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GI assessment Flashcards

Exam 4 content

1
Q

How much of the body mass is made up of the GI system?

A

5%

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2
Q

From the outermost to the innermost what are the layers of the GI tract?

A

serosa, longitudinal muscle layer, circular muscle layer, submucosa, and the mucosa

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3
Q

What are the three layers of the mucosa?

A

outermost to innermost: muscularis mucosae, lamina propria, and epithelium

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4
Q

What is significant about the three layers of the mucosa?

A

muscularis mucosa: moves the villi
lamina propria: contains blood vessels, nerve endings and immune cells
epithelium: where GI contents are sensed, enzymes are secreted, and nutrients are absorbed

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5
Q

How do the longitudinal and circular muscle layers work to propagate gut motility?

A

the longitudinal layer shortens and lengthens while the circular layer decreases its diameter to promote motility

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6
Q

What effect does the extrinsic SNS have on the GI system?

A

inhibits GI motility

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7
Q

What effect does the extrinsic PNS have on the GI system?

A

activates GI motility

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8
Q

What is significant about the enteric nervous system?

A

it is an independent nervous system that controls motility, secretions and blood flow.

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9
Q

What does the celiac plexus innervate?

A

it innervates the proximal GI organs and transverse colon.

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10
Q

What does the hypogastric plexus innervate?

A

it innervates the descending colon and the distal GI tract

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11
Q

What are the 4 approaches to blocking the celiac plexus?

A
  1. trans-crural
  2. intraoperative
  3. endoscopic ultrasound-guided
  4. peritoneal lavage
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12
Q

where is the myenteric plexus located?

A

between the smooth muscle layers of the gut

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13
Q

what does the submucosal plexus do?

A

it transmits info from the epithelium to the enteric and central nervous systems

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14
Q

What two plexus’ are apart of the enteric system?

A
  1. myenteric plexus
  2. submucosal plexus
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15
Q

What is the myenteric plexus responsible for? And how does it do this?

A

controlling motility, which is carried out by enteric neurons and interstitial cells of Cajal (ICC- the GI pacemakers) and smooth muscle cells

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16
Q

What does the submucosal plexus control?

A

controls absorption, secretion and mucosal blood flow

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17
Q

what is an upper GI endoscopy?

A

endoscope is placed in the esophagus, stomach, pylorus and duodenum used for diagnostic or therapeutic purposes

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18
Q

What are some challenges anesthesia faces with upper GI scopes?

A

sharing the airway with the endoscopist
usually done w/o ETT, must closely monitor airway
procedure is usually done outpatient

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19
Q

What is the major challenge anesthesia faces with patients receiving colonoscopies?

A

patient dehydration d/t bowel prep and NPO status

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20
Q

What is a high resolution manometry?

A

A high pressure catheter measures pressures along the entire esophageal length. Used to treat motility disorders

This can also be done in the small intestine as well

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21
Q

What procedure is used to assess swallowing function and GI transit?

A

GI series with ingested barium

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22
Q

How is a gastric emptying study performed?

A

patient fasts for 4+ hours then consumes a meal with a radiotracer. Frequent imaging is done over the next 1-2 hours

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23
Q

What is different about a lower GI series?

A

Barium is given in an enema instead of ingested to look for colon and rectal abnormalities

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24
Q

What are some examples of anatomical esophageal disease?

A

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

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25
What are some examples of mechanical esophageal disease?
achalasia, esophageal spasms and a hypertensive LES
26
What are some examples of neurologic esophageal disease?
stroke, vagotomy, hormone deficiencies
27
what are some common symptoms of esophageal disease?
dysphagia, heartburn and GERD
28
How could you differentiate esophageal dysmotility from mechanical esophageal dysphagia?
dysmotility: symptoms occur with BOTH liquids and solids mechanical: symptoms only occur with solids
29
What does GERD feel like?
heartburn, nausea or a lump in the throat
30
What is achalasia?
a neuromuscular disorder that inhibits the LES from relaxing and keeps food from passing from the esophagus into the stomach. Long-term achalasia has a higher risk of esophageal cancer
31
What are some symptoms of achalasia?
dysphagia, regurgitation, heartburn, and chest pain
32
How is achalasia diagnosed?
via esophageal manometry or esophagram
33
How many types of achalasia are there and which has the worst outcomes?
type 1: minimal esophageal pressure type 2: entire esophagus is pressurized, but responds well to treatment type 3: esophageal spasms w/ premature contractions, worst outcomes
34
what is the treatment for achalasia?
All treatments are palliative... meds: nitrates and CCB to relax LES endoscopic botox injections pneumatic dilation laproscopic Hellar myotomy peri-oral endoscopic myotomy (POEM) esophagectomy--> for advanced dx states
35
Which esophageal procedure has high incidence of developing a pneumothorax?
The POEM surgical procedure
36
Which esophageal procedure is the most effective non-surgical procedure?
pneumatic dilation
37
Which esophageal procedure in the most effective surgical procedure?
laprascopic Hellar myotomy
38
What are some anesthesia considerations for patients undergoing esophageal procedures?
patients are a high aspiration risk. RSI or awake intubation is indicated
39
The pain from esophageal spasms mimics what other pain?
mimics angina
40
Which patient population is esophageal spasms most common in?
the elderly
41
What are the treatments for esophageal spasms?
nitroglycerine, antidepressants and PD-I's
42
What are esophageal diverticula?
outpouchings in the wall of the esophagus
43
What is Zenker diverticulum in the pharyngoesophageal area?
diverticula that cause bad breath d/t food retention
44
Hiatal hernias are often associated with____
GERD
45
Why is the prognosis for esophageal cancer so poor?
there is an abundance of lymphatics in the neck area which can lead to lymph node metastasis
46
What are the two types of esophageal cancers?
most are Adenocarcinomas, the rest are Squamous cell carcinomas
47
What are some anesthesia considerations for esophagectomy patients?
it can be performed transthoracic, transhiatal, or via minimally invasive technique High risk of recurrent laryngeal nerve injury Patients are often malnourished High risk for aspiration
48
How common is GERD?
occurs in 15% of adults
49
What are the reflux contents of GERD?
HCl, pepsin, pancreatic enzymes and bile
50
What are the 3 mechanisms of gastro-esophageal incompetence?
1. transient LES relaxation 2. LES hypotension 3. autonomic dysfunction of the the GE junction
51
What is a normal pressure in the LES? What is the pressure associated with GERD?
normal: 29 mmHg GERD: 13 mmHg (more relaxed)
52
What are some treatment options for GERD?
-avoid trigger foods -antacids, H2 blockers, PPIs -Nissen Fundoplication, Toupet or LINX procedure
53
What do cimetidine and ranitidine do?
H2 blockers, used to decrease acid secretion and increase gastric pH
54
When are PPI's generally given to patients with GERD?
the night before or the morning of surgery
55
What antacid is given to pregnant women undergoing emergent C sections?
sodium citrate
56
Which patients are typically given metoclopramide?
diabetics, obese patients, and pregnant patients
57
What nerve is responsible for increasing the number and force of GI contractions?
the vagus nerve
58
What nerve is responsible for inhibiting GI contractions?
splanchnic nerve
59
which hormones are responsible for GI movement?
increase motility: gastrin and motilin decrease motility: gastric inhibitory peptide
60
What is the most common cause of non-variceal upper GI bleeding?
peptic ulcer disease
61
is pain associated with PUD improved with fasting or with food?
improved with food
62
peptic ulcer perforation causes what?
severe epigastric pain d/t acidic secretions entering the peritoneum. Mortality d/t shock or perforation if left untreated for >48hours
63
What are some symptoms of a gastric outlet obstruction? Treatment?
sx: recurrent vomiting, dehydration, hyperchloremic alkalosis tx: Nasogastric tube, IV hydration, normally resolves in about 72 hr
64
What are common causes of gastric ulcers?
excessive NSAID use, H. pylori, or ETOH
65
What are some treatment options for gastric ulcers?
antacids, H2 blockers, PPIs, prostaglandin analogues
66
What is the treatment for H. Pylori?
Triple therapy: 2 abx and a PPI for 14 days
67
How many types if gastric ulcers are there and how are they graded?
5 types, they are graded based on their location and whether or not there is acid hypersecretion
68
What is Zollinger Ellison Syndrome?
a pancreatic tumor (gastrinoma) that causes gastrin hypersecretion
69
What are some symptoms associated with Zollinger Ellison syndrome?
peptic ulcer disease, erosive esophagitis, diarrhea, and GERD Pts. have increased gastric volume, electrolyte imbalances and endocrine abnormalities
70
What is segmentation?
this occurs in the small intestines where two nearby areas contract and isolate a segment to hold the contents in place long enough to be absorbed into circulation.
71
What controls segmentation? What controls motility?
segmentation: the enteric nervous system motility: extrinsic nervous system
72
what are some reversible causes of small bowel dysmotility?
mechanical obstructions (hernias, malignancy, adhesions), bacterial overgrowth, ileus, electrolyte imbalances, critical illness
73
What are some nonreversible causes of small bowel dysmotility?
structural (scleroderma, connective tissue diseases, IBD) neuropathic (intrinsic and extrinsic nervous system dysfunction)
74
What is the function of the large intestine?
acts as a reservoir for waste and extracts remaining water and electrolytes. Has giant migrating complexes that produce mass movements that occur 6-10x per day in a healthy state
75
What are the two most common diseases associated with the large intestine?
IBS and IBD
76
what causes IBD (inflammatory bowel disease)?
contractions are suppressed by inflammation but the giant migrating complexes remain and further compress the inflamed mucosa, which can lead to significant erosions and hemorrhage
77
what is ulcerative colitis?
a inflammatory bowel disease that disrupts the mucosa in part or all of the colon
78
What are some symptoms of UC?
diarrhea, rectal bleeding, cramping, N/V and weight loss
79
What are some labs associated with UC?
increased plts increased erythrocyte sedimentation rate decreased H&H decreased albumin
80
What is toxic megacolon?
a complication triggered by electrolyte imbalances. About half of these patients end up requiring a colectomy. Colon perf is a dangerous complication (15% mortality rate)
81
What is Chron's disease?
an acute or chronic inflammatory process that affects the bowels (most commonly the terminal ileum)
82
What are some symptoms of Chron's disease?
weight loss, fear of eating, anorexia, diarrhea, RLQ pain. Persistent inflammation progresses to a fibrous narrowing that leads to a bowel obstruction.
83
What is the mainstay drug to treat IBD?
5-acetylsalicylic acid (5-ASA) antibacterial and anti-inflammatory
84
What are some other medical treatments for IBD?
glucocorticoids, rifaximin, flagyl, cipro and purine analogues
85
What are some surgical considerations for IBD?
it is to be a last resort, and should be conservative. Small intestine resection should be limited, if > 2/3 SI resected, patient will require TPN
86
What are carcinoid tumors and where do they occur?
95% occur in the GI tract. These tumors secrete peptides and vasoactive substances like gastrin, insulin, somatostatin, motilin, neurotensin, tachykinins, glucagon and serotonin
87
What are some symptoms of carcinoid syndrome?
flushing, diarrhea, HTN or hypotension, bronchoconstriction. May cause right heart fibrosis from the release of vasoactive substances.
88
How is carcinoid syndrome diagnosed? Treated?
Dx: plasma or urine serotonin levels Tx: avoid serotonin-triggers, serotonin antagonists and somatostatin analogues
89
What are some anesthesia considerations for carcinoid tumors/syndrome?
give octreotide prior to surgery to attenuate volatile hemodynamic changes
90
What prevents the pancreas from autodigestion?
proteases are packaged in precursor form there are protease inhibitors there is low intra-pancreatic calcium
91
What are the most common causes of pancreatitis?
gallstones and alcohol abuse
92
What are the symptoms associated with acute pancreatitis?
excruciating epigastric pain that radiates to the back, N/V and abdominal distention, steatorrhea, ileus, fever, tachycardia and hypotension
93
What labs are associated with acute pancreatitis?
increased serum amylase and lipase
94
What are the treatments for pancreatitis?
aggressive IV fluids, NPO to rest the pancreas, enteral feeding, opioids
95
What is the surgical treatment for acute pancreatitis?
ERCP, fluoroscopic examination of biliary and pancreatic ducts
96
melena indicates bleeding above the _____
cecum (where the small intestine meets the colon)
97
what is an ileus?
a massive dilation of the colon without mechanical obstruction. "Lazy colon"
98
What drug produces immediate results when treating an ileus?
neostigmine 2-2.5 mg over 5 min. Cardiac monitoring is required.
99
What are some anesthesia considerations w/ regards to the GI system?
1. the more Norepi--> the more GI inhibition 2. VA depress gut motility 3. Nitrous oxide will diffuse into the gas filled cavities faster than it can diffuse out 4. opioids reduce gut motility and cause delayed gastric emptying
100
Do NMBD affect gut motility?
no they only affect skeletal muscle so gut motility remains intact
101
If neostigmine (for reversal) produces powerful cholinergic effects, what do we usually give with it? Does sugammadex have these same effects?
Give glycopyrrolate (anti-cholinergic) No sugammadex does not have any effects on GI motility

Assessment Spring (15 decks)

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