GI diseases Flashcards
GERD - decreased resting tone of LES
with GERD - 13 mmHg
without - 29 mmHg
airway effects of GERD
- cough
- pharyngitis
- laryngitis
- bronchitis
- pneumonia
- wheezing
_____ of _________ have evidence of esophagitis or esophageal acid exposure
50% of asthmatics
GERD aspiration risk
significantly increased
carefully consider using __________ bc ____________
[GERD]
anti-cholinergic drugs
they decrease LES tone
__________ increases both LES and intragastric pressure
Succinylcholine
(barrier pressure - LES minus intragastric pressure - is unchanged)
H2 blockers increase ________ and decrease ____________
pH
gastric acid secretion
PPIs inhibit _________ drugs and may increase ______ risks
anti-platelet
CAD
GERD may require
cricoid pressure
drugs that increase LES tone
metoclopramide
neostigmine
succinycholine
a-adrenergic stimulants
drugs that decrease LES tone
atropine
glyco
b-adrenergic stimulants
propofol
HH is herniation of stomach above _____ ______ into the _____ _______
hiatus diaphragm
mediastinal cavity
(can be classified from type I - IV)
Most HH patients do NOT have _______ symptoms but may have _________
GERD
esophagitis
anesthesia treats HH patients as __________ risk depending on severity of _________ symptoms with: (3 things)
aspiration risk
GERD
Treatment: cricoid pressure, PPIs, H2 blockers
PUD Ulcer:
gastric mucosal loss and inflammation
overproduction of _____ _____ and _______ erode protective mucosal layer. It may begin as erosions and then may penetrate deep/perforate
HCL acid
pepsin
prostaglandins:
gastric epithelial layer for protection and repair
NSAIDs are
anti prostaglandins
90% of gastric and duodenal ulcers are caused from
H. pylori infections
PUD complications (3)
hemorrhage
perforation
gastric outlet obstruction
PUD hemorrhage remains unchanged since introduction of:
H2- receptor antagonists
PUD perforation
sudden severe epigastric pain
peritoneum contaminated with gastric secretions
PUD gastric outlet obstruction
caused by acute inflammation and swelling in pyloric channel and duodenum
vomiting: treat as full stomach
ulcerative colitis - confined to mostly
rectum and rectosigmoid
30% of ppl have proximal involvement
20% have total colitis
UC - mucosa becomes ulcerated, __________, and ______________.
edematous and hemorrhagic
UC - inflammatory polyps can develop with
long standing disease
UC - 3 major symptoms of ulcerated mucosa
- rectal bleeding
- diarrhea
- crampy rectal pain, abdominal pain
UC anesthesia implications - may present for colectomy
- colon perforation/obstruction possible
- vomiting - may need aspiration precautions
- dehydration - may need hydration
- Hct may be low from rectal hemorrhage
- electrolyte imbalances
UC anesthesia implications - steroids
may need stress dosing
UC anesthesia implications - if presenting for sx with active disease expect _________ _________ and _____ ______.
increased WBCs (leukocytosis)
low albumin (may affect drug binding)
Pancreatitis most common causes
pancreatitis is the acute inflammation of the pancreas
caused by gallstones and ETOH
pancreatitis symptoms
- severe mid-epigastric pain
- N/V
- abdominal distention, ileus
- dyspnea may be from ascites or pleural effusions
- fever
- shock: tachycardia and hypotension
pancreatitis lab work
elevated serum amylase and lipase
pancreatitis treatment (5)
- aggressive IV rehydration
- NPO to rest pancreas**
- opioids
- removal of obstructing gallstones and/or sphincterotomy (ECRP to reduce risk of cholangitis)
- aspirate intra-abdominal fluids
gallbladder disease
cholestasis:
cholelithiasis:
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.
cholelithiasis is more prevalent in
women
gallbladder contraction is stimulated by
food intake
cholecystitis
gallstone obstruction leading to acute inflammation
cholecystitis labs
jaundice liver and pancreatic enzyme elevation
cholecystitis symptoms
- 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)
cholecystitis treatments (4) and treatment of choice (1). (5 total)
- IV fluids
- opioids
- antibiotics
- surgery
- laparoscopic cholecystectomy is treatment of choice**
cholecystitis symptoms not resolving or obstruction post lap chole:
- may need ECRP
- sphincterotomy opens duct to allow bile drainage
- pressure measurements of sphincter performed (may hold opioids to allow accurate measurement)
biliary obstruction is an acute obstruction of the ________________ that can mimic ________________.
common bile duct
cholecystitis
chronic cholecystitis causes ________ ________ of gallbladder impairing ability to sufficiently excrete ________
fibrotic changes
bile
biliary obstruction often presents with _________ ________:
Charcot’s Triad
- fever/chills
- RUQ pain
- jaundice
some ppl with biliary obstruction may also present with: (3)
- anorexia
- acute weight loss
- N/V
biliary obstruction radiographic findings:
dilated biliary tree and common bile duct
biliary obstruction treatment: (2)
- 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
biliary obstruction anesthesia
can be GA or MAC
bowel obstruction occurs at:
any place in the tract
bowel obstruction can be caused by: (3)
- cancer
- fibrotic constriction: previous injury, adhesions
- paralysis of gut
effects depend on where the obstruction is ________
located
stomach and small intestine obstruction effects: (3)
- intestinal juices backflow leading to vomiting
- loss of water and potassium
- loss of acid from stomach and base from small intestine
large intestine bowel obstruction effects: (3)
- colonic dilation/ischemia leading to perforation if untreated
- avoid opioids and anti-cholinergics
- neostigmine dose shown to decompress colon
