GI Flashcards
What do diffuse esophageal spasms mimic?
- Mimics angina
- if they come in for a scope for this, they have probably already seen a cardiologist
- most often occur in elderly
Upper Endoscopy:
sedation goal?
type of anesthesia?
What do you need to have?
- Goal: to avoid apnea
- avoid oversedation
- have entire airway setup ready just in case
- TIVA- propofol
- maybe with fentanyl and/or lidocaine to decrease cough/gag with scope
- Bite block, before sedation
- Ambu bag
- airway setup
A little about how this works…
- Pt will be positioned on side
- Surgeon will flood stomach with irrigation while scoping
- Will suction stomach out before removing scope
- both irrigation and suction happen through this scope wand thingie
What does ERCP stand for?
What is it used for?
- Endoscopic Retrograde Cholangio-pancreatography
- used to diagnose and treat conditions of the bile ducts
- gallstones
- inflammatory strictures
- leaks (from trauma and surgery)
- cancer
How does an ERCP “work?”
Duration of procedure?
Type of anesthesia?
Concern?
- ERCP combines the use of X-rays and an endoscope
- duration is 30 min to 2 hours
- TIVA if short case, GA if case is more complicated
- Concern for aspiration, extubate wide awake with full airway protective reflexes back.
What is chronic peptic esophagitis?
surgery?
- “heartburn”
- retrosternal discomfort relieved by antacids
- if persistant and severe, may require surgery
- Nissen fundoplication
What are some anesthetic considerations for a pt with chronic peptic esophagitis?
- Pretreatment with aspiration/RSI meds
- antibiotics
- NG or OG inserted for surgery
- keep to gravity
- use NG if it will need to remain post-op
- N/V post op- zofran
- pain management
How can the Nissen fundoplication be done?
Anesthesia type?
- Open or laparoscopic
- Laparoscopic is more commone
- 5 small incisions
- one for laparoscope, the other 4 to retract and manipulate
- General anesthesia
What is the Roux en y surgery?
- bypass procedure that creates a stomach pouch out of a small portion of the stomach and attaches it directly to the small intestine, bypassing a large part of the stomach and duodenum
- laparoscopic most common
What should you consider with an obese patient?
- Positioning- ramping for intubation
- airway may be difficult
- RSI
Anesthesia considerations for Hiatal hernia?
- RSI- premeds
- implications depend on severity of the signs and symptoms
- Ex. does the patient sleep sitting up?
- awake extubation
- OG
Anesthesia considerations for achalasia?
- Risk of aspiration
- pre-induction decompression
- may place NG to suction
What is peptic ulcer disease?
Signs and symptoms?
- Mucosal alteration of the esophagus, stomach or duodenum due to increased gastrin and HCl production
- S/S
- midepigastric pain, relieved by food or antacids
- hemorrhage resulting in chronic anemia
- Gastric outlet obstruction
What is gastric outlet syndrome?
- obstruction at the pyloris exiting stomach
- If pt retains >300 ml 30 minutes after drinking 750 ml of saline
What are the treatments for PUD?
What are the anesthetic implications of these treatments?
- H-2 antagonists and anticholinergics are used to treat PUD more than surgery
- pyloroplasty and/or vagotomy
- Anesthetic implications:
- H-2 antagonists may inhibit CYP450
- nasogastric suctioning
- RSI
What is UC?
- inflammation of colonic mucosa
- rectum and distal colon
- most common in women age 25-45 and Jewish origin
- diarrhea, cramping, abdominal pain
- low grade fever, fatigue, weight loss during exacerbations
What is crohn’s disease?
What are some extracolonic features of this disease?
- Inflammation of all layers of the bowel
- leads to fistula development
- Extracolonic features
- arthritis
- calcium oxalate (renal and gallstones due to increased absorption of oxalate by the colon
- decreased albumin-protein loss via diseased bowel
What are the anesthetic considerations for Inflammatory bowel disease?
- Fluid and electrolyte management
- avoid nitrous oxide
- supplemental (stress dose) steroids may be indicated
- anticholinesterases increase intraluminal pressure
- stay on lower end of dosing
- try to get 3-4 twitches back before reversing
What do carcinoid tumors cause?
what is the treatment?
- Carcinoid tumors secrete corticotropic hromones, GHRF, and cause cushing syndrome
- Carcinoid syndrome
- cutaneous flushing
- bronchospasm
- hypotension
- diarrhea
- treatment
- somatostatin analogue octreotide
- resection of tumor by surgery
What are some anesthesia considerations for a patient with a carcinoid tumor?
- continue the octreotide
- can interfere with insulin release; exacerbate diabetes
- short half life, must be given continuously
- binds to receptor sites on the tumor to decrease symptoms
- bronchospasm of carcinoid tumor can be resistant to treatment
- Octreotide 100-200 mcg IV
- histamine blockers and ipratropium
- avoid histamine releasing drugs
- avoid ketamine
- avoid catecholamines b/c they release seratonin
- Arterial line necessary d/t hemodynamic variables
What are some concerns for acute and chronic pancreatitis?
- Acute
- can have major organ involvement
- ARDS
- renal failure
- GI hemorrhage
- DIC
- shock- hypovolemia seen even in mild pancreatitis
- fluid management very important
- can have major organ involvement
- Chronic
- DM results from loss of endocrine function
- malnutrition
- opioids used for pain control
Where does GI bleeding often originate from?
- Most often from the upper GI tract
- Bleeding from the lower GI tract (diverticulosis or tumor) accounts for 10-20%, commonly older patients
What are some concerns regarding a patient with a GI bleed?
- low H&H
- hypotension and tachycardia (if blood loss exceeds 25% of total blood volume)
- must replace fluid volume, which may make anemia more obvious
- If esophageal vericies are bleeding, considered a full stomach
Appendicitis:
symptoms
treatment/considerations
- Pain, N/V, dehydration, anorexia
- preload with fluids
- Surgical treatment
- may need RSI d/t slow digestion experienced by anybody in pain
- antibiotics
- avoid N2O
Anesthesia considerations for bowel obstruction
- No metochlopramide- avoid agents that increase gastric motility
- no N2O
- RSI
- Low albumin
- require fluid volume replacement and electrolyte corrections
- OGT to suction or gravity
What are the anesthetic considerations for a patient with cholecystitis?
type of surgery?
- Laparoscopic approach
- insufflation will increase intra-abdominal pressure
- insufflation can interfere with ventialtion; reverse trendelenberg position will help
- impacts cardiovascular system and venous return
- high intra-abdominal pressure causes concern for reflux (OG tube)
- ETCO2 will increase- d/t ventilation changes and the insufflated CO2 into the abdomen
- decrease TV, increase RR
- Opioids can cause spincter of Oddi spasm whenever dealing with the gallbladder
- Can improve with Naloxone, glucagon, or NTG
- Don’t actually use naloxone ever
- NTG may be better for a diabetic patient
