GI Flashcards
1
Q
The GI system is ___% of body mass
A
5%
2
Q
What are the 5 main fx of the GI system
A
- motility
- digestion
- absorption
- excretion
- criculation
3
Q
What are the layers of the GI system from outer to inner
A
Serosa -> longitudinal muscle -> circular muscle layer -> submucosa -> mucosa
4
Q
What are the layers of the mucosa
A
muscularis mucosae, lamina propria, epithelium
5
Q
The __________ layer contracts to shorten the length of the intestinal segment
A
longitudinal muscle layer
6
Q
The ________ layer contracts to decrease the diameter of the intestinal lumen
A
circular muscle layer
7
Q
What does the Celiac plexus innervate
A
GI organs up to the proximal transverse colon
8
Q
What does the hypogastric plexus innervate
A
descending colon and distal GI tract
9
Q
What are the different approaches to blocking the celiac plexus
A
- trans-cural
- intraoperative
- endoscopic US guided
- peritoneal lavage
10
Q
The ______ lies between the smooth muscle layers and regulates the smooth muscle
A
myenteric plexus
11
Q
The ______ transmits info from the epithelium to the enteric and CNS
A
submucosal plexus
12
Q
The myenteric plexus regulates
A
motility
13
Q
The submucosal plexus regulates
A
sensory, blood flow, absorption
14
Q
The muscularis mucosa functions to
A
move the villi
15
Q
The lamina propria contains
A
blood vessels and nerve endings, immune and inflammatory cells
16
Q
The epithelium is where GI contents are _____, _______, and ________
A
sense, enzymes secreted, nutrients are absorbed
17
Q
The GI tract is innervated by the ______
A
ANS
18
Q
The GI ANS consists of
A
- extrinsic NS
- enteric NS
19
Q
In the GI ANS the SNS is primarily ______ and the PNS is primarily ______
A
inhibitory, excitatory
20
Q
The enteric nervous system controls
A
motility, secretions, blood flow
21
Q
The myenteric plexus controls ______ which is carried out by ______, ______, and _____
A
motility, enteric neurons, interstitial cells of Cajal (ICC cells, GI pacemakers), and smooth muscle cells
22
Q
The submucosal plexus controls ______, _____, and _____
A
absorption, secretion, mucosal blood flow
23
Q
What are the anesthesia challenges in an upper GI endoscopy procedure
A
- sharing airway with endoscopist
- usually done without ETT, must closely manage airway
- Procedure performed outside main OR (limited equipment)
24
Q
Anesthesia challenges of colonoscopy include
A
- patient dehydration d/t bowel prep and NPO status
25
_____________ is a diagnostic procedure where a pressure catheter measures pressures along the entire esophageal length
High resolution manometry (HRM)
usually dx motility disorders
26
GI series with ingested barium is used to dx ______
swallowing function, GI transit
27
Gastric emptying study involves
Patient fasts 4+ hours, consumes meal with radiotracer (usually eggs), frequent imagine for 1-2hrs
28
A small intestine manometry is used to evaluate
evaluates contractions during three periods: fasting, during meal, post-prandial
abnormal results are grouped into mypathic and/or neuropathic causes
29
A _______ involves barium enema to outline the intestines which allows for detection of ______ abnormalities
lower GI series, colon/rectal abnormalities
30
Diseases of the esophagus are grouped into which 3 categories
- anatomical
- mechanical
- neurologic
31
What are examples of anatomical disorders of the esophagus
diverticula, hiatal hernia, changes associated w/ acid reflux
32
What are examples of mechanical disorders of the esophagus
achalasia, esophageal spasms, hypertensive LES
33
What are examples of neurologic esophageal disorders
stroke, vagotomy, hormone deficiencies
34
Most common sx of esophageal disease
dysphagia, heartburn, GERD
35
What are the 3 types of achalasia
- type 1: minimal esophageal pressure, response well to myotomy
- type 2: entire esophagus pressurized, responds well to tx, has best outcomes
- type 3: esophageal spasms w/ premature contractions; has worst outcomes
36
neuromuscular disorder of the esophagus that creates an outflow obstruction d/t inadequate LES ton and dilated hypomobile esophagus
achalasia
37
What is treatment for achalasia
- nitrates and CCBs to relax LES
- botox injections
- pneumatic dilation* most effective nonsurgical tx
- Laparoscopic hellar myotomy* most effective surgx tx
- Peri-oral endoscopic myotomy (POEM): endoscopic division of muscle layers: 40% risk for pneump
all tx are palliative
38
Esophageal cancer has poor survival d/t
abundant lymphatics leading to lymph node mets
39
Most esophageal cancers are
adenocarcinomas located in lower esophagus
r/t GERD, Barretts, obesity
can also be squamous cell
40
Esophagectomy has high risk of injury to which nerve
recurrent laryngeal nerve
41
GERD reflux contents include
- pepsin
- HCl
- pancreatic enzymes
- bile (worst)
42
Bile reflux is associated with ______
Barrett metaplasia and adenocarcinoma
43
Normal LES pressure is _____ and average GERD LES pressure is ______
normal 29mmHg
GERD 13 mmHg
44
Treatment of GERD includes
- antacids
- H2 blockers
- PPIs
- Nissen fundoplication
- Toupet
- LINX
45
Factors that increase intraoperative aspiration risk
- emergent surgery
- full stomach
- difficult airway
- inadequate depth of anesthesia
- lithotomy position, trendlenberg
- Autonomic neuropathy
- gastroparesis
- DM
- Pregnancy
- morbid obesity
- severe illness
- inc. intraabdominal pressure
46
Solids must be broken down to ____ size particles before entering duodenum
1-2mm
47
Motility of the stomach is controlled by _____ and _____ neural regulation
intrinsic, extrinsic
48
______ stimulates the vagus nerve to increase the number and force of stomach contractions
PNS
49
_______ stimulates the splanchnic nerve to inhibit stomach contractions
SNS
50
____ and _____ increase the strength and frequency of contraction
gastrin, motilin
51
_______ inhibits stomach contractions
gastric inhibitory peptide
52
Peptic ulcer disease has burning epigastric pain exacerbated by _____ and improved with ______
exacerbated by fasting, improved w/ meals
53
Treatment for pyloric obstruction includes
NGT, IV hydration, NPO x72hrs
54
What are the 5 types of gastric ulcers
- type 1: along the lesser curvature close to incisura *no acid hypersecretion
- type 2: two ulcers, first on gastric body, second duodenal, * usually acid hypersecretion
- type 3: prepyloric with *acid hypersecretion
- type 4: at lesser curvature near gastroesophageal junction; *no acid hypersecretion
- type 5: anywhere in stomach, usually caused by NSAID use
55
Which types of gastric ulcers occur with no acid hypersecretion
Type 1 and 4
56
which types of gastric ulcers occur with acid hypersecretion
type 2 and 3
57
Which type of gastric ulcer occur from NSAID use
type 5
58
Zollinger ellisson syndrome is caused by a _______ tumor causing ______ hypersecretion
Non B-cell pancreatic tumor, gastrin hypersecretion
59
The feedback loop that is absent in ZE syndrome is _____
gastrin normally stimulates gastric acid secretion. Gastric acid normally inhibits further gastrin release. absent in ZE syndrome resulting in gastrin hypersecretion
60
ZE syndrome most commonly occurs in female or male
M > F, ages 30-50
61
The major function of the small intestine is to
circulate contents and expose them to the mucosal wall to maximize absorption
62
The circular and longitudinal muscle layers coordinate to achieve _____
segmentation
63
_______ occurs when two nearby areas contract and isolate a segment to hold the contents in place long enough to be absorbed into circulation
segmentation
64
segmentation is controlled mainly by the ______ with motility by the ______
enteric nervous system, extrinsic nervous system
65
Nonreversible causes of small bowel dysmotility include
- structural: scleroderma, connective tissue disorders, IBD
- neuropathic: pseudo-obstruction c/b intrinsic and extrinsic nervous systems dysfunction
66
The large intestine acts as a ______
reservoir for waste and indigestible material before elimination and it extracts remaining electrolytes and water
67
Giant migrating complexes serve to produce mass movements across the large intestine approximately every _______
6-10x per day
68
Two types of inflammatory bowel disease include
- Ulcerative colitis
- Chron's
69
Ulcerative colitis symptoms
diarrhea, rectal bleeding, crampy abdominal pain, N/V, weight loss
70
Labs in UC may show
inc platelets, inc. erythrocyte sedimentation rate, dec. H/H, dec. albumin
71
Hemorrhage requiring ____ units of blood in 24-48hrs warrants ______
6+ units, surgical colectomy
72
______ is a complication triggered by e-lyte disturbances
toxic megacolon
73
________ is an acute or chronic inflammatory process that may affect any/all of the bowel
Chron's disease
74
Most common site of Chron's disease is the _______, usually presenting with ______
terminal ilium, usually presenting w/ ileocolitis w/ RLQ pain and diarrhea
75
Inflammatory bowel disorder (IBD) treatment includes
Medical:
- 5-acetylsalicylic (5-ASA)
- PO/IV gucocorticoids
- ABx: rifaximin, flagyl, cipro
- purine analogues
Surgical:
- last resort = resection
76
Greater than _______ resection leads to "short bowel syndrome" requiring ____
>2/3, TPN
77
Carcinoid tumors secrete _________
peptines and vasoactive substances: gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon, serotonin, others...
78
Carcinoid syndrome occurs when
large amounts of carcinoid secretions reach systemic circulation
79
carcinoid syndrome normally affects which side of the heart more
Right heart worse than left. Left usually protected as the lungs clear some of the vasoactive substances
80
_____ should be given before surgical removal of carcinoid tumors
octreotide
81
_____ and ______ account for 60-80% of acute pancreatitis
gallstones and alcohol abuse
82
Hallmark labs of acute pancreatitis include
inc. serum amylase and lipase
83
Melena indicates bleeding is above the _____
cecum (where SI meets LI/colon
84
with GI bleeds, _____ is typically elevated d/t absorbed nitrogen into bloodstream
BUN >40mg/dL
