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Assessment Exam 4 > Gastrointestinal Assessment Spring '24-2 > Flashcards

Gastrointestinal Assessment Spring '24-2 Flashcards

1
Q

What are the main functions of the GI tract?

A

Motility, digestion, absorption, excretion, circulation

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2
Q

What are the layers of the GI tract from outermost to innermost?

A

Serosa, longitudinal muscle, circular muscle, submucosa, mucosa

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3
Q

What layers are within the mucosa of the GI tract?

A

Muscularis mucosae, lamina propria, epithelium

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4
Q

What is the serosa in the GI tract?

A

Smooth membrane of thin connective tissue and cells

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5
Q

How does the longitudinal muscle layer contribute to gut motility?

A

Shortens the length of the intestinal segment

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6
Q

What is the function of the circular muscle layer in gut motility?

A

Decrease the diameter of the intestinal lumen

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7
Q

How do the longitudinal and circular muscle layers work together in gut motility?

A

Propagate gut motility

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8
Q

What is the innervation of the GI organs up to the proximal transverse colon?

A

Celiac plexus

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9
Q

Where does the innervation of the descending colon and distal GI tract come from?

A

Inferior hypogastric plexus

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10
Q

How can the celiac plexus be blocked?

A

Transcrural, intraoperative, endoscopic ultrasound-guided, peritoneal lavage

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11
Q

Where does the myenteric plexus lie? What does the myenteric plexus regulate?

A

Between smooth muscle layers. It regulates mooth muscle

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12
Q

What does the submucosal plexus do?

A

Transmits information to nervous systems

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13
Q

What is the mucosa composed of?

A

Muscularis mucosa, lamina propria, immune cells, epithelium

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14
Q

What is the function of the muscularis mucosa?

A

Move the villi

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15
Q

What is found in the lamina propria?

A

Blood vessels & nerve endings

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16
Q

What are some functions of the epithelium in the mucosa?

A

Sensing GI contents, secreting enzymes, absorbing nutrients, excreting waste

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17
Q

What is the innervation of the GI tract?

A

Autonomic nervous system

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18
Q

What are the components of the GI ANS?

A

Extrinsic SNS, Extrinsic PNS, Enteric NS

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19
Q

What is the function of the extrinsic SNS in the GI tract?

A

Inhibitory, decreases GI motility

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20
Q

What is the function of the extrinsic PNS in the GI tract?

A

Excitatory, activates GI motility

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21
Q

What does the enteric nervous system control?

A

Motility, secretion, blood flow

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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

What does the myenteric plexus control?

A

Motility

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24
Q

What controls absorption, secretion, and mucosal blood flow?

A

Submucosal plexus

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25
Q

How do both plexuses respond to stimulation?

A

Sympathetic and parasympathetic

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26
Q

What is an Upper Gastrointestinal Endoscopy?

A

Endoscope inserted into upper GI tract

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27
Q

What areas does an upper GI endoscopy examine?

A

Esophagus, stomach, pylorus, duodenum

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28
Q

What are some challenges related to anesthesia in upper GI endoscopy?

A

Sharing airway with endoscopist

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29
Q

What are some challenges related to anesthesia in colonoscopy?

A

Dehydration due to bowel prep

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30
Q

What is High Resolution Manometry (HRM)?

A

Pressure catheter measures pressures along esophageal length

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31
Q

What is a common use of High Resolution Manometry?

A

Diagnose motility disorders

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32
Q

What is assessed in a GI series with ingested barium?

A

Swallowing function and GI transit

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33
Q

What is a Gastric emptying study?

A

Patient fasts, then consumes a meal with a radiotracer and undergoes imaging

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34
Q

What is the purpose of small intestine manometry?

A

Evaluates contractions and motility

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35
Q

What are the three periods during which contractions are evaluated in small intestine manometry?

A

Fasting, during a meal, post-prandial

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36
Q

What are abnormal results in small intestine manometry grouped into?

A

Myopathic and/or neuropathic causes

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37
Q

What does a lower GI series involve? How does this help in a lower GI series?

A

Barium enema administration. This Outlines the intestines for radiograph visibility

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38
Q

What are the three groups that esophageal diseases are grouped into?

A

Anatomical, Mechanical, Neurologic

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39
Q

What are examples of anatomical causes of esophageal diseases?

A

Diverticula, Hiatal hernia, Chronic acid reflux

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40
Q

What are examples of mechanical causes of esophageal diseases?

A

Achalasia, Esophageal spasms, Hypertensive LES

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41
Q

What can cause neurologic causes of esophageal diseases?

A

Neurologic disorders like stroke, vagotomy, hormone deficiencies

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42
Q

What are the most common symptoms of esophageal disease?

A

Dysphagia, heartburn, GERD

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43
Q

What is dysphagia?

A

Difficulty swallowing

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44
Q

What are the two types of dysphagia?

A

Oropharyngeal, esophageal

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45
Q

How is esophageal dysmotility characterized?

A

Symptoms occur with both liquids & solids

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46
Q

What type of dysphagia is characterized by symptoms only occurring with solid food?

A

Mechanical esophageal dysphagia

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47
Q

What is gastroesophageal reflux disease (GERD)?

A

Effortless return of gastric contents into pharynx

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48
Q

What are the common symptoms of GERD?

A

Heartburn, nausea, ‘lump in throat’

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49
Q

What is Achalasia characterized by?

A

Outflow obstruction and inadequate LES tone

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50
Q

What could be the cause of Achalasia?

A

Loss of ganglionic cells of esophageal myenteric plexus

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51
Q

What are the symptoms of Achalasia?

A

Dysphagia, regurgitation, heartburn, chest pain

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52
Q

How is Achalasia diagnosed?

A

Esophageal manometry and/or esophagram

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53
Q

What are the three classes of Achalasia?

A

Type 1, Type 2, Type 3

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54
Q

What are the treatments for esophageal disease Achalasia?

A

Medications, Endoscopic botox injections, Pneumatic dilation, Laparoscopic Hellar Myotomy, Peri-oral endoscopic myotomy (POEM), Esophagectomy

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55
Q

Which treatment is considered the most effective nonsurgical option for Achalasia?

A

Pneumatic dilation

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56
Q

What is the best surgical treatment for Achalasia?

A

Laparoscopic Hellar Myotomy

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57
Q

What does POEM stand for in the context of Achalasia treatment?

A

Peri-oral endoscopic myotomy

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58
Q

When is esophagectomy considered as a treatment for Achalasia?

A

Only in the most advanced disease states

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59
Q

What is indicated for patients with Achalasia at increased risk for aspiration?

A

RSI or awake intubation

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60
Q

What are diffuse esophageal spasms?

A

Spasms in distal esophagus; common in elderly

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61
Q

How are diffuse esophageal spasms diagnosed?

A

Dx on esophagram

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62
Q

What is a characteristic symptom of pharyngoesophageal diverticulum?

A

Bad breath from food retention

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63
Q

What is the recommended treatment for diffuse esophageal spasms?

A

NTG, antidepressants, PD-I’s

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64
Q

Why are all types of esophageal diverticula considered aspiration risks?

A

Removal of particles and RSI indicated

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65
Q

What is a hiatal hernia?

A

Stomach herniation into thoracic cavity

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66
Q

What are some causes of hiatal hernia?

A

Weakening of anchors of GE junction to diaphragm

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67
Q

What are common symptoms associated with hiatal hernia?

A

May be asymptomatic; often linked to GERD

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68
Q

What is the incidence rate of esophageal cancer in the US?

A

4-5/100,000 people

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69
Q

What are common presentations of esophageal cancer?

A

Progressive dysphagia and weight loss

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70
Q

Why is the survival rate of esophageal cancer poor?

A

Abundant lymphatics leading to lymph node metastasis

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71
Q

What is the most common type of esophageal cancer?

A

Adenocarcinomas located in lower esophagus

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72
Q

What risk factors are associated with adenocarcinomas of the esophagus?

A

GERD, Barretts, Obesity

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73
Q

Which type of esophageal cancer accounts for the rest?

A

Squamous cell carcinoma

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74
Q

What are the different types of esophagectomy approaches?

A

Transthoracic, transhiatal, minimally invasive

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75
Q

What is a risk associated with esophagectomy related to the recurrent laryngeal nerve?

A

High risk of injury, 40% resolve spontaneously

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76
Q

Why are patients often malnourished preoperatively and for months after esophagectomy?

A

Pts often malnourished

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77
Q

What complications may present in patients with a history of chemotherapy or radiation who undergo esophagectomy?

A

Pancytopenia & dehydration

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78
Q

What is a significant risk for post-esophagectomy patients?

A

High aspiration risk for life

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79
Q

What is GERD associated with in terms of gastric functions?

A

Incompetence of the gastro-esophageal junction

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80
Q

What are the primary symptoms of GERD?

A

Heartburn, dysphagia, mucosal injury

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81
Q

What percentage of adults suffer from GERD?

A

15%

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82
Q

What types of substances are refluxed in GERD?

A

HCl, pepsin, pancreatic enzymes, bile

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83
Q

What is bile reflux related to in GERD patients?

A

Bile reflux is associated with Barrett metaplasia & adenocarcinoma

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84
Q

What are the three mechanisms leading to GE incompetence in GERD?

A

Transient LES relaxation, LES hypotension, Autonomic dysfunction of GE junction

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85
Q

What is the average LES pressure in patients with GERD?

A

13 mmHg

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86
Q

What is the normal LES pressure?

A

29 mmHg

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87
Q

What are the treatment options for GERD?

A

Avoid trigger foods, use Antacids, H2 blockers, PPIs, consider surgery

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88
Q

What are some preoperative interventions for GERD?

A

Cimetidine, Ranitidine, PPIs, Sodium Citrate, Metoclopramide

89
Q

What is Metoclopramide used for in GERD patients?

A

Gastrokinetic; often reserved for diabetics, obese, pregnant

90
Q

What precautions should be considered for GERD patients?

A

Aspiration precautions!

91
Q

When is RSI indicated in GERD patients?

A

RSI indicated. Cricoid pressure has become controversial

92
Q

What factors can increase the risk of intraoperative aspiration?

A

Emergent surgery, Full Stomach, Difficult airway, Inadequate anesthesia depth

93
Q

Which conditions or situations can contribute to a higher risk of intraoperative aspiration?

A

Autonomic Neuropathy, Gastroparesis, DM, Pregnancy

94
Q

What are some other factors that can increase the risk of intraoperative aspiration?

A

Lithotomy, ↑ Intraabdominal pressure, Severe Illness, Morbid Obesity

95
Q

What is the shape of the stomach?

A

J-shaped

96
Q

What are the main functions of the stomach?

A

Reservoir for food, mixes/breaks down food, forms chyme, slows emptying into the small intestine

97
Q

To what size must solids be broken down before entering the duodenum?

A

1-2 mm particles

98
Q

What type of regulation controls the motility of the stomach?

A

Intrinsic and extrinsic neural regulation

99
Q

What effect does parasympathetic stimulation have on stomach contractions?

A

Increases number and force

100
Q

Which nerve is involved in parasympathetic stimulation of the stomach?

A

Vagus nerve

101
Q

What does sympathetic stimulation do to stomach contractions?

A

Inhibits them

102
Q

Which nerve is involved in sympathetic stimulation of the stomach?

A

Splanchnic nerve

103
Q

What substances increase the strength and frequency of stomach contractions?

A

Gastrin & motilin

104
Q

What substance inhibits stomach contractions?

A

Gastric inhibitory peptide

105
Q

What is the most common cause of non-variceal upper GI bleeding?

A

Peptic Ulcer Disease

106
Q

What is the lifetime prevalence of peptic ulcer disease in women? What is the lifetime prevalence in men?

A

Women 10%
Men 12%

107
Q

How many deaths per year are attributed to peptic ulcer disease?

A

15,000

108
Q

What is commonly seen with peptic ulcer disease?

A

Helicobacter Pylori

109
Q

What are the symptoms of peptic ulcer disease?

A

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

110
Q

What is the risk of perforation in those who do not receive treatment for peptic ulcer disease?

A

10%

111
Q

What can occur in perforation of a peptic ulcer?

A

sudden/severe epigastric pain c/b acidic secretions into peritoneum

112
Q

What is the main cause of mortality in peptic ulcer disease cases?

A

shock or perforation >48h

113
Q

What are the potential onsets for Gastric Outlet Obstruction?

A

Acute or slow

114
Q

What can cause acute obstructions in Gastric Outlet Obstruction?

A

Edema & inflammation in pyloric channel

115
Q

Symptoms of Pyloric Obstruction include:

A

Recurrent vomiting, dehydration, hyperchloremic alkalosis

116
Q

Initial treatment options for Gastric Outlet Obstruction

A

NGT, IV hydration

117
Q

Usual resolution time for Gastric Outlet Obstruction with initial treatment

A

72h

118
Q

What can repetitive ulceration & scarring lead to in Gastric Outlet Obstruction?

A

Fixed-stenosis and chronic obstruction

119
Q

What are the common causes of gastric ulcers?

A

Excessive NSAIDs, H. Pylori, ETOH

120
Q

What is the treatment for gastric ulcers?

A

Antacids, H2 blockers, PPIs

121
Q

How is H. Pylori infection usually treated in the context of gastric ulcers?

A

Triple therapy (2 abx + PPI) x 14 days

122
Q

What is Zollinger-Ellison Syndrome?

A

Non B cell islet tumor of pancreas causing gastrin hypersecretion

123
Q

How does gastrin contribute to Zollinger-Ellison Syndrome?

A

Stimulates gastric acid secretion with absent feedback loop

124
Q

What are the symptoms of Zollinger-Ellison Syndrome?

A

Peptic ulcer dz, erosive esophagitis, diarrhea

125
Q

What is the treatment for Zollinger-Ellison Syndrome?

A

PPIs and surgical resection of gastrinoma

126
Q

What percentage of patients with gastrinomas are metastatic at the time of diagnosis?

A

Up to 50%

127
Q

How do patients with Zollinger-Ellison Syndrome present in terms of gender and age?

A

Males more than females; most common between ages 30-50

128
Q

What is the major function of the small intestine?

A

To circulate the contents and expose them to the mucosal wall to maximize absorption of water, nutrients, and vitamins.

129
Q

How does small intestinal motility aid digestion?

A

It mixes contents of the stomach with digestive enzymes, reducing particle size and increasing solubility.

130
Q

What mechanism does the small intestine use to ensure ample absorption time?

A

Segmentation

131
Q

What controls segmentation in the small intestine?

A

Mainly the enteric nervous system with modulation by the extrinsic nervous system.

132
Q

What are the two muscle layers of the small intestine involved in segmentation?

A

The circular and longitudinal muscle layers.

133
Q

What are some reversible causes of small bowel dysmotility?

A

mechanical obstruction, bacterial overgrowth, ileus

134
Q

What are some nonreversible causes of small bowel dysmotility?

A

structural or neuropathic

135
Q

What are examples of structural causes of nonreversible small bowel dysmotility?

A

scleroderma, connective tissue disorders, IBD

136
Q

What are examples of neuropathic causes of nonreversible small bowel dysmotility?

A

pseudo-obstruction

137
Q

What symptoms can neuropathic causes of small bowel dysmotility lead to?

A

bloating, nausea, vomiting, abdominal pain

138
Q

What is the function of the large intestine?

A

Acts as a reservoir and extracts electrolytes/water

139
Q

How does distention of the ileum affect the ileocecal valve?

A

Relaxes to allow intestinal contents into the colon

140
Q

What role do giant migrating complexes play in the large intestine?

A

Produce mass movements

141
Q

What is the primary symptom of colonic dysmotility?

A

Altered bowel habits and/or intermittent cramping

142
Q

What are the most common diseases associated with colonic dysmotility?

A

IBS and IBD

143
Q

What are the Rome II criteria for IBS?

A

Abdominal discomfort + 2 of the following: defecation relieves discomfort, pain with abnormal frequency, pain with change in stool form

144
Q

What is the effect of inflammation on colonic contractions in IBD?

A

Suppression

145
Q

How do giant migrating complexes contribute to hemorrhage and erosion in IBD?

A

Increased frequency and pressure compress inflamed mucosa

146
Q

What is the second most common inflammatory disorder?

A

IBD

147
Q

What are the two main types of IBD?

A

UC & Crohn’s

148
Q

What is the incidence of IBD?

A

18:100,000 ppl

149
Q

What are the symptoms of Ulcerative Colitis?

A

Diarrhea, rectal bleeding, crampy abdominal pain, N/V, fever, weight loss

150
Q

What are some laboratory findings in UC?

A

↑plts, ↑ESR, ↓H&H, ↓albumin

151
Q

When does hemorrhage in UC warrant surgical colectomy?

A

6+ units blood in 24-48 hrs

152
Q

What is toxic megacolon triggered by?

A

E-lyte disturbances

153
Q

What percentage of UC cases require colectomy?

A

Around half

154
Q

What is the mortality rate for colon perforation in UC?

A

15%

155
Q

What is the most common site of Crohn’s Disease?

A

Terminal ilium

156
Q

What are the two patterns of disease in Crohn’s Disease?

A

Penetrating-fistulous, obstructing

157
Q

What are common symptoms of Crohn’s Disease?

A

Weight loss, fear of eating, anorexia, diarrhea

158
Q

What happens due to persistent inflammation in Crohn’s Disease?

A

Fibrous narrowing & stricture formation

159
Q

What does extensive inflammation in Crohn’s Disease lead to?

A

Malabsorption & steatorrhea

160
Q

How can Crohn’s Disease affect areas outside the bowel?

A

Arthritis, dermatitis, kidney stones

161
Q

What is the mainstay treatment for IBD?

A

5-Acetylsalicylic acid (5-ASA)

162
Q

What types of medications are used during IBD flares?

A

PO/IV Glucocorticoids

163
Q

Name two antibiotics used in IBD treatment.

A

Rifaximin, Flagyl, Cipro

164
Q

What type of drugs are used as a last resort in IBD treatment before surgery?

A

Purine analogues

165
Q

When is surgery considered in IBD treatment?

A

Last resort

166
Q

How much of the small intestine can be safely resected to avoid short bowel syndrome?

A

<1/2 length

167
Q

What is the consequence of resecting >2/3 of the small intestine?

A

Short bowel syndrome, requiring TPN

168
Q

What is the origin of most carcinoid tumors?

A

GI tract

169
Q

What are some substances secreted by carcinoid tumors?

A

Peptides, vasoactive substances

170
Q

What symptoms may occur in carcinoid syndrome?

A

Flushing, diarrhea, HTN/HoTN, bronchoconstriction

171
Q

How is carcinoid syndrome diagnosed?

A

Urinary or plasma serotonin levels

172
Q

What is a treatment option for carcinoid tumors?

A

Avoid serotonin-triggers, control diarrhea

173
Q

What should be given preoperatively for carcinoid tumors to attenuate hemodynamic changes?

A

Octreotide

174
Q

What is acute pancreatitis?

A

Inflammatory disorder of the pancreas

175
Q

What are the common causes of acute pancreatitis?

A

Gallstones and alcohol abuse

176
Q

How does alcoholism contribute to the increased incidence of acute pancreatitis?

A

Likely due to increased alcoholism

177
Q

How can pancreatitis be triggered?

A

Failure of autodigestion prevention mechanisms

178
Q

What obstructs the ampulla of Vater in pancreatitis?

A

Gallstones

179
Q

What are the symptoms of Acute Pancreatitis?

A

excruciating epigastric pain, N/V, abd distention, steatorrhea, ileus, fever, tachycardia, HoTN

180
Q

What are the hallmark labs seen in Acute Pancreatitis?

A

↑serum amylase & lipase

181
Q

What imaging modalities are used in Acute Pancreatitis?

A

contrast CT or MRI, endoscopic US (EUS)

182
Q

What are the complications of Acute Pancreatitis?

A

shock, ARDS, renal failure, necrotic pancreatic abscess

183
Q

What is the treatment for Acute Pancreatitis?

A

Aggressive IVF, NPO, enteral feeding, opioids

184
Q

What is the preferred feeding method over TPN in Acute Pancreatitis?

A

enteral feeding

185
Q

What are the interventions in Endoscopic-retrograde cholangiopancreatography (ERCP)?

A

stone removal, stent placement, sphincterotomy, hemostasis

186
Q

What percentage of blood loss will lead to hypotension and tachycardia?

A

> 25%

187
Q

What does melena indicate about the location of the bleed?

A

Above the cecum

188
Q

What is the usual indication of orthostatic hypotension in GI bleeding?

A

HCT <30%

189
Q

What is typically elevated in the blood due to absorbed nitrogen in upper GI bleeding?

A

BUN >40 mg/dL

190
Q

What is the diagnostic/therapeutic procedure of choice for upper GI bleeding?

A

EGD

191
Q

What is the last resort for uncontrolled variceal bleeding?

A

Mechanical balloon tamponade

192
Q

What are some causes of lower GI bleeding?

A

Diverticulosis, tumors, colitis

193
Q

What procedure is performed as soon as the patient is hemodynamically stable in lower GI bleeding?

A

Unprepped sigmoidoscopy

194
Q

When is a colonoscopy performed in lower GI bleeding?

A

If patient can tolerate prep

195
Q

What is the next step if there is persistent bleeding in lower GI bleeding cases?

A

Angiography and embolic therapy

196
Q

What is adynamic ileus?

A

Massive dilation of colon without obstruction

197
Q

What are the causes of adynamic ileus?

A

Electrolyte disorders, immobility, narcotics, anticholinergics

198
Q

How is adynamic ileus treated?

A

Restore electrolyte balance, hydrate, mobilize, suction, enemas

199
Q

What is the effect of neostigmine in adynamic ileus?

A

Produces immediate results in 80-90%

200
Q

What can happen if adynamic ileus is left untreated?

A

Ischemia and perforation

201
Q

How does anxiety levels in patients impact GI activity preoperatively?

A

Higher anxiety = higher inhibition of GI activity

202
Q

What effect do volatile anesthetics have on GI activity?

A

Depress activity in stomach, small intestine, and colon

203
Q

Which part of the GI tract is the first to recover postoperatively?

A

Small intestine

204
Q

What can volatile agents coupled with sympathetic nervous system hyperactivity do to GI function?

A

Inhibit GI function and motility

205
Q

What is the effect of nitrous oxide on gas-containing cavities?

A

Diffuses faster than nitrogen

206
Q

When should nitrous oxide be avoided?

A

Lengthy abdominal surgeries or distended bowel

207
Q

How do neuromuscular blockers (NMBs) affect GI motility?

A

Remains intact

208
Q

What effect does Neostigmine have on bowel peristalsis?

A

Increase PNS activity and bowel peristalsis

209
Q

How do anticholinergic medications counteract the bradycardia associated with neostigmine?

A

By partially offsetting cholinergic activity

210
Q

Does Sugammadex have any effect on motility?

A

No

211
Q

What are the effects of opioids on the GI system?

A

Reduced motility, constipation, delayed gastric emptying

212
Q

Where are the peripheral mu-opioid receptors located in the GI system?

A

Myenteric and submucosal plexuses

213
Q

What adverse events can result from opioid use in the GI system?

A

Nausea, anorexia, delayed digestion

214
Q

What are the layers of the GI tract wall from outermost to innermost?

A

Serosa, longitudinal muscle, circular muscle, submucosa, mucosa

215
Q

Which nervous system innervates the GI tract and what are its components?

A

Autonomic nervous system; SNS, PNS

216
Q

What are the two primary movements within and along the GI tract?

A

Mixing and propulsive movements

217
Q

How can anesthesia medications affect GI function?

A

Alter mechanisms

218
Q

What adverse effect do opioids have on the bowel?

A

Decrease GI function

219
Q

What conditions can be induced by hemodynamic changes and bowel manipulation?

A

Ileus, inflammatory states, mesenteric ischemia

Assessment Exam 4 (9 decks)

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