GI Cases powerpoint (includes spinal levels) Flashcards

Question

chapman points: Liver

Answer 1

5th and 6th intercostal space from mid-clavicular line to the sternum on the right - intertransverse space, midway between the spinous and transverse processes, between 5th and 6th vertebrae on the right

Answer 2

6th and 7th intercostal space from the mid-clavicular line to the sternum on the left -- intertransverse space, midway between the spinous and transverse processes, between 6th and 7th vertebrae on the left

Answer 3

6th and 7th intercostal space from mid-clavicular line to the sternum on the right intertransverse space, midway between the spinous and transverse processes, between 6th and 7th vertebrae on the right

Answer 4

7th and 8th intercostal space on the right intertransverse space, midway between the spinous and transverse processes, between 7th and 8th vertebrae on the right

Answer 5

7th and 8th intercostal space on the left - intertransverse space, midway between the spinous and transverse processes, between 7th and 8th vertebrae on the left

Answer 6

intercostal spaces between the 8th and 9th, 9th and 10th, and 10th and 11th ribs near the cartileges bilaterally intertransverse spaces, midway between the spinous and transverse processes, between 8th and 9th, 9th and 10th, 10th and 11th vertebrae on the left

Answer 7

upper edge near the tip of the 12th rib on the R 11th intertransverse space on the right

Answer 8

between ASIS and greater trocanter face of 11th rib at its junction with tip of TP of 11th vertebrae on the right

Answer 9

lesser trocanter downward

Answer 10

an area 1-2” wide, extending from the trocanter to within an inch of the patella on the front, outer aspect of the femur – on the right side = upper 1/5 indicates cecum, next 3/5 ascending colon, last 1/5 for the first 2/5 of transverse colon; on the left side = first 1/5 just above the knee corresponds to the last 3/5 of transverse colon, middle 3/5 is the descending colon, last 1/5 is the sigmoid; extreme upper end of the trocanter on the left side is the recto-sigmoid junction TP of L2 – TP of L4 a triangular area reaching across to the iliac crest

Answer 11

Hemorrhoids, Rectum – on the sacrum close to the ilium at the lower end of the SI jt Hemorrhoids – just above the ischial tuberosity (anterior points)

Answer 12

Colonic points are along the anterior femur. Broad ligament and prostate points are along the lateral femur.

Answer 13

Sympathetic innervation is supplied by cell bodies in the spinal cord and fibers that terminate in the prevertebral ganglia (celiac, superior, and inferior mesenteric ganglia); these are the preganglionic neurons. These nerve fibers synapse with postganglionic neurons in the ganglia, and the fibers leave the ganglia and reach the end organ along the major blood vessels and their branches. Rarely, there is a synapse in the paravertebral (chain) ganglia, as seen with sympathetic innervation of other organ systems.

Answer 14

The vagus nerve, (CN 10th), innervates the esophagus, stomach, gallbladder, pancreas, first part of the intestine, cecum, and the proximal part of the colon. The vagus exits the cranium via the jugular foramen (along with the accessory and glossopharyngeal nerves). Consistent with the typical organization of the parasympathetic nervous system, the preganglionic nerve cell bodies lie in the brainstem (vagus) or the sacral spinal cord (pelvic). Axons from these neurons run in the nerves to the gut (vagus and pelvic nerves, respectively), where they synapse with postganglionic neurons in the wall of the organ, which in this case are enteric neurons in the gut wall.

Answer 15

``` Tends to inhibit GI function Frequently activated in pathological situations Inhibits smooth muscle Induces contraction of sphincters Regulates blood flow in the GI tract ```

Answer 16

Activates physiological processes in the gut wall Allows filling of the stomach to occur without an increase in intraluminal pressure Generally involved in relaxation of sphincters Contraction of smooth muscle layers in the colon Controls the caliber of the internal anal sphincter

Answer 17

``` Constipation Bloating Pain Contraction of sphincters Increased vasomotor tone (may lead to decreased mucus production in stomach and intestines) ```

Answer 18

``` Nausea Vomiting Diarrhea Hypermotility Relaxation of sphincters Increased mucus secretion Increased acid production in the stomach ```

Answer 19

Gastritis, Ulcers (peptic and duodenal), GERD What is the medical treatment approach? Antacids, H2-blockers, PPIs, antibiotics

Answer 20

Failure to pass flatus or stool for 3-6 days after surgery | Transient impairment of function and motility

Answer 21

``` Mechanical irritation Edema of tissues – mesentery and intestine Inflammatory molecules which cause the Activation of inhibitory neural reflexes Medications, particularly opiates ```

Answer 22

``` Nasogastric suctioning Rectal stimulation Ambulation Medications - laxatives - erythromycin - metoclopromide - cisapride - alvimopan -methylnaltrexone Gum chewing – stimulates the gastrocolic reflex? NSAIDs Thoracic epidural analgesia with lidocaine or bupivacaine ```

Answer 23

``` Electrolyte imbalance Dehydration Gastric perforation Nasal irritation or erosion of mucosa Infection Rectal perforation Impaired nutrition Delayed healing Increased pain from withholding of opiate pain reliever Increased bleeding due to anti-platelet activity from NSAID Gastric mucosal erosions from NSAID Other adverse effects of NSAIDs Meningitis/spinal headache from epidural analgesia Cost ```

Answer 24

Sympathetic: Increased Tone Increased vascular tone – decreased O2 and nutrients to the tissues Decreased peristalsis Lymphatics Impaired flow increases tissue congestion Impaired nutrient absorption from the intestines Congestion increases the likelihood of fibrosis, and susceptibility to infection

Answer 25

autonomic plexi within the wall of the intestine: Synapses between visceral afferents, the parasympathetic and sympathetic occur here. Plexi modify autonomic activity according to the local needs of that region of the intestine to move bolus, digest, etc.

Answer 26

pacemakers of the gut slow waves are generated in interstitial cells of cajal

Answer 27

``` Sliding surfaces: Peritoneum Pericardium Pleura Meninges ```

Answer 28

Double layer system - serous fluid creates suction between surfaces of the peritoneum, etc. Ligamentous system – folds of peritoneum or pleura binding an organ to the wall of the cavity or to another organ Not present for structural stability like skeletal ligaments Turgor and Intracavitary pressure – hold the viscera in place, remain constant in mass, yet stick together Mesenteric system- folds of peritoneum that support the nerves, arteries, veins and lymphatics of the small and large intestines Omental system – folds of peritoneum that join 2 elements of the digestive tract together and has a neurovascular role

Answer 29

Any restriction, fixation or adhesion limits mobility and motility, along with viscerospasm and tethering (ptosis). Diaphragm moves about 20,000 times per day. Heart beats about 100,000 times per day Approximately 30-50 cc’s of blood is ejected from the left ventricle per beat causing a wave propagation through the arteries. Even the smallest restriction takes on great significance as it is stressed thousands of times per day along a pathologically modified axis of motion.

Answer 30

``` Infection/inflammation Trauma Surgery Pregnancy Scoliosis/short leg syndrome Craniosacral dysfunction ```

Answer 31

``` Evaluate for: Painfulness Differences in tension Position of the organ Tone of the organ ```

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GI Cases powerpoint (includes spinal levels) Flashcards

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