food retention
Pharyngoesophageal
**aka Zenker diverticulum
98
_______ diverticulum may be caused by old adhesions or inflamed lymph nodes
Midesophageal
99
In _______ diverticulum pts may experience achalasia
Epiphrenic
**aka supradiaphragmatic
100
A herniation of the stomach into the thoracic cavity. Occurs through the esophageal hiatus in the diaphragm
Hiatal hernia
101
What are the (3) mechanisms of gastroesophageal incompetence?
1. Transient LES relaxation due to gastric distention
2. LES hypotension (normal LES pressure = 29mmHg, avg GERD pressure = 13mmHg)
3. Autonomic dysfunction of GE junction
102
_______ stimulates the vagus nerve to increase the number and force of contractions in the stomach
PNS
103
_______ stimulation to the splanchnic nerve inhibits these contractions
SNS
104
Neurohormonal control of GI movement: _______ and _______ increase the strength and frequency of contractions
Gastrin; motilin
105
Neurohormonal control of GI movement. _______ _______ _______ inhibits contractions
Gastric inhibitory peptide
106
T/F: the majority of nutrients are absorbed in the large intestine
False: small intestine
107
_______ occurs when two nearby areas contract and isolate a segment to hold the contents in place long enough to be absorbed into the circulation
Segmentation
**Controlled by the enteric nervous system
108
What are nonreversible causes of small bowel dysmotility?
Structural: scleroderma, connective tissue disorders, IBD
Neuropathic: pseudo-obstruction (weak uncoordinated contractions)
109
The two type of IBD are _______ _______ and _______
Ulcerative colitis and crohn's
110
T/F: Neostigmine 2-25 mg over 5-mins can produce immediate results when treating an ileus
True!
111
The _______ _______ is the first part of the GI tract to recover from anesthesia, followed by the _______ in approximately 24-hrs and then the _______ 30-40 hrs postop
Smll intestine, stomach, colon
112
Volatile anesthetics depress the _______, _______, and _______
Electrical, contractile, propulsive GI activity
113
T/F: Volatile agents, couple with SNS hyperactivity associated with surgery can inhibit GI function and motility
True!
114
T/F: NMBs can also affect GI motility
False: NMBs only affect skeletal muscle
115
_______ will increase PNS activity and bowel peristalsis by increasing the frequency & intensity of contractions
Neostigmine
**Recall neostigmine is used to treat ileus
