GI Flashcards
Name some factors/agents that decrease LES tone
-inhaled anesthetics
-propofol
-opioids
-anticholinergics
-beta agonists
-glucagon
-obesity
-hiatal hernia
-pregnancy
-cricoid pressure
Name some factors/agents that increase LES tone
-SCh (RSI w/ this)
-cholinergics
-acetylcholine
-anticholinesterase
-alpha agonist
-antacids
-serotonin
-histamine
-metoprolol
-metoclopramide
What CNs innervate the LES?
CN 9, 10, 11
What is achalasia
LES can’t relax, so food backs up in esophagus and leads to regurg
What disorders have development of achalasia
-DM
-CVA
-ALS
-Amyloidosis
-Scleroderma
What is barrett’s esophagus
Chronic GERD leading to epithelial cell changes (malignancy risk)
When elements from abdominal cavity (usually stomach) herniates through the esophageal hiatus to the mediastinum
Hiatal hernia
What do you worry about w/ hiatal hernia?
Aspiration (decreased LES tone)
***Aspiration profilaxis if pt. is symptomatic
What is the worst complication w/ gastritis?
Major gastric bleeding
With severe bleeding w/ gastritis, what 3 blood products are you giving?
RBCs/Plts/FFP
Main focus on gastritis tx. (non-emergent)
H. pylori (via antibiotics)
2 most common causes of peptic ulcer disease
H pylori
NSAIDs
Is bleeding risk w/ PUD similar to gastritis?
Yes
Most frequent complication of gastric ulcer disease
Perforation
4 Big anesthesia takeaways/implications for gastritis/PUD/GUD
-Avoid placing anything in esophagus
-GI profilaxis
-RSI
-A-line & be ready to give blood products/volume resuscitation
What 2 complications would you put in NGT and drain preop?
Adynamic colon
Colon obstruction
What meds do you avoid w/ GI obstruction????
GI prokinetics
***REGLAN
***N2O
__________ analgesia can be used to reduce post op Ileus
Multimodal
what is the most common general surgery emergency?
appendicitis
Classic presentation of appendicitis
-RLQ pain
-N/V
-anorexia
-fever
Signs of appendix perforation
abd pain gets more intense and diffuse
Abdominal rigidity
HR increase
Temp increase
Does appendectomy require GA?
Yes
Aspriation risk w/ appendectomy?
YESSS
Is routine GI profilaxis recommended?
No
Take GERD meds DOS?
Yes
Most important factor in aspiration risk reduction
Know your patient
Name some risk factors for aspiration
-full stomach
-emergency surgery
-OB pts (esp. C-section)
-GI obstruction
-DM
-GERD
-Hiatal hernia
-inadquate anesthesia
-hypotension
-Low LES tone
-head injury
-decrease LOC
-seizures
-obesity
-N/V
-opioids
-cardiac arrest
-scleroderma
Where do we look w/ ultrasound to check gastric volume?
Pyloric antrum
Effects of preop fasting?
-insulin resistance/postop hyperglycemia
-dehydration
-muscle waisting
-immune compromise
clear liquids minimum fasting period
2 hrs
Breast milk minimum fasting period
4hrs
Infant formula, non-human milk, light meal minimum fasting period
6hrs
t/f, type of liquid matters more than volume w/ preop fasting
true
High fat content w/ meal requires ___hrs of fasting
8hrs
If post pyloric, can TF be continued?
Yes
If not post pyloric, how long to hold TF?
8hrs
NO fluid or solid fluid ___hrs prior to procedure
2hrs
Meals NPO > ___ hrs may be detrimental
8hrs
_______ antacids are NOT recommended at all
Particulate antacids
Non-particulate antacids (bicitrate/sodium citrate) do what?
increase pH
H2 receptor antagonists & PPIs do what?
reduce volume
increase pH
How many doses of PPI preop
2
When should you not give gastric prokinetics (reglan)?
Parkinsons
Bowel obstruction
Antiemedics do what?
moderate N/V
Do antiemetics help prevent aspiration?
NOO
Are anticholinergics (atropine/glycopyrrolate) recommended at all?
NOO
