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Co-Existing Disease 1 > GI Diseases > Flashcards

GI Diseases Flashcards

1
Q

Difficult in swallowing of solid foods and is classic symptom of all esophageal disease

A

Dysphagia

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2
Q

Swallowing of fluid tends to cause more difficulty than swallowing solid

A

Achalasia

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3
Q

Idiopathic destruction of what of the entire esophagus, which results in functional narrowing of the lower esophagus, and peristaltic failure through its length?

A

Parasympathetic ganglia

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4
Q

When asked where the food is getting stuck during dysphagia symptoms, pts will often point to what site of the obstruction?

A

Cervical region

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5
Q

The actual site of obstruction for dysphagia symptoms is always where the level at which the level of obstruction is perceived?

A

At or below

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6
Q

Dysphagia will present as what other thing?

A

Bronchial asthma

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7
Q

What are the 4 esophageal diseases?

A
  1. Diffuse esophageal spasm
  2. GERD
  3. Hiatal hernia
  4. Esophageal diverticula
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8
Q

What disease is due to dysfunction of autonomic nervous system that can cause dysphagia, regurgitation, and chest pain?

A

Diffuse esophageal spasm

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9
Q

Diffuse esophageal spasm may mimic what other thing?

A

Angina pectoris

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10
Q

How is diffuse esophageal spasm treated? (2)

A

Nifedipine and isosorbide which decreases LES pressure

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11
Q

What disease has LES weakening muscle, gastric acid from the stomach renters the esophagus?

A

Chronic peptic esophagitis (GERD)

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12
Q

Prophylactic meds for GERD?

A

Cimetidine and ranitidine (H2 antagonist) that decreases gastric acid secretion and increases gastric pH

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13
Q

What surgery treatment will help GERD?

A

Nissan fundoplication

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14
Q

What 6 agents increase LES tone?

A 
Raglan 
Neostigmine 
Sux 
Metoprolol
Alpha adrenergic stimulants 
Antacids
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15
Q

What 6 agents decrease LES tone?

A 
Atropine 
Glycopyrrolate 
Dopamine 
Beta adrenergic stimulants
Opioids 
Propofol
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16
Q

What 3 agents have no change in LES tone?

A

Propranolol
Atracurium
Nitrous oxide

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17
Q

Chemical pneumonitis or aspiration pneumonitis caused by aspiration especially during pregnancy (volume greater than 25ml with pH less than 2.5)

A

Mendelson’s syndrome

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18
Q

What is the main clinical feature of mendelson’s syndrome/aspiration pneumonitis?

A

Signs fo general hypoxia, 2-5 hrs after anesthesia

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19
Q

Treatment for mendelson’s syndrome/aspiration pneumonitis?

A

Non-particulate antacid (Na citrate) or H2 antagonist (ranitidine)

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20
Q

If pt has developed mendelson’s syndrome, only treatment is what to maintain saturation?

A

Mechanical ventilation

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21
Q

What is protrusion of a portion of the stomach through the hiatus of the diaphragm and then into the thoracic activity

A

Hiatal hernia

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22
Q

How do you treat hiatal hernia?

A

Similar to GERD

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23
Q

Classified according to location for esophageal diverticula: upper, mid, lower?

A

Zenker’s (upper)
Traction (mid)
Epiphrenic (lower)

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24
Q

What should you take caution with for a zenker diverticulum?

A

NG tube

25
Q

Bleeding from a laceration in the mucosa at the junction of the stomach and esophagus that is usually caused by severe vomiting because of alcoholism or bulimia or food poising?

A

Mallory-Weiss syndrome

26
Q

Mallory-Weiss syndrome presents with what?

A

Hematemesis

27
Q

What 3 things can cause peptic ulcer disease?

A
  1. NSAID
  2. Stress
  3. Tumor (zollinger-Ellison syndrome)
28
Q

Anesthetic changes for peptic ulcer disease?

A

Treat as full stomach and avoid NSAID

29
Q

Rare condition in which one or more tumors form in your pancreas or upper part of your small intestine and these tumors (gastrinomas) secrete large amounts of hormone gastric which causes your stomach to produce too much acid?

A

Zollinger-Ellison syndrome

30
Q

What should be added to the treatment regimen for pts with septic shock that is unresponsive to IV fluids and vasopressor therapy?

A

Low dose hydrocortisone (50 mg every 6 hrs or 100mg bolus followed by 10mg/hr for seven days)

31
Q

What is the role for steroids in sepsis in the absence of shock?

A

There is no role

32
Q

Without being treated, generalized peritonitis almost always causes what?

A

Death

33
Q

What is the second leading causes of cancer death after lung?

A

Colorectal cancer

34
Q

Polyps greater than what are more likely invasive for colorectal cancer?

A

1.5cm

35
Q

Periop blood transfusions have been associated with what long term survival in esophageal cancer?

A

Decrease

36
Q

Anesthesia management for colorectal cancer (4)

A
  1. GA or combines epidural/GA
  2. 2 large bore IV’s
  3. Anticipate large 3rd space losses
  4. Monitor urine output
37
Q

What is the most common cause of pancreatitis?

A

Gallstones

38
Q

This has shown correlation between what and risk of acute pancreatitis?

A

Alcohol consumption

39
Q

For every increment of 5 drinks of hard liquor consumed in one sitting, the risk of developing acute pancreatitis increased by how much?

A

52%

40
Q

What 4 things can cause chronic pancreatitis?

A
  1. Smoking
  2. Cystic fibrosis
  3. Steatorrhea
  4. IDDM
41
Q

A condition characterized bu deficiency of exocrine pancreatic enzymes, resulting in the inability to digest food properly, or maldisgestion

A

Exocrine pancreatic insufficiency (EPI)

42
Q

Spasm of the sphincter of oddi causes pain similar to what?

A

Angina pain

43
Q

What is used to measure the pressure in this sphincter?

A

ERCP

44
Q

What can decrease sphincter of oddi baseline pressure?

A

Glucagon (.1mg)

45
Q

What inhibits contractions of the sphincter of Oddi and brings about cessation for 3-8mins?

A

N-butylscopolamine bromid (buscopan) (40mg)

46
Q

What drug causes significant relaxation of the sphincter of oddi that decreases baseline pressure from 8.9 to 2.9 and enables the endoscopic to extract small common bile duct stones without papillotomy?

A

Nitroglycerin (1.2mg sublingual)

47
Q

What can elevate sphincter baseline pressure?

A

Narcotics

48
Q

What drugs have no effect on the sphincter of oddi?

A

Sedatives of the diazepam type

49
Q

What is the whipple surgery?

A

Removal of the head of the pancreas due to pancreatic cancer

50
Q

The 5 yr survival rate after a Whipple procedure is about what?

A

20-25%

51
Q

When the tumors of the small intestine start secreting, it results in what?

A

Carcinoid syndrome

52
Q

Treatment for carcinoid syndrome?

A

Interferon and usually combined with somatostatin analogues (chemotherapy is little benefits and not indicated)

53
Q

Somatostatin analogues (o treatise or lanreotide) does what for carcinoid syndrome?

A

Potent inhibitor of growth hormone

54
Q

Carcinoid have what kind of heart problems?

A

R heart due to tricuspid stenosis from serotonin action

55
Q

Physical exam pay attention to what specific thing for carcinoid syndrome?

A

Pellagra (not get enough niacin, Vit b)

56
Q

Induction for carcinoid syndrome?

A

Use anxiolytics without histamine relating properties

57
Q

Drugs that produce a carcinoid crisis? (9)

A 
Sux 
Mivacruium 
Atracurium 
Tubocurarine
Pentothal
Epi 
NorE
Dopamine 
Iosproterenol
58
Q

What is primarily used to diagnose and treat conditions of the bile ducts and main pancreatic duct?

A

Endoscopic retrograde cholangiopancreatography (ERCP)

59
Q

2 positions for ERCP?

A

LLD and prone

Co-Existing Disease 1 (8 decks)

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