GI Assessment 2025 (Exam 4) Flashcards by Jeremy Steele

How much of the total body mass does the GI constitute?

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From outermost to innermost these layers are:

Serosa –> Longitudinal muscle
layer –> Circular muscle layer –> Submucosa –> Mucosa (innermost layer)

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How many muscles are in the GI tract and what do they work to do?

2 muscles:

Longitudinal layer
Circular Layer

Work together to propagate gut motility

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What 4 nerve plexus are found in the GI organs?

Celiac Plexus
hypogastric plexus
myenteric plexus
submucosal plexus

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The celiac plexus innervates the:

GI organs up to proximal transverse colon

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Innervation of the descending colon and distal GI tract comes from the

hypogastric plexus

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myenteric plexus regulates the

Smooth muscle layers

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Which nerve plexus transmits information from the
epithelium to the enteric and central nervous systems

submucosal plexus

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the epithelium is where the GI contents are

sensed
nutrients are absorbed
enzymes are secreted
waste is excreted

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In the GI tract, the extrinsic SNS is primarily

inhibitory and decreases GI motility (fight or flight)

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In the GI tract,The extrinsic PNS is primarily

excitatory and activates GI motility (rest and digest)

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Enteric nervous system is the independent nervous system, which controls

motility
secretion
blood flow

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The enteric nervous system is comprised of the ____ and ____ plexus

myenteric plexus
submucosal plexus

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The myenteric plexus controls ____, which is
carried out by ____ neurons, ____ ____ of
____ (aka ____, GI pacemakers), and ____ ____ cells

The myenteric plexus controls motility, which is
carried out by enteric neurons, interstitial cells of
Cajal (aka ICC cells, GI pacemakers), and smooth muscle cells.

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Which plexus in the enteric nervous system controls absorption, secretion, and mucosal blood flow?

Submucosal plexus

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What are the anesthesia challenges of a colonoscopy?

Pt dehydration d/t bowel prep and NPO status

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An upper GI endoscopy is placed where? (4)

esophagus
stomach
pylorus
duodenum

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What procedure measures pressures along entire esophageal length and is used to dx motility disorders?

High Resolution Manometry (HRM)

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A barium enema allows for detection of ____ and ____ anatomical abnormalities and is called a ____

A barium enema allows for detection of colon and rectal anatomical abnormalities and is called a Lower GI series

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Esophageal diseases are grouped into what 3 catagories?

Do any of these overlap with each other?

Anatomical
Mechanical
Neurologic

Yes, many disease states overlap

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Mechanical causes of esophageal disease include: (3)

aka ____ issues

achalasia
esophageal spasms
a hypertensive LES

Aka muscle issues

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stroke, vagotomy (removal of vagus nerve), and hormone deficiencies are all ____ causes of esophageal disease

Neurologic

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Most common sx of esophageal dz:

dysphagia, heartburn (GERD)

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Esophageal dysmotility sx occur w/:

both liquids & solids

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Mechanical esophageal dysphasia sx occur:

w/solid food only

effortless return of gastric contents into pharynx is known as

GERD

What is Achalasia?

neuromuscular disorder of the esophagus consistng of an outflow obstruction d/t inadequate LES tone and a dilated hypomobile esophagus

This disorder could be related to the loss of ganglionic cells of the esophageal myenteric plexus

Achalasia

How is Achalasia diagnosed?

esophageal manometry (HRM) and/or esophagram

what are the 3 classes of achalasia?

Type 1: minimal esophageal pressure Type 2: entire esophagus pressurized Type 3: esophageal spasms w/premature contractions

achalasia Tx for Type 1: minimal esophageal pressure

responds well to myotomy

Which type of Achalasia has best outcomes?

Type 2: entire esophagus pressurized

Which type of Achalasia has worst outcomes?

Type 3: esophageal spasms w/premature contractions

All treatments are palliative for this disease

Achalasia

Give these meds to relax the LES for Achalasia

nitrates and CCBs

What is the most effective nonsurgical tx for Achalasia?

Pneumatic sphincter dilation

Laparoscopic Hellar Myotomy is the

Best surgical tx for achalasia - cutting sphincter to loosen it

Peri-oral endoscopic myotomy (POEM) is

another surgical tx for achalasia where the LES muscle layers are divided endoscopically

Why is Peri-oral endoscopic myotomy (POEM) a less desirable tx for achalasia?

40% of pts develop pneumothorax or pneumoperitoneum

what procedure is only considered in the most advanced dz states of achalasia?

Esophagectomy - removal of esophagus

Achalasia Pts are ↑ risk for ____ How should the CRNA proceed?

aspiration RSI or awake intubation is indicated

Diffuse Esophageal Spasms usually occur in

distal esophagus; likely d/t autonomic dysfunction (PNS)

outpouchings in the wall of the esophagus is known as

Esophageal Diverticula

What are the 3 locations for Esophageal Diverticula?

1. Pharyngoesophageal (Zenker diverticulum) 2. Midesophageal 3. Epiphrenic (supradiaphragmatic)

All Esophageal Diverticula are considered ____ risks

Aspiration Removal of particles and RSI indicated

Sx of GERD

heartburn dysphagia mucosal injury (acid burns)

3 mechanisms of GE incompetence:

1. Transient LES relaxation, elicited by gastric distention 2. LES hypotension 3. Autonomic dysfunction of GE junction

What is normal LES pressure?

LES pressure = 29mmHg

Avg LES pressure with GERD

13 mmHg

Tx meds for GERD

Antacids, H2 blockers, PPIs

Use___ ___ with all pts with GERD

Aspiration precautions

Surgery pts with GERD should be intubated how?

RSI

In the stomach, solids must be broken down into:

1-2 mm particles before entering the duodenum

Most common cause of non-variceal upper GI bleeding is

Peptic ulcer disease

There is a 10% risk of perforation in those who do not receive treatment with what disease?

Peptic ulcer disease

Peptic ulcer disease mortality is d/t ____ or ____

Peptic ulcer disease mortality is d/t **Shock** or **perforation > 48hrs**

Pyloric obstruction sx:

Recurrent vomiting, dehydration & hyperchloremic alkalosis

Pyloric obstruction tx includes

NGT, IV hydration Normally resolves in 72h

What is the triple therapy tx for gastric ulcers d/t H. Pylori?

2 abx + PPI x 14 days

major function of the small intestine is to

circulate the contents and expose them to the mucosal wall to maximize absorption of water, nutrients, and vitamins

In which disorder is it helpful to distinguish etiologies based on reversible and nonreversible causes

Small bowel dysmotility

Reversible causes of Small bowel dysmotility are (3)

mechanical obstruction Bacterial growth ileus

Nonreversible causes of Small bowel dysmotility are

1. Structural 2. Neuropathic

Nonreversible Structural causes of Small bowel dysmotility are (3)

scleroderma connective tissue disorders IBD

Nonreversible Neuropathic causes of Small bowel dysmotility are

pseudo-obstruction in which the intrinsic and extrinsic nervous systems are altered

Distention of the ileum will relax the ____ ____ to allow intestinal contents to enter the colon

ileocecal valve

What serves to produce mass movements across the large intestine?

Giant migrating complexes

In a healthy state, how often do Giant migrating complexes occur

6-10x per day

The two primary symptoms of colonic dysmotility are?

1. Altered Bowel habits 2. intermittent cramping in large intestine

IBS and IBD are the most common diseases associated with ___ ____

colonic dysmotility

Rome II criteria defines ____ as having abdominal discomfort along with 2 of the 3 following features:

IBS defecation relieves discomfort pain is assoc w/abnormal frequency pain is associated with a change in the form of the stool

Why are contractions suppressed in IBD?

colonic wall compression by the inflamed mucosa while giant migrating complexes remain

When giant migrating complexes increase in frequency with IBD, what can this lead to?

their pressure effect can further compress the already inflammed mucosa leading to hemorrhage Thick mucus secretions significant erosions

What is the 2nd most common inflammatory disorder (after RA)?

Inflammatory bowel disease (IBD)

In severe cases of ulcerative colitis, the mucosa of the colon and rectum can be:

hemorrhagic edematous ulcerated

differentiating Sx of ulcerative colitis is

Rectal bleeding

when hemorrhage with ulcerative colitis requires ___ ___ ____ in ____ then ____ ____ is warranted

when hemorrhage with ulcerative colitis requires **6+ units of blood** in **24-48 hrs** then **surgical colectomy** is warranted

Toxic megacolon (inflammed and dilated colon) is a complication triggered by

electrolyte disturbances

Half of toxic megacolon cases require ____ and half of the cases ____

colectomy resolve

If toxic megacolon leads to colon perfuration, the mortality rate is

15%

Crohn's disease is an acute or chronic inflammatory process that may effect

any or all of the bowel

Where is the most common site for Crohn's? What sx present here?

terminal ilium (end of SB) presents with ileocolitis with RLQ pain and diarrhea

What are the two patterns of Crohn's?

Penetrating-fistulous or obstructing

What is the treatment for IBD? (AAA)

5-Acetylsalicylic acid (5-ASA) - mainstay for IBD Antibacterial Anti-inflammatory

What is the surgery performed with IBD? Is it done early on in disease?

Small intestine resection Done as last resort

Small intestine resection for IBD should be limited to removal of ____

< 1/2 the length of the small intestine

If Small intestine resection for IBD is ____ it will result in ____ ____ ____ which will require ___

If Small intestine resection for IBD is **> 2/3** it will result in **short bowel syndrome** which will require **TPN**

Carcinoid Syndrome occurs in ____ of pts with ____

10% carcinoid tumors

Pts with carcinoid syndrome may acquire

Right heart endocardial fibrosis

Why is the left heart more protected in pts with carcinoid syndrome?

the lungs clear some of the vasoactive substances

When treating carcinoid syndrome, what should be avoided?

serotonin triggers

How are carcinoid tumors often found?

incidentally during surgery for suspected appendicitis

What are the top 3 most common locations for carcinoid tumors to be found based on presentation?

1. Small intestine - abdominal pain (51%) 2. Rectum - bleeding (39%) 3. Small intestine - intestinal obstruction (31%)

What are the most common causes of acute pancreatitis?

Gallstones and alcohol abuse (60-80% cases)

The hallmark labs for acute pancreatitis are?

↑serum amylase & lipase

Tx for acute pancreatitis? (4)

Aggressive IVF NPO to rest pancreas (effort to decrease panc. enzymes) enteral feeding (preferred over TPN) opioids

EGD is dx/therapeutic procedure of choice for

GI bleeding

The presence of ____ indicates bleed is above the ____ where SI meets colon

melena (digested blood) cecum

What is the last resort for variceal bleeding?

Mechanical balloon tamponade

Colonic ileus characterized by massive dilation of the colon without ____ ____ What is causing the ileus?

mechanical obstruction Gas build up causes the ileus

What 4 things can complicate an ileus?

1. e-lyte disorders 2. immobility 3. excessive narcotics 4. anticholinergics (atropine, glyco)

How do anesthetics effect the GI system? (4)

Volatile anesthetics depress the: spontaneous, electrical, contractile, and propulsive activity in the stomach, small intestine, and colon

In what order does the GI tract recover from anesthesia?

Small intestine 1st Stomach 2nd - 24 hrs Colon 3rd - 30-40 hrs

Which anesthetic gas should be avoided in lengthy abdominal surgeries?

Nitrous Oxide (distension risk)

Do NMBs affect GI motility?

No, they act on skeletal muscle GI motility remains intact as it is smooth muscle

Where is there a high density of peripheral mu-opioid receptors found?

The myenteric and submucosal plexuses in the enteric system