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Physical & Health Assessment COPY - Grayson > GI Diseases (Exam III) > Flashcards

GI Diseases (Exam III) Flashcards

1
Q

What are general symptoms of esophageal diseases?

A
  • Dysphagia
  • Heartburn
  • Regurgitation
  • Chest pain
  • Odynophagia
  • Globus sensation
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2
Q

Differentiate dysphagia and odynophagia.

A
  • Dysphagia - difficulty swallowing
  • Odynophagia - painful swallowing
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3
Q

What is a normal LES (lower esophageal sphincter) resting tone?

A

29 mmHg

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4
Q

What is Achalasia?
What does it result in?

A
  • Esophageal obstruction due to inadequate LES relaxation (usually from LES HTN).
  • Reduced peristalsis and dilated espophagus
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5
Q

What is the biggest risk with achalasia?
How would anesthetic practices change for a achalasia patient?

A
  • Aspiration
  • NPO for 24-48 hours prior to Heller myotomy or POEM.
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6
Q

How is achalasia treated?

A

Through relief of obstruction (can’t fix peristalsis).
- Nitrates (low dose)
- CCBs (low dose)
- Botox
- Balloon Dilation
- Heller Myotomy (LES reduction)
- Per Oral endoscopic myotomy

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7
Q

How would a esophageal motility vs structural issue be delineated?

A
  • Structural = difficulty w/ solids
  • Motility = difficulty w/ solids & liquids.
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8
Q

How would a esophageal motility vs structural issue be delineated?

A
  • Structural = difficulty w/ solids
  • Motility = difficulty w/ solids & liquids.
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9
Q

What would an esophageal spasm look like under direct visualization?

A
  • Corkscrew or rosary bead appearance.
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10
Q

What medications could be used to treat esophageal spasms?

A
  • Nitroglycerin
  • Trazodone
  • Imipramine
  • Sildenafil
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11
Q

What is an esophageal diverticulum?
What kinds are there?

A

Esophageal wall out-pouching
- Pharyngoesophageal (Zenker’s)
- Mid-esophageal
- Epiphrenic (supradiaphragmic)

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12
Q

What are the main symptoms of esophageal diverticula?

A
  • Halitosis (bad breath)
  • Dysphagia (worse with larger pockets)
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13
Q

What is the treatment for esophageal diverticula?

A
  • Small - medium: nothing
  • Medium - large: removal
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14
Q

What are anesthesia considerations and risks for esophageal diverticula?

A
  • No cricoid pressure
  • Avoid NGT
  • Intubate w/ head elevated
  • Aspiration risk
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15
Q

What type of hernia is depicted by 1 on the figure below?

A

Normal (no hernia)

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16
Q

What type of hernia is depicted by 2 on the figure below?

A

Sliding Hiatal hernia

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17
Q

What type of hernia is depicted by 3 on the figure below?

A

Paraesophageal Hiatal hernia

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18
Q

What types of cancer are normally seen with esophageal cancer?
Where are they located typically?

A
  • Squamous cell carcinoma (mid-esophagus)
  • Adenocarcinomas (distal esophagus)
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19
Q

What signs/symptoms are indicative of esophageal cancer?

A
  • Progressive dysphagia
  • Weight loss
  • Pancytopenia
  • Lung Injury
  • Malnourishment/dehydration
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20
Q

What is the treatment for esophageal cancer?

A
  • Esophagectomy
  • Chemotherapy
  • Radiation
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21
Q

What deficient LES pressure is typically seen with GERD?

A

13 mmHg

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22
Q

What typically causes GERD?

A
  • LES hypotension
  • GE junction abnormality (hiatal hernia)
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23
Q

What complications can occur with chronic GERD?

A
  • Esophagitis
  • Laryngopharyngeal reflux
  • Recurrent pulmonary aspiration (chronic cough)
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24
Q

What treatments are used for GERD?

A
  • Lifestyle modifications
  • PPIs > H2 antagonists
  • Niessen fundiplocation
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25
Q

What are anesthesia considerations for GERD patients?

A

Manage Aspiration risk

  • Ranitidine > cimetidine
  • PPI’s
  • Na⁺ citrate + reglan
  • RSI + Cricoid pressure recommended.
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26
Q

What is peptic ulcer disease (PUD) ?
How does it present and what causes it?

A
  • Ulcers of mucosal lining of stomach or duodenum causing a burning epigastric pain; caused by H. Pylori decreasing normal gastric mucosa HCO₃⁻ .
  • H. Pylori + NSAIDs.
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27
Q

Who is at greater risk for PUD?

A
  • Alcoholics
  • Elderly
  • Malnourished
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28
Q

What significant risk factors come from untreated PUD?

A
  • Bleeding
  • Peritonitis → sepsis
  • Dehydration
  • Perforation
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29
Q

What is the mortality risk of bleeding from PUD?

A
  • 10 - 20%
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30
Q

What sort of perforation risk is conferred from untreated PUD?
What symptom is seen with perforation?

A
  • 10% risk
  • Sudden and severe epigastric pain
31
Q

What drugs (along with abbreviated MOA’s) are used to treat PUD?

A
  • Antacids (OTC relief of dyspepsia)
  • H2 receptor antagonists (ranitidine & famotidine are better than cimetidine)
  • PPI’s
  • Prostaglandin Analogues (Misoprostol maintains mucosal integrity)
  • Cytoprotective agents (Sucralfate creates chemical barrier)
32
Q

How is H. Pylori treated?

A
  • PPI + 2 ABX for 14 days
33
Q

Which antibiotics are used for H. Pylori treatment?

A
  • Clarithromycin and amoxicillin or metronidazole.
34
Q

What is post-gastrectomy dumping syndrome?

A
  • Release of GI vasoactive hormones from pyloric sphincter dysfunction causing food to move from the stomach into small bowel too early.
35
Q

Differentiate Early vs Late Dumping syndrome.

A
  • Early - lots of symptoms (cramping, ↓BP, N/V/D, etc)
  • Late - Hypoglycemia
36
Q

What is the treatment for dumping syndrome?

A
  • Dietary modifications
  • Octreotide
37
Q

What is ulcerative colitis?
What are all the signs/symptoms?

A
  • Mucosal disease involving all or most of the colon to rectum.
  • Bleeding, tenesmus, N/V/D, fever, and weight loss.
38
Q

What is tenesmus?

A
  • Tenesmus = Urge to poop
39
Q

What major complications can occur with severe ulcerative colitis ?

A
  • Massive hemmorrhage
  • Toxic megacolon
  • Obstruction
  • Perforation
40
Q

What is the surgical treatment for ulcerative colitis?

A
  • Total proctocolectomy
41
Q

What is Crohn’s disease?
What are the symptoms?

A
  • Acute/Chronic bowel inflammation
  • Weight loss, inflammatory mass, bowel spasm, steatorrhea, & stricture formation.
42
Q

What anatomical feature separates the small and large intestine?

A

Ileocecal valve

43
Q

What surgical treatment exists for severe Crohn’s disease?

A
  • Bowel resection
  • Proctocolectomy
44
Q

What medical treatment exists for mild-moderate IBS?
What meds are used in severe cases?

A
  • Normal cases: 5-ASA, glucocorticoids, ciprofloxacin and metronidazole.
  • Severe cases: Azathioprine & 6MP or methotrexate & cyclosporine
45
Q

What organs are a part of the foregut?

A
  • Thymus
  • Esophagus
  • Lungs
  • Stomach
  • Duodenum
  • Pancreas
46
Q

What organs are a part of the midgut?

A
  • Appendix
  • Ileum
  • Cecum
  • Ascending Colon
47
Q

What organs are a part of the hindgut?

A
  • Distal large intestine
  • Rectum
48
Q

Less than _____% of carcinoid tumors originate in the lung tissue.
What “gut” are the lungs located in?

A
  • 25%
  • Foregut
49
Q

What do carcinoid tumors secrete?

A
  • Insulin
  • Histamine
  • Serotonin

GI peptides and/or vasoactive substances

50
Q

Compare/contrast serotonin secretion from all parts of the gut.

A
  • Foregut - Low serotonin secretion
  • Midgut - High serotonin secretion
  • Hindgut - Rare serotonin secretion
51
Q

Which part of the gut is prone to development of carcinoid syndrome?

A
  • Midgut

Foregut is atypical, hindgut is rare.

52
Q

What is carcinoid crisis/syndrome?
What are the signs & symptoms?

A
  • Release of serotonin and/or histamine from carcinoid tumor.
  • Flushing, diarrhea, ↓↑BP, bronchostriction/wheezing.
53
Q

What symptoms commonly present with small intestine carcinoid tumor?

A
  • Abdominal pain (51%)
  • Intestinal obstruction (31%)
54
Q

What symptoms commonly present with rectal carcinoid tumors?

A
  • Bleeding (39%)
55
Q

What symptoms commonly present with bronchus carcinoid tumors?

A
  • Asymptomatic (31%)
56
Q

Where are metastases from carcinoid tumors most often found?
What is the presenting symptom?

A
  • Liver; found via hepatomegaly
57
Q

What most often provokes carcinoid crisis?

A
  • Biopsy of tumor
  • Chemo
  • Stress
58
Q

What drugs may provoke mediator release (serotonin, histamine, etc) from carcinoid tumors?

A
  • Succinylcholine
  • Atracurium
  • Epi/NE
  • Dopamine
  • Isoproterenol
  • Thiopental
59
Q

What drugs are used in the treatment of carcinoid tumor crisis?

A
  • 5HT blockers
  • H-antagonists
  • Somatostatin analogues (Octreotide)
  • Ipratropium
60
Q

How do somatostatin analogues treat carcinoid tumor patients?

A
  • Prevention of Carcinoid Crisis
61
Q

What are the causes of acute pancreatitis?

A
  • Gallstones & EtOH abuse (60-80% of cases)
  • AIDS
  • Hyperparathyroidism
  • Trauma
62
Q

What lab values indicate acute pancreatitis?

A
  • ↑ serum amylase & lipase
63
Q

What do the Ranson criteria indicate?
What would the below indicate:
- 0-2 criteria?
- 3-4 criteria?
- 5-6 criteria?
- 7-8 criteria?

A
  • Ranson Criteria indicate severity & mortality of acute pancreatitis.
  • 0-2 = <5% mortality
  • 3-4 = 20% mortality
  • 5-6 = 40% mortality
  • 7-8 ≈ 100% mortality
64
Q

What are treatments for acute pancreatitis?

A
  • Aggressive IV fluids
  • Colloids
  • NPO
  • Enteral/TPN
  • NGT suction
  • Pain management
  • Gallstone removal
65
Q

What are signs/symptoms of chronic pancreatitis?

A
  • Post-prandial epigastric pain
  • Emaciated
  • Steatorrhea
  • DM
66
Q

What conditions put one at risk of chronic pancreatitis?

A
  • Chronic EtOH
  • Cystic fibrosis (?)
  • Hyperparathyroidism
67
Q

What’s the number one cause of upper gastric GI bleeding? Number 2?

A
  1. Varices
  2. Peptic Ulcer Disease
68
Q

Where are bleeding uclers most often found in peptic ulcer disease?

A
  • Duodenal (36%)
  • Gastric (24%)
69
Q

What is the most common cause of lower GI bleeding?

A
  • Colonic Diverticulosis (41%)
70
Q

What characterizes initial acute upper GI bleeding?

A
  • ↓BP and ↑HR w/ 25% or more blood loss
  • HCT normal at beginning
  • Anemia
71
Q

What are signs of chronic upper GI bleeding?

A
  • Orthostatic hypotension from Hct <30%
  • BUN >40mg/dL
72
Q

What anesthetic technique should be employed for upper GI bleeding?

A
  • RSI (rapid sequence intubation)
73
Q

In patients with carcinoid tumors, how early should octreotide be administered to prevent crisis during surgery:

A. 4 hours
B. 24 hours
C. 12 hours
D. 8 hours

A

B. 24 hours

Physical & Health Assessment COPY - Grayson (24 decks)

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