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Advanced Health Assessment > GI > Flashcards

GI Flashcards

exam 4

1
Q

The GI tract constitutes approx ___% of total body mass​

A

5

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2
Q

GIs main functions are (5)

A

motility, digestion, absorption, excretion, and circulation​

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3
Q

what are the outer to inner layers of the GI tract

A

From outermost to innermost these layers are: the serosa, longitudinal muscle layer, circular muscle layer, submucosa, and mucosa

Within the mucosa is (outermost to innermost) is the muscularis mucosae, lamina propria, and epithelium

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4
Q

The longitudinal muscle layer contracts to ______ the length of the intestinal segment​

The circular muscle layer contracts to _____ the diameter of the intestinal lumen​

A

The longitudinal muscle layer contracts to shorten the length of the intestinal segment​

The circular muscle layer contracts to decrease the diameter of the intestinal lumen​

this is how motility works

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5
Q

the mucosa is composed of….

A

the muscularis mucosa, which functions to move the villi​

the lamina propria, which contains blood vessels & nerve endings​

immune and inflammatory cells​

the epithelium, where the GI contents are sensed, enzymes are secreted, and nutrients are absorbed​

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6
Q

myenteric plexus controls _____, carried out by enteric neurons, interstitial cells of Cajal (aka ICC cells, GI pacemakers), and smooth muscle cells

submucosal plexus controls _____, ______, and mucosal blood flow​

A

motility

absorption, secretion

Both of these plexuses respond to sympathetic and parasympathetic stimulation​

​

​

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7
Q

The extrinsic SNS is primarily inhibitory and ______ GI motility​

The extrinsic PNS is primarily excitatory and ______ GI motility​

A

The extrinsic SNS is primarily inhibitory and decreases GI motility​

The extrinsic PNS is primarily excitatory and activates GI motility​

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8
Q

Celiac plexus: Innervates the GI organs up to the _____ transverse colon​

Hypogastric plexus: Innervates the _____ colon and distal GI tract​

A

Celiac plexus: Innervates the GI organs up to the proximal transverse colon​

Hypogastric plexus: Innervates the descending colon and distal GI tract​

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9
Q

The celiac plexus can be blocked via different approaches, including: ​

A

The celiac plexus can be blocked via different approaches, including: ​

Trans-crural​

Intraoperative​

endoscopic ultrasound-guided​

peritoneal lavage​

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10
Q

Myenteric plexus lies btw the smooth muscle layers and regulates the _________

Submucosal plexus transmits info from the epithelium to the enteric and _________

A

Myenteric plexus lies btw the smooth muscle layers and regulates the smooth muscle​

Submucosal plexus transmits info from the epithelium to the enteric and central nervous systems​

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11
Q

EGD is usually done with or without an ETT

A

without

usually under MAC, giving propofol

usually done in an endoscopy suite

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12
Q

what are Anesthesia challenges​ with colonoscopies?

A

Pt dehydration d/t bowel prep & NPO status​

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13
Q

What is a High Resolution Manometry (HRM):

A

a pressure catheter measures pressures along entire esophageal length​

generally used to dx motility disorders​

we arent usually involved here

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14
Q

GI series with ingested barium is a

A

: radiologic assessment of swallowing function and GI transit ​

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15
Q

Gastric emptying study: pt fasts for ____ hrs, then consumes a meal with a radiotracer, usually eggs. Frequent imaging for the next 1-2 hrs ​

A

4 hours

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16
Q

Small intestine manometry evaluates contractions during three periods:

A

Small intestine manometry: catheter measures contraction pressures and motility of the small intestine​

evaluates contractions during three periods: fasting, during a meal, and post-prandial​

Abnormal results are grouped into myopathic and/or neuropathic causes​

​

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17
Q

what is a lower GI series: Barium enema

A

outlines the intestines and it is visible on radiograph, allowing for detection of colon/rectal abnormalities​

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18
Q

Anatomical esophageal diseases

A

diverticula, hiatal hernia, and changes assoc w/ chronic acid reflux

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19
Q

Mechanical esophageal issues are

A

Mechanical: achalasia, esophageal spasms, and a hypertensive LES​

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20
Q

Neurologic esophageal issues are

A

Neurologic: neurologic disorders such as stroke, vagotomy, or hormone deficiencies ​

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21
Q

most common sx of esophageal diseases are

A

dysphagia, heartburn, GERD​

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22
Q

_____ dysphagia are common after nhead and neck surgeries

A

Oropharyngeal

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23
Q

Esophageal dysmotility: sx occur w/ both ____ & _____
Mechanical esophageal dysphasia: sx only occur w/____ food ​

A

Esophageal dysmotility: sx occur w/ both liquids & solids​

Mechanical esophageal dysphasia: sx only occur w/solid food ​

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24
Q

Achalasia

A

Achalasia: neuromuscular disorder of the esophagus creating an outflow obstruction d/t inadequate LES tone and a dilated hypomobile esophagus​

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25
whats the cause of Achalasia
Theoretically, c/b loss of ganglionic cells of the esophageal myenteric plexus​
26
Dx os achalasia made w/esophageal _____ and/or ____ ​
Dx made w/esophageal manometry and/or esophagram ​
27
achalasia: Type 1: minimal esophageal pressure, responds well to ______​ Type 2: entire esophagus pressurized; responds ____ to treatment, has best outcomes​ Type 3: esophageal ___ w/premature contractions; has worst outcomes ​
Type 1: minimal esophageal pressure, responds well to myotomy​ Type 2: entire esophagus pressurized; responds well to treatment, has best outcomes​ Type 3: esophageal spasms w/premature contractions; has worst outcomes ​
28
What are the treatments of achalasia?
best tx is lap hellar myotomy
29
esophageal spasms. can mimic ____ and treated with _____
chest pain; nitro
30
all esophageal divertucula are ___ risks
aspiration RSI
31
Hiatal Hernia: Herniation of stomach into _____ cavity, occurs through the esophageal _____ in the diaphragm​
Hiatal Hernia: Herniation of stomach into thoracic cavity, occurs through the esophageal hiatus in the diaphragm​ c/b weakening in connective tissues that anchor the GE junction to the diaphragm​ May be asymptomatic; often associated with GERD
32
esophageal cancer presents with what sx
Presents w/progressive dysphagia and weight loss​
33
most esophageal cancers are what type
Most are adenocarcinomas, located in lower esophagus​ These are r/t GERD, Barretts, Obesity​ Squamous cell carcinoma accounts for the rest of esophageal cancers​
34
high risk of what nerve injury with esophagectomy?
laryngeal
35
GERD is ....
Incompetence of the gastro-esophageal junction, leading to reflux​
36
3 mechanisms of GE incompetence are
3 mechanisms of GE incompetence: ​ Transient LES relaxation, elicited by gastric distention​ LES hypotension (normal LES pressure-29mmHg, avg GERD pressure-13 mmHg)​ Autonomic dysfunction of GE junction​
37
what is the reflux in GERD?
HCL, pepsin, pancreatic enzymes, bile​
38
Bile reflux is associated w/_____ metaplasia & adenocarcinoma​
barrett
39
tx of GERD
antacids are first line active for long term treatment
40
PPI are given the ____ _____ surgery for GERD
night before
41
Factors That ↑ Intraop Aspiration Risk​
Emergent surgery​ Full Stomach​ Difficult airway​ Inadequate anesthesia depth​ Lithotomy​ and trendelenberg Autonomic Neuropathy Gastroparesis​ DM​ Pregnancy​ ↑ Intraabdominal pressure​ Severe Illness​ Morbid Obesity​ ​​ ​ ​ ​
42
Solids must be broken down into ____ mm particles before entering the duodenum
1-2mm
43
The motility of the stomach is controlled by ____ and _____ neural regulation​ PNS stimulates the ____ nerve to increase the number and force of contractions
The motility of the stomach is controlled by intrinsic and extrinsic neural regulation​ PNS stimulates the vagus nerve to increase the number and force of contractions
44
SNS stimulation to the ____ nerve inhibits these contractions​
SNS stimulation to the splanchnic nerve inhibits these contractions​
45
gastrin & motilin increase the ____ and freque____ncy of contractions ​ gastric inhibitory peptide inhibits _____​
gastrin & motilin increase the strength and frequency of contractions ​ gastric inhibitory peptide inhibits contractions​
46
Most common cause of non-variceal upper GI bleeding​ is......
PUD
47
PUD is associated with what bacteria
H Pylori
48
PUD is exacerbated by ____. Relieved by ____
fasting' eating
49
PUD perforation Sx
Perforation- sudden/severe epigastric pain c/b acidic secretions into peritoneum​ Mortality is d/t shock or perforation >48h
50
Pyloric obstruction sx and tx
Recurrent vomiting, dehydration & hyperchloremic alkalosis tx: NGT, IV hydration, NPO for 72 hr​
51
List the 5 types of gastric ulcers
5 types, normally c/b excessive NSAIDS, H. Pylori, ETOH​
52
What is the treatment for different causes of gastric ulcers
Tx: Antacids, H2 blockers, PPIs, prostaglandin analogues, cytoprotective agents​ H. Pylori tx=Tripple therapy (2 abx + PPI) x 14 days​
53
Zollinger Ellison Syndrome​ is ......
Non B cell pancreatic tumor (gastrinoma), causing gastrin hypersecretion​ just a bunch of stomach acid in the stomach CONSIDERED A FULL STOMACH ALWAYS
54
Gastrin stimulates gastric acid ______. Gastric acid normally inhibits further _____ release (neg feedback)​
Gastrin stimulates gastric acid secretion. Gastric acid normally inhibits further gastrin release (neg feedback)​
55
tx of ZES
Tx: PPIs and surgical resection of gastrinoma​
56
The major function of the small intestine is to _____ contents and expose them to the mucosal wall to maximize absorption
The major function of the small intestine is to circulate contents and expose them to the mucosal wall to maximize absorption
57
The circular and ____ muscle layers coordinate to achieve segmentation​
The circular and longitudinal muscle layers coordinate to achieve segmentation​
58
Reversible and nonreversible causes of small bowel dysmotility:​
59
The large intestine acts as a reservoir for waste and indigestible material before elimination and it extracts remaining ____ and ____​
The large intestine acts as a reservoir for waste and indigestible material before elimination and it extracts remaining electrolytes and water​
60
Giant migrating complexes serve to produce..... In the healthy state, these complexes occur approximately _____x a day​
Giant migrating complexes serve to produce mass movements across the large intestine​ 6-10X
61
In ________, contractions are suppressed due to inflammation, but the giant migrating complexes remain
In IBD, contractions are suppressed due to inflammation, but the giant migrating complexes remain 2 types are UC and crohns disease
62
Ulcerative Colitis: _____ dz of part or all of the colon​
mucosal only in the colon
63
SX of ulcerative colitis
Sx: diarrhea, rectal bleeding, crampy abdominal pain, N/V, fever, weight loss​
64
Crohns is Acute or chronic inflammatory process that may affect ______
any/all of the bowel
65
Persistent inflammation with Crohns can lead to ...
gradually progresses to fibrous narrowing & stricture formation​
66
1/3 Crohn’s pts have an additional sx s/a ......
1/3 Crohn’s pts have an additional sx s/a arthritis, dermatitis, kidney stones​
67
describe the medical and surgical treatments for IBD
68
Carcinoid Tumors​ are
tumors that Secrete peptides & vasoactive substances: gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, serotonin, other biological actives​
69
Carcinoid Syndrome occurs in ___% of pts w/carcinoid tumors​
10
70
what is Carcinoid Syndrome
Lg amts of serotonin & vasoactive substances reach systemic circulation​ Sx: flushing, diarrhea, HTN/HoTN, bronchoconstriction​ May acquire right heart endocardial fibrosis​ Left heart generally more protected as the lungs clear some of the vasoactive substances​ Dx: urinary or plasma serotonin levels, CT/MRI​ Tx: avoid serotonin-triggers, serotonin antagonists & somatostatin analogues​ Preop: Octreotide before surgery and prior to tumor manipulation to attenuate volatile hemodynamic changes​
71
the ___ side of the heart is more vulnerable in carcinoid syndrome pt
right this is because the lungs can get rid of some of the vasoactive substances once is reached the left lung
72
you give ______ for the preop treatment of Carcinoid Tumors​
Preop: Octreotide before surgery and prior to tumor manipulation to attenuate volatile hemodynamic changes​
73
Autodigestion of the pancrease is normally prevented by...
Proteases packaged in precursor form​ Protease inhibitors​ Low intra-pancreatic calcium, which decreases trypsin activity​
74
most common causes of pancreatitis is
-gallstones (block ampula of vater) - alcohol abuse Gallstones obstruct ampulla of vater, causing pancreatic ductal HTN​ Pancreatitis is also seen in immunodeficiency syndrome, hyperparathyroidism/↑Ca²​
75
What labs are seen in pancreatitis?
↑serum amylase & lipase​
76
TX of pancreatitis
Tx: Aggressive IVF, NPO to rest pancreas, enteral feeding (preferred over TPN), opioids​ TPN associated w/greater risk of infectious complications​
77
Upper GI bleeding is ____ common than lower GIB​
more
78
in upper GI bleeding BUN typically >____ mg/dL d/t absorbed nitrogen into bloodstream​
40
78
Melena indicates bleed is above the _____ (where SI meets colon)​
cecum
79
lower GI bleed is usually due to ....
diverticulosis, tumors, colitis​
80
Persistent bleeding warrants ____ and ____ therapy​
Persistent bleeding warrants angiography and embolic therapy​
81
Ileus is ...
characterized by massive dilation of the colon without mechanical obstruction​ Loss of peristalsis leads to distention of the colon​
82
Ileus can be caused by....
May be c/b e-lyte disorders, immobility, excessive narcotics, anticholinergics​ Also thought to be due to neural-input imbalance of excessive SNS stimulation along with inadequate PNS input to the colon
83
TX of Ileus
Tx: Restore e-lyte balance, hydrate, mobilize, NG suction, enemas​ Neostigmine 2-2.5mg over 5 min produces immediate results in 80-90%​ Cardiac monitoring required​ If left untreated, ischemia and perforation may occur
84
the higher the preop anxiety the higher preop ___ inhibition they are starting with
SNS
85
The ____ intestine is the first part of the GI tract to recover, followed by the stomach in approximately ____ hours and then the colon ___ to ___ hrs postop​
The small intestine is the first part of the GI tract to recover, followed by the stomach in approximately 24 hours and then the colon 30 to 40 hrs postop​
86
NMBs only affect ____ muscle, so GI motility remains intact​
skeletal
87
There is a high density of peripheral ____-opioid receptors in the myenteric and submucosal plexuses​
Mu
88
Activation of the mu-receptors causes __ ___ ____ and slower GI transit ​
delayed gastric emptying
89
The enteric nervous system controls (3)
The enteric nervous system controls motility, secretion, and blood flow​
90
lamina propria is where the __ and ____ are located
immune cells are and blood vessels are

Advanced Health Assessment (11 decks)

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