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NUNA 684 Advanced Pathophysiology > GI diseases > Flashcards

GI diseases Flashcards

1
Q

GERD - decreased resting tone of LES

A

with GERD - 13 mmHg
without - 29 mmHg

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2
Q

airway effects of GERD

A
  • cough
  • pharyngitis
  • laryngitis
  • bronchitis
  • pneumonia
  • wheezing
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3
Q

_____ of _________ have evidence of esophagitis or esophageal acid exposure

A

50% of asthmatics

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4
Q

GERD aspiration risk

A

significantly increased

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5
Q

carefully consider using __________ bc ____________

[GERD]

A

anti-cholinergic drugs
they decrease LES tone

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6
Q

__________ increases both LES and intragastric pressure

A

Succinylcholine
(barrier pressure - LES minus intragastric pressure - is unchanged)

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7
Q

H2 blockers increase ________ and decrease ____________

A

pH
gastric acid secretion

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8
Q

PPIs inhibit _________ drugs and may increase ______ risks

A

anti-platelet
CAD

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9
Q

GERD may require

A

cricoid pressure

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10
Q

drugs that increase LES tone

A

metoclopramide
neostigmine
succinycholine
a-adrenergic stimulants

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11
Q

drugs that decrease LES tone

A

atropine
glyco
b-adrenergic stimulants
propofol

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12
Q

HH is herniation of stomach above _____ ______ into the _____ _______

A

hiatus diaphragm
mediastinal cavity

(can be classified from type I - IV)

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13
Q

Most HH patients do NOT have _______ symptoms but may have _________

A

GERD
esophagitis

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14
Q

anesthesia treats HH patients as __________ risk depending on severity of _________ symptoms with: (3 things)

A

aspiration risk
GERD

Treatment: cricoid pressure, PPIs, H2 blockers

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15
Q

PUD Ulcer:

A

gastric mucosal loss and inflammation

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16
Q

overproduction of _____ _____ and _______ erode protective mucosal layer. It may begin as erosions and then may penetrate deep/perforate

A

HCL acid
pepsin

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17
Q

prostaglandins:

A

gastric epithelial layer for protection and repair

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18
Q

NSAIDs are

A

anti prostaglandins

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19
Q

90% of gastric and duodenal ulcers are caused from

A

H. pylori infections

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20
Q

PUD complications (3)

A

hemorrhage
perforation
gastric outlet obstruction

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21
Q

PUD hemorrhage remains unchanged since introduction of:

A

H2- receptor antagonists

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22
Q

PUD perforation

A

sudden severe epigastric pain
peritoneum contaminated with gastric secretions

23
Q

PUD gastric outlet obstruction

A

caused by acute inflammation and swelling in pyloric channel and duodenum
vomiting: treat as full stomach

24
Q

ulcerative colitis - confined to mostly

A

rectum and rectosigmoid

30% of ppl have proximal involvement
20% have total colitis

25
Q

UC - mucosa becomes ulcerated, __________, and ______________.

A

edematous and hemorrhagic

26
Q

UC - inflammatory polyps can develop with

A

long standing disease

27
Q

UC - 3 major symptoms of ulcerated mucosa

A
  1. rectal bleeding
  2. diarrhea
  3. crampy rectal pain, abdominal pain
28
Q

UC anesthesia implications - may present for colectomy

A
  • colon perforation/obstruction possible
  • vomiting - may need aspiration precautions
  • dehydration - may need hydration
  • Hct may be low from rectal hemorrhage
  • electrolyte imbalances
29
Q

UC anesthesia implications - steroids

A

may need stress dosing

30
Q

UC anesthesia implications - if presenting for sx with active disease expect _________ _________ and _____ ______.

A

increased WBCs (leukocytosis)
low albumin (may affect drug binding)

31
Q

Pancreatitis most common causes

A

pancreatitis is the acute inflammation of the pancreas

caused by gallstones and ETOH

32
Q

pancreatitis symptoms

A
  • severe mid-epigastric pain
  • N/V
  • abdominal distention, ileus
  • dyspnea may be from ascites or pleural effusions
  • fever
  • shock: tachycardia and hypotension
33
Q

pancreatitis lab work

A

elevated serum amylase and lipase

34
Q

pancreatitis treatment (5)

A
  1. aggressive IV rehydration
  2. NPO to rest pancreas**
  3. opioids
  4. removal of obstructing gallstones and/or sphincterotomy (ECRP to reduce risk of cholangitis)
  5. aspirate intra-abdominal fluids
35
Q

gallbladder disease

cholestasis:
cholelithiasis:

A

gallbladder disease

cholestasis: impediment or stoppage of bile flow
cholelithiasis: (gallstones) - result of western diet and prevalence increases with age, obesity, rapid weight loss, and pregnancy.

36
Q

cholelithiasis is more prevalent in

A

women

37
Q

gallbladder contraction is stimulated by

A

food intake

38
Q

cholecystitis

A

gallstone obstruction leading to acute inflammation

39
Q

cholecystitis labs

A

jaundice liver and pancreatic enzyme elevation

40
Q

cholecystitis symptoms

A
  • N/V
  • abdominal pain (can start mid-epigastrum and then move RUQ, back)
  • tenderness
  • fever
  • leukocytosis
  • dehydration/electrolye abnormalities
  • murphy’s sign (inspiration causes pain)
41
Q

cholecystitis treatments (4) and treatment of choice (1). (5 total)

A
  • IV fluids
  • opioids
  • antibiotics
  • surgery
  • laparoscopic cholecystectomy is treatment of choice**
42
Q

cholecystitis symptoms not resolving or obstruction post lap chole:

A
  • may need ECRP
  • sphincterotomy opens duct to allow bile drainage
  • pressure measurements of sphincter performed (may hold opioids to allow accurate measurement)
43
Q

biliary obstruction is an acute obstruction of the ________________ that can mimic ________________.

A

common bile duct
cholecystitis

44
Q

chronic cholecystitis causes ________ ________ of gallbladder impairing ability to sufficiently excrete ________

A

fibrotic changes
bile

45
Q

biliary obstruction often presents with _________ ________:

A

Charcot’s Triad

  1. fever/chills
  2. RUQ pain
  3. jaundice
46
Q

some ppl with biliary obstruction may also present with: (3)

A
  1. anorexia
  2. acute weight loss
  3. N/V
47
Q

biliary obstruction radiographic findings:

A

dilated biliary tree and common bile duct

48
Q

biliary obstruction treatment: (2)

A
  • ERCP with pressure readings can definitively diagnose stones in the common bile duct
  • sphincterotomy opens ductal stricture and allows stone and bile to flow through
49
Q

biliary obstruction anesthesia

A

can be GA or MAC

50
Q

bowel obstruction occurs at:

A

any place in the tract

51
Q

bowel obstruction can be caused by: (3)

A
  1. cancer
  2. fibrotic constriction: previous injury, adhesions
  3. paralysis of gut
52
Q

effects depend on where the obstruction is ________

A

located

53
Q

stomach and small intestine obstruction effects: (3)

A
  1. intestinal juices backflow leading to vomiting
  2. loss of water and potassium
  3. loss of acid from stomach and base from small intestine
54
Q

large intestine bowel obstruction effects: (3)

A
  1. colonic dilation/ischemia leading to perforation if untreated
  2. avoid opioids and anti-cholinergics
  3. neostigmine dose shown to decompress colon

NUNA 684 Advanced Pathophysiology (16 decks)

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