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SU 17: Grape Varieties > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Trigeminal nerve:

A

Nasopharynx

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2
Q

Glossopharyngeal nerve:

A

Posterior third of the tongue and oral pharynx

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3
Q

Superior laryngeal nerve

A

base of tongue and inferior epiglottis to the vocal cords

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4
Q

Recurrent laryngeal nerve

A

vocal cords distally

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5
Q

Branches of the Vagus nerve

A

Remaining larynx and trachea

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6
Q

The esophagus originates at the pharynx at approximately what cervical level?

A

C6 and extends to the stomach

3 functional zones:

  • upper esophageal sphincter
  • esophageal body
  • lower esophageal sphincter

Passes through a space created by the Right crus of the diaphragm

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7
Q

Layers of the esophageal wall:

A
  • Outer longitudinal layer
  • Inner circular muscular layer of smooth and striated muscle
  • mucosal lining
    • squamous epithelium
    • except for distal 1-2 cm which is composed of columnar epithelium
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8
Q

Blood supply to esophagus:

A
  • Interior thyroid arteries: cervical esophagus

- Aortic esophageal branches of bronchial arteries: thoracic esophagus

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9
Q

Intrinsic innervation of the gut (also known as the Enteric Nervous system):

A

2 interconnected plexuses:

  • Myenteric or Auerback plexus
  • Submucosal or Meissner plexus
  • This system extends from the esophagus to anus.
  • The enteric nervous system can operate autonomously, although the autonomic NS (PNS and SNS) can influence functions.
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10
Q

Extrinsic Innervation of the gut (Autonomic NS):

A

Sympathetic: “gastroparesis” fight or flight, slows gut.
-Acts on myenteric plexus to modulate rather than control motor activity

Parasympathetic: “Speeds up” rest and digest
-Cranial nerves IX Glossalpharyngeal, X Vagus, XI Accessory. Mostly the Vagus nerve.

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11
Q

Normal esophageal function:

A

-Both the upper and lower esophageal sphincters are closed at rest.

  • Velocity of swallowing: 3-4cm/sec
  • maximum pressure 150mmHg
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12
Q

Lower esophageal sphincter tone:

A
  • swallowing decreases LES tone within 1.5-2.5 seconds and is maintained over the duration of the peristaltic wave (6-8 seconds)
  • Normal LES tone is 20mmHg
  • Vagal innervation is predominant.
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13
Q

Dysphagia:

A

Difficulty swallowing.

Barium swallow study
Upper endoscopy

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14
Q

Problems associated with Chronic EtOH:

A
  • impaired esophageal peristalsis
  • LES hypotonia (weak)
  • Degeneration of Auerbach plexus (Intrinsic innervation)
  • Mallory weis tear
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15
Q

Achalasia:

A

-Failure of the lower esophageal sphincter tone to relax during swallowing accompanied by a lack of peristalsis.

Conditions associated with Achalasia:

  • DM
  • Stroke
  • Amyotrophic lateral sclerosis (ALS, Lou Gehrig’s dx)
  • Connective tissue diseases (amyloidosis, scleroderma)
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16
Q

Barrett Esophagus:

A
  • Normal squamous epithelium changes to metaplastic columnar epithelium.
  • Close association with development of esophageal carcinoma.

Causes:

  • Smoking
  • Chronic EtOH
  • Chronic exposure to acidic gastric contents (inflammation), GERD
17
Q

Gastroesophageal Reflux Disease (GERD):

A

-Failure of the LES to function properly permitting stomach contents to reflux into the esophagus and possibly the pharynx.

Therapies:

  • Proton pump inhibitors (PPI’s) -Omeprazole
  • Histamine-2 (H2) blockers -famotidine
18
Q

Hiatal Hernia:

A
  • Caused by weakness in the diaphragm that allows a portion of the stomach to migrate upward into the thoracic cavity.
  • 5 types

Symptoms:

  • retrosternal pain of burning quality esp after meals
  • assumed predisposed to developing peptic esophagitis

Surgical Tx: Nissen (anchors the stomach below the diaphragm by sewing part of the stomach up on itself)

19
Q

Esophageal Diverticula:

A

Pouches within the esophagus.

  • Zenker: upper esophagus
  • Traction: mid esophagus
  • Epiphrenic- near LES

Food sequestered in the pouch places patient at higher risk of aspiration.

-staged repair, usually 2 separate surgeries

20
Q

Symptoms and complications of Esophageal Carcinoma:

A

Esophageal Malignancy:

  • Advanced age
  • Cachectic/Malnourished
  • Suffering from age related/metastatic disease process

Possible Hx of preoperative Radiation/Chemo

  • bone marrow suppression
  • intrathoracic and pulmonary fibrosis
  • increased friability of tissues
21
Q

Anesthesia considerations for esophageal disease:

A
  • Hx of GERD w/ active reflux symptoms = plan for aspiration prophylaxis during induction & emergence (no LMAs, ETT only)
  • must be fully awake and have demonstrated conscious control of the airway prior to extubation.
  • RSI: don’t mask ventilate, want to avoid pushing air into stomach.
  • reglan may be helpful, however, to not give to pt with ilius.
22
Q

Ivor-Lewis Repair:

A

Done for Esophageal CA

-Anterior abdominal incision, R thoracotomy.

23
Q

Ivor-Lewis- McKeown Type repair:

A

Done for Esophageal CA

  • R neck incision
  • Excision of diseased esophagus
  • anastomosis of stomach to cervical esophageal remnant.

-Can cause injury to recurrent laryngeal nerve which can impair the ability to cough and cause aspiration PNA.

24
Q

Funds of the stomach:

A
  • Thin-walled and distensible
  • upper part of stomach
  • primary function is storage (4 hours)
25
Q

Distal Stomach:

A
  • Thick walled for mixing of food

- Slow release of chyme (food mixed with gastric juices) through pyloric sphincter into the duodenum.

26
Q

Acid release in the stomach is mediated by:

A
  • Vagal nerve stimulation
  • Gastrin release: G cell response to gastric distention
  • Mistamine release

Acid secretion os parietal cells requires a hydrogen/Potassium exchange pump (ATP used)

SU 17: Grape Varieties (9 decks)

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