GI Diseases (Exam IV) Flashcards
1
Q
What are general symptoms of esophageal diseases?
A
- Dysphagia
- Heartburn
- Regurgitation
- Chest pain
- Odynophagia
- Globus sensation
2
Q
Differentiate dysphagia and odynophagia.
A
- Dysphagia - difficulty swallowing
- Odynophagia - painful swallowing
3
Q
What is a normal LES (lower esophageal sphincter) resting tone?
A
29 mmHg
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
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.
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
7
Q
How would a esophageal motility vs structural issue be delineated?
A
- Structural = difficulty w/ solids
- Motility = difficulty w/ solids & liquids.
8
Q
How would a esophageal motility vs structural issue be delineated?
A
- Structural = difficulty w/ solids
- Motility = difficulty w/ solids & liquids.
9
Q
What would an esophageal spasm look like under direct visualization?
A
- Corkscrew or rosary bead appearance.
10
Q
What medications could be used to treat esophageal spasms?
A
- Nitroglycerin
- Trazodone
- Imipramine
- Sildenafil
11
Q
What is an esophageal diverticulum?
What kinds are there?
A
Esophageal wall out-pouching
- Pharyngoesophageal (Zenker’s)
- Mid-esophageal
- Epiphrenic (supradiaphragmic)
12
Q
What are the main symptoms of esophageal diverticula?
A
- Halitosis (bad breath)
- Dysphagia (worse with larger pockets)
13
Q
What is the treatment for esophageal diverticula?
A
- Small - medium: nothing
- Medium - large: removal
14
Q
What are anesthesia considerations and risks for esophageal diverticula?
A
- No cricoid pressure
- Avoid NGT
- Intubate w/ head elevated
- Aspiration risk
15
Q
What type of hernia is depicted by 1 on the figure below?
A
Normal (no hernia)
16
Q
What type of hernia is depicted by 2 on the figure below?
A
Sliding Hiatal hernia
17
Q
What type of hernia is depicted by 3 on the figure below?
A
Paraesophageal Hiatal hernia
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)
19
Q
What signs/symptoms are indicative of esophageal cancer?
A
- Progressive dysphagia
- Weight loss
- Pancytopenia
- Lung Injury
- Malnourishment/dehydration
20
Q
What is the treatment for esophageal cancer?
A
- Esophagectomy
- Chemotherapy
- Radiation
21
Q
What deficient LES pressure is typically seen with GERD?
A
13 mmHg
22
Q
What typically causes GERD?
A
- LES hypotension
- GE junction abnormality (hiatal hernia)
23
Q
What complications can occur with chronic GERD?
A
- Esophagitis
- Laryngopharyngeal reflux
- Recurrent pulmonary aspiration (chronic cough)
24
Q
What treatments are used for GERD?
A
- Lifestyle modifications
- PPIs > H2 antagonists
- Niessen fundiplocation
25
What are anesthesia considerations for GERD patients?
Manage Aspiration risk
- **Ranitidine** > cimetidine
- PPI's
- Na⁺ citrate + reglan
- **RSI + Cricoid pressure** recommended.
26
What is peptic ulcer disease (PUD) ?
How does it present and what causes it?
- 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**.
27
Who is at greater risk for PUD?
- Alcoholics
- Elderly
- Malnourished
28
What significant risk factors come from untreated PUD?
- Bleeding
- Peritonitis → **sepsis**
- Dehydration
- **Perforation**
29
What is the mortality risk of bleeding from PUD?
- 10 - 20%
30
What sort of perforation risk is conferred from untreated PUD?
What symptom is seen with perforation?
- 10% risk
- Sudden and severe epigastric pain
31
What drugs (along with abbreviated MOA's) are used to treat PUD?
- 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
How is H. Pylori treated?
- **PPI + 2 ABX for 14 days**
33
Which antibiotics are used for H. Pylori treatment?
- Clarithromycin and amoxicillin or metronidazole.
34
What is post-gastrectomy dumping syndrome?
- **Release of GI vasoactive hormones** from pyloric sphincter dysfunction causing food to move from the stomach into small bowel too early.
35
Differentiate Early vs Late Dumping syndrome.
- **Early** - lots of symptoms (cramping, ↓BP, N/V/D, etc)
- **Late** - Hypoglycemia
36
What is the treatment for dumping syndrome?
- Dietary modifications
- Octreotide
37
What is ulcerative colitis?
What are all the signs/symptoms?
- Mucosal disease involving all or most of the colon to rectum.
- Bleeding, tenesmus, N/V/D, fever, and weight loss.
38
What is tenesmus?
- Tenesmus = Urge to poop
39
What major complications can occur with severe ulcerative colitis ?
- Massive hemmorrhage
- Toxic megacolon
- Obstruction
- Perforation
40
What is the surgical treatment for ulcerative colitis?
- Total proctocolectomy
41
What is Crohn's disease?
What are the symptoms?
- Acute/Chronic bowel inflammation
- Weight loss, inflammatory mass, bowel spasm, steatorrhea, & stricture formation.
42
What anatomical feature separates the small and large intestine?
Ileocecal valve
43
What surgical treatment exists for severe Crohn's disease?
- Bowel resection
- Proctocolectomy
44
What medical treatment exists for mild-moderate IBS?
What meds are used in severe cases?
- Normal cases: 5-ASA, glucocorticoids, ciprofloxacin and metronidazole.
- Severe cases: Azathioprine & 6MP or methotrexate & cyclosporine
45
What organs are a part of the foregut?
- Thymus
- Esophagus
- Lungs
- Stomach
- Duodenum
- Pancreas
46
What organs are a part of the midgut?
- Appendix
- Ileum
- Cecum
- Ascending Colon
47
What organs are a part of the hindgut?
- Distal large intestine
- Rectum
48
Less than _____% of carcinoid tumors originate in the lung tissue.
What "gut" are the lungs located in?
- 25%
- Foregut
49
What do carcinoid tumors secrete?
- **Insulin**
- **Histamine**
- **Serotonin**
*GI peptides and/or vasoactive substances*
50
Compare/contrast serotonin secretion from all parts of the gut.
- **Foregut** - Low serotonin secretion
- **Midgut** - High serotonin secretion
- **Hindgut** - Rare serotonin secretion
51
Which part of the gut is prone to development of carcinoid syndrome?
- Midgut
*Foregut is atypical, hindgut is rare*.
52
What is carcinoid crisis/syndrome?
What are the signs & symptoms?
- Release of serotonin and/or histamine from carcinoid tumor.
- Flushing, diarrhea, ↓↑BP, bronchostriction/wheezing.
53
What symptoms commonly present with small intestine carcinoid tumor?
- Abdominal pain (51%)
- Intestinal obstruction (31%)
54
What symptoms commonly present with rectal carcinoid tumors?
- Bleeding (39%)
55
What symptoms commonly present with bronchus carcinoid tumors?
- Asymptomatic (31%)
56
Where are metastases from carcinoid tumors most often found?
What is the presenting symptom?
- Liver; found via hepatomegaly
57
What most often provokes carcinoid crisis?
- **Biopsy** of tumor
- Chemo
- Stress
58
What drugs may provoke mediator release (serotonin, histamine, etc) from carcinoid tumors?
- Succinylcholine
- Atracurium
- Epi/NE
- Dopamine
- Isoproterenol
- Thiopental
59
What drugs are used in the treatment of carcinoid tumor crisis?
- 5HT blockers
- H-antagonists
- Somatostatin analogues (*Octreotide*)
- Ipratropium
60
How do somatostatin analogues treat carcinoid tumor patients?
- Prevention of Carcinoid Crisis
61
What are the causes of acute pancreatitis?
- **Gallstones & EtOH abuse** (60-80% of cases)
- AIDS
- Hyperparathyroidism
- Trauma
62
What lab values indicate acute pancreatitis?
- ↑ serum amylase & lipase
63
What do the Ranson criteria indicate?
What would the below indicate:
- 0-2 criteria?
- 3-4 criteria?
- 5-6 criteria?
- 7-8 criteria?
- 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
What are treatments for acute pancreatitis?
- Aggressive IV fluids
- Colloids
- NPO
- Enteral/TPN
- NGT suction
- Pain management
- Gallstone removal
65
What are signs/symptoms of chronic pancreatitis?
- Post-prandial epigastric pain
- Emaciated
- Steatorrhea
- DM
66
What conditions put one at risk of chronic pancreatitis?
- Chronic EtOH
- Cystic fibrosis (?)
- Hyperparathyroidism
67
What's the number one cause of upper gastric GI bleeding? Number 2?
1. Varices
2. Peptic Ulcer Disease
68
Where are bleeding uclers most often found in peptic ulcer disease?
- Duodenal (36%)
- Gastric (24%)
69
What is the most common cause of lower GI bleeding?
- Colonic Diverticulosis (41%)
70
What characterizes initial acute upper GI bleeding?
- ↓BP and ↑HR w/ 25% or more blood loss
- HCT normal at beginning
- Anemia
71
What are signs of chronic upper GI bleeding?
- Orthostatic hypotension from Hct <30%
- BUN >40mg/dL
72
What anesthetic technique should be employed for upper GI bleeding?
- RSI (rapid sequence intubation)
73
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
B. 24 hours
