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Gastrointestinal (Exam 4) Flashcards

1
Q

What percentage of total body mass does the GI Tract constitute?

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 (Outer to Inner)?

A

Serosa
Longitudinal Muscle Layer
Circular Muscle Layer
Submucosa
Mucosa

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4
Q

What are the layers of the Mucosa (Outer to Inner)?

A

Muscularis mucosae
Lamina Propria
Epithelium

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5
Q

What is the Serosa and its function?

A

Smooth membrane of connective tissue.
Secretes serous fluid to enclose the cavity and reduce friction between muscle movements

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6
Q

What does the longitudinal muscle layer do?

A

Contracts to shorten the length of the intestinal segment.

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7
Q

What does the circular muscle layer do?

A

Contracts to decrease the diameter of the intestinal lumen.

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8
Q

What do the longitudinal and circular muscle layer do together?

A

Propagate gut motility

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9
Q

Innervation of the GI organs up to the proximal transverse colon is supplied by what?

A

Celiac Plexus

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10
Q

Innervation of the descending colon and distal GI tract is supplied by what?

A

Inferior Hypogastric Plexus

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11
Q

The Celiac Plexus can be blocked by which four techniques?

A

Transcrural
Intraoperative
Endoscopic US-guided
Peritoneal Lavage

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12
Q

The Mesenteric (Myenteric) Plexus lies between what two layers?

A

Longitudinal and Circular muscle

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13
Q

What is the function of the Mesenteric (Myenteric) Plexus?

A

Regulate the smooth muscle

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14
Q

What is another name for the Mesenteric (Myenteric) Plexus?

A

Auerbach’s Plexus

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15
Q

What is the function of the Submucosal (Meissner’s) Plexus?

A

Transmit information from the epithelium to the enteric and central nervous system

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16
Q

What is the function of the Muscularis Mucosae?

A

Layer of smooth muscle that moves the villi

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17
Q

The lamina propria contains what?

A

Blood vessels
Nerve endings

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18
Q

What type of cells are located in the mucosa?

A

Immune cells
Inflammatory cells

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19
Q

What happens in the epithelium?

A

GI contents are sensed
Enzymes are excreted
Nutrients absorbed
Waste excreted

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20
Q

The GI tract is innervated by what system?

A

Autonomic Nervous System

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21
Q

The GI ANS consists of what two systems?

A

Extrinsic Nervous System
Enteric Nervous System

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22
Q

T/F
The Extrinsic Nervous System has SNS and PNS components?

A

True

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23
Q

What is the function of the Extrinsic SNS?

A

To inhibit and decrease GI motility

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24
Q

What is the function of the Extrinsic PNS?

A

To excite and activate GI motility

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25
Q

What is the function of the Enteric Nervous System?

A

Independent system that controls:
Motility
Secretion
Blood flow

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26
Q

The Enteric System is composed of what two plexus?

A

Myenteric Plexus
Submucosal Plexus

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27
Q

The Myenteric Plexus controls motility via what three things?

A

Enteric Neurons
Interstitial Cells of Cajal
Smooth Muscle Cells

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28
Q

The Submucosal Plexus controls what three things?

A

Absorption
Secretion
Mucosal Blood Flow

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29
Q

Does the Enteric System Respond to sympathetic and parasympathetic stimulation?

A

Yes

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30
Q

Upper Gastrointestinal Endoscopy can be used to observe what four areas?

A

Esophagus
Stomach
Pylorus
Duodenum

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31
Q

What anesthesia challenges are present with a UGE?

A

Sharing the airway with an endoscopist
Procedure typically not done in an OR

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32
Q

What anesthesia challenges are present with a colonoscopy?

A

Dehydration from bowel prep
Dehydration from being NPO

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33
Q

What is a High-resolution Manometry (HRM)?

A

A pressure catheter that measures pressures along the entire esophageal length

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34
Q

What is an HRM used for?

A

Diagnosis of Motility Disorders

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35
Q

What is a GI series with ingested Barium used for?

A

Assessing swallowing function and GI transit

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36
Q

How long does a patient fast for a Gastric Emptying Study?

A

4 hours

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37
Q

With Small Intestine Manometry, contractions are being observed during what 3 periods?

A

Fasting (4hrs)
During a meal
Post-prandial (2 hrs post)

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38
Q

How is a Lower GI series performed?

A

Via barium enema

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39
Q

What is a Lower GI series used for?

A

Detection of colon and rectal anatomical abnormalities

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40
Q

Diseases of the esophagus are divided into what 3 categories?

A

Anatomical
Mechanical
Neurologic

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41
Q

What abnormalities are considered anatomical in nature?

A

Diverticula
Hiatal Hernia
Changes w/chronic acid reflux

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42
Q

What abnormalities are considered mechanical?

A

Achalasia
Esophageal Spasms
Hypertensive LES

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43
Q

What can cause neurologic GI diseases?

A

Stroke
Vagotomy
Hormone Deficiencies

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44
Q

What are the 3 common symptoms of esophageal disease?

A

Dysphagia
Heartburn
GERD

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45
Q

What is dysphagia?

A

Difficulty swallowing

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46
Q

What can lead to oropharyngeal dysphagia?

A

Head and neck surgery

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47
Q

Esophageal dysmotility relates to trouble with swallowing what?

A

liquid AND solid foods

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48
Q

Mechanical esophageal dysphagia has trouble swallowing what?

A

solid food

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49
Q

What is Achalasia?

A

Disorder of the esophagus consisting of an outflow obstruction d/t inadequate LES tone and a dilated hypo-mobile esophagus

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50
Q

What symptoms are present with Achalasia?

A

Dysphagia
Regurgitation
Heart burn
Chest pain

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51
Q

Long-term Achalasia puts you at risk for what condition?

A

Esophageal cancer

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52
Q

How is Achalasia diagnosed?

A

Esophageal manometry
Esophagram

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53
Q

Achalasia is divided into how many classes?

A

Three

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54
Q

What occurs with Type I Achalasia?

A

Minimal esophageal pressure
Responds well to myotomy

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55
Q

What occurs with Type II Achalasia?
How are the outcomes?

A

Entire esophagus is pressurized
Responds well to treatment, has the best outcomes

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56
Q

What occurs with Type III Achalasia?
How are the outcomes?

A

Esophageal spams with premature contractions
Has worst outcomes

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57
Q

What medications are used to treat Achalasia?

A

Nitrates and CCBs to relax the LES

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58
Q

What type of injection can be given for Achalasia?

A

Endoscopic botox

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59
Q

What is the most EFFECTIVE treatment for Achalasia?

A

Pneumatic dilation

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60
Q

What is the BEST SURGICAL treatment for Achalasia?

A

Laparoscopic Hellar Myotomy

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61
Q

What other type of Myotomy can be used for Achalasia?

A

Peri-oral endoscopic myotomy (POEM)

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62
Q

What is POEM?
What complications can develop?

A

Endoscopic division of LES muscle layers
40% chance of pneumothorax or pneumoperitoneum

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63
Q

When would an esophagectomy be considered for Achalasia?

A

Last-ditch in advanced disease state

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64
Q

What type of intubation technique would be best for Achalasia patients?
Why?

A

RSI or awake intubation
high risk for aspiration

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65
Q

What is Diffuse Esophageal Spasm?

A

Spasm of the distal esophagus

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66
Q

What causes Diffuse Esophageal Spasm

A

Autonomic dysfunction

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67
Q

Who is most prone to Diffuse Esophageal spasm?

A

Elderly patients

68
Q

How do you diagnose Diffuse Esophageal spasm?

A

Esophagram

69
Q

Diffuse Esophageal Spasm pain mimics what condition?

70
Q

How do you treat Diffuse Esophageal Spasm?

A

NTG
Antidepressants
PDE-I’s

71
Q

What is Esophageal Diverticula?

A

Outpouching in the wall of the esophagus

72
Q

How many different types of diverticula are there?

73
Q

What symptom can occur with Pharyngoesophageal or Zenker diverticulum?

A

Bad breath (d/t food retention)

74
Q

What can cause Midesophageal Diverticulum?

A

Old adhesions or inflamed lymph nodes

75
Q

What can cause Epiphrenic or Supradiaphragmatic diverticulum?

76
Q

Are patients with any of the 3 diverticula aspiration risks?

A

Yes; remove the particles and perform RSI

77
Q

What is a hiatal hernia?
What causes it?
What symptoms can occur?

A

Herniation of the stomach into the thoracic cavity
Weakening anchors of GE junctions to the diaphragm
Can be asymptomatic or have GERD like symptoms

78
Q

Esophageal Cancer affects how many people in the US?

A

4-5 out of 100,000

79
Q

What two cancers cause Esophageal Cancers?

A

Adenocarcinoma ( r/t GERD, Barretts, Obesity)
Squamous Cell Carcinoma

80
Q

What surgical option is available for Esophageal Cancer?

A

Esophagectomy

81
Q

What risk come with an esophagectomy?

A

Recurrent laryngeal nerve injury

82
Q

What considerations must we be aware of with Esophageal Cancer patients?

A

Malnourishment pre/post-op
Pancytopenia
Dehydration
High aspiration risk

83
Q

What is GERD?
What symptoms are present?

A

Gastro-esophageal reflux disease
Heartburn, dysphagia, mucosal injury

84
Q

GERD occurs in what percentage of the population?

85
Q

What are the contents of GERD reflux?

A

HCL
Pepsin
Pancreatic enzymes
Bile

86
Q

Bile reflux is associated with what 2 conditions?

A

Barrett metaplasia
Adenocarcinoma (worst)

87
Q

What’s a normal LES pressure?

88
Q

What is the average LES pressure with GERD?

89
Q

What are the treatments for GERD?

A

Avoid trigger foods
Antacids, H2 Blockers, PPIs
Toupet procedure
LINX
Nissen procedure (severe)

90
Q

What are the pre-op considerations for GERD?

A

Cimetidine, Ranitidine
PPIs night before
PPIs morning of
Sodium Citrate (OB pts)
Metoclopramide (DM, OB)
Aspiration precautions

91
Q

What are the discussed 12 factors that increase intra-op aspiration risk?

A

Emergent surgery
Full stomach
Difficult airway
Inadequate anesthesia
Lithotomy
Autonomic Neuropathy
Gastroparesis
DM
Pregnancy
Inc Intraa-abd pressure
Severe illness
Morbid obesity

92
Q

The stomach breaks down food to form what compound?

93
Q

Food must be broken down to what size before entering the duodenum?

94
Q

Parasympathetic stimulation of the Vagus nerve causes what in the stomach?

A

Increase number and force of contractions

95
Q

Sympathetic stimulation of the stomach does what?

A

inhibits contractions via the Splanchnic Nerve

96
Q

What two compounds increase the strength and frequency of contractions in the stomach?

A

Gastrin
Motilin

97
Q

What compound inhibits contractions in the stomach?

A

Gastric inhibitory peptide

98
Q

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

A

Peptic Ulcer Disease

99
Q

What’s the prevalence of PUD in males and females?

A

12% men
10% women

100
Q

What bacteria is PUD often associated with?

101
Q

What symptoms occur with PUD?
What improves symptoms?

A

epigastric pain w/fasting
Eating

102
Q

What is the risk of perforation if PUD isn’t treated?

A

10%
Mortality increases >48h post-shock or perforation

103
Q

What causes Gastric Outlet Obstruction?

A

Edema and inflammation in the pyloric channel at the beginning of the duodenum

104
Q

What signs occur with pyloric obstruction?

A

Recurrent vomiting
Dehydration
*Hyperchloremic Alkalosis

105
Q

How do you treat Gastric Outlet Obstruction?
How long until it resolves?

A

NGT decompression
IV hydration
72 hours

106
Q

What are the 3 main causes of gastric ulcers?

A

Excessive NSAID use
H. Pylori
ETOH

107
Q

Repetitive ulceration can lead to what two conditions?

A

Fixed stenosis
Chronic obstruction

108
Q

How many classifications are there for Gastric Ulcers?

109
Q

Describe a Type I ulcer

A

Along the lesser curvature near incisura; no acid hypersecretion

110
Q

Described a Type II ulcer

A

Two ulcers, first on gastric body, second duodenal; usually with acid hypersecretion

111
Q

Describe a Type III ulcer

A

Prepyloric with acid hypersecretion

112
Q

Describe a Type IV ulcer

A

At lesser curvature near GE junction; no acid hypersecretion

113
Q

Describe a Type V ulcer

A

Anywhere in the stomach, seen with NSAID use

114
Q

What are the five medication treatments for Gastric Ulcers?

A

Antacids
H2 antagonists
PPIs
Prostaglandin analogues
Cytoprotective agents

115
Q

What is the treatment for H. Pylori?

A

Triple Therapy
2 abx + PPI x 14 days

116
Q

What is Zollinger Ellison Syndrome?

A

Non-B cell islet tumor of the pancreas causing gastrin hypersecretion.
This causes high levels of gastric acid

117
Q

What signs are seen with Zollinger Ellison Syndrome?

A

Peptic ulcer disease
Erosive esophagitis
Diarrhea

118
Q

Does Zollinger Ellison occur more frequently in males or females?

A

Males, ages 30-50

119
Q

What percentage of patients with gastrinoma are metastatic when diagnosed with ZES?

120
Q

What are the treatment options for ZES?

A

PPIs
Surgical resection of gastrinoma

121
Q

What preoperative considerations are there for patients with ZES?

A

Correct electrolytes
Increase pH (alkalize)
RSI

122
Q

What is the small intestines major function?

A

Circulate contents
Maximize absorption of water, nutrients, and vitamins

123
Q

What is segmentation?

A

When two nearby areas contract and isolate a segment of intestine

124
Q

What two things coordination segmentation?

A

Circular and longitudinal muscle layers

125
Q

What are reversible causes of small bowel dysmotility?

A

Mechanical obstructions
Bacterial overgrowth
ileus
electrolyte imbalances
critical illness

126
Q

What are nonreversible causes of small bowel dysmotility?

A

Scleroderma, IBD
Pseudo-obstruction

127
Q

The large intestine is a reservoir for what two things?

A

waste
indigestible material

128
Q

Movement of the large intestine and colon are called what?
How often do they occur?

A

Giant migrating complex
6-10 times a day

129
Q

Colonic dysmotility has what two symptoms?

A

Altered bowel habits
Intermittent cramping

130
Q

What two commons diseases are associated with colonic dysmotilty?

131
Q

Per Rome II criteria IBS is defined as abdominal discomfort along with __

A

defecation relieving discomfort
pain associated w/abnormal frequency
pain associated with change in form of stool

132
Q

What is the second most common inflammatory disorder?

A

Inflammatory bowel disease (IBD)

133
Q

IBD is divided into what two diseases?

A

Ulcerative colitis
Crohn’s disease

134
Q

What is Ulcerative Colitis?

A

Mucosal disease of the rectum and part or all of the colon

135
Q

What are signs of UC?

A

Diarrhea
Rectal bleeding
Abdominal cramp/pain
N/V
Fever
Weight loss

136
Q

What is a complication of UC?

A

Toxic Megacolon
May require colectomy

137
Q

Colon perforation has a _ mortality rate

138
Q

What is Crohn’s Disease?

A

Acute or chronic inflammation that may affect any/all bowel

139
Q

What is the most common site affected by Crohn’s?

A

Terminal ilium

140
Q

Persistent inflammation with Crohn’s can lead to what 4 issues?

A

Fibrous narrowing
Stricture formation
Chronic Bowel Obstruction
Malabsorption
Steatorrhea
Fecal vomitus via fistula

141
Q

How do you treat IBD?

A

5-ASA
Glucocorticoids
Rifaximin, Flagyl, Cipro
Purine analogues
Bowel resection (last)
Limit to < 1/2 length

142
Q

Most carcinoid tumors originate where?

143
Q

Why are carcinoid tumors problematic?

A

Release of peptides and vasoactive substances

144
Q

What is carcinoid syndrome?
How prevalent is it?

A

Large amounts of serotonin and vasoactives reach the systemic circulation
10% of patients with carcinoid tumors

145
Q

What are signs of Carcinoid Syndrome?

A

Flushing
Diarrhea
HTN/HoTN
Bronchoconstriction

146
Q

What is the treatment for Carcinoid Syndrome?

A

Avoid serotonin triggers
Control diarrhea
serotonin antagonist
somatostatin analogues

147
Q

What are pre-op considerations for Carcinoid Syndrome?

A

Give octreotide to attenuate hemodynamic changes

148
Q

What are the two most common causes of Acute Pancreatitis?

A

Gallstones
ETOH abuse
60-80% of cases

149
Q

What other conditions can cause Acute Pancreatitis?

A

Immunodeficiency Syndrome
Hyperparathyroidism

150
Q

How do gallstones cause acute pancreatitis?

A

Obstruction of Ampulla of Vater
Pancreatic ductal HTN

151
Q

What are the hallmark signs and lab values for Acute Pancreatitis?

A

Epigastric pain radiating to the back
Elevated Serum amylase and lipase

152
Q

What type of nutrition is preferred for Acute Pancreatitis?

A

Enteral feeding

153
Q

Which type of GI bleed is more common, upper or lower?

A

Upper GI bleed

154
Q

Melena is an indication of _?

A

Bleed is above the cecum

155
Q

How do we treat an Upper GI bleed?

A

EGD with ligation
Mechanical balloon tamponade (last resort)

156
Q

Lower GI bleeds typically occur in what population?

A

Elderly patients

157
Q

What are the 3 main causes for Lower GI bleeds?

A

Diverticulosis
Tumors
Colitis

158
Q

What is an Adynamic Ileus?

A

Ileus with massive dilation of the colon without mechanical obstruction
Loss of peristalsis

159
Q

What are possible causes for an ileus?

A

Electrolyte imbalance
Immobility
Excessive narcotics
Anticholinergics
Neurological imbalance

160
Q

What are the treatment options for an ileus?

A

Replace electrolytes
Hydration
Mobilization
NGT decompression
Enema
Neostigmine 2-2.5 mg (over 5 mins)

161
Q

What effects do volatile anesthetics have on the GI tract?

A

Depress spontaneous, electrical, contractile, and propulsive activity

162
Q

List the parts of the GI tract in which they recover post anesthesia?

A

Small intestine
Stomach (post 24 hrs)
Colon (post 30-40 hrs)

163
Q

What anesthetic gas should be avoided with GI surgery?

A

Nitrous Oxide

164
Q

Do NMBs affect the GI system?

165
Q

Activation of what pain receptor causes delayed gastric emptying?

A

Mu-receptor

Physical Assessment (3 decks)

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