GI Disorders Flashcards by Cindy Ehret

How much fluid does the GI tract produce per day?

How much fluid is not absorbed?

only 100 ml

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Where does parasympathetic stimulation from the spinal cord originate?

Medulla

S2 - S4

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What occurs when you distend the bowels?

What drug do you give to correct the effects?

Bradycardia → Vasodilation → Hypotension

Glycopyrrolate

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What secretions are alkaline from greatest to least?

saliva
gastric fluid
bile
pancreatic fluid
small intestine
colon

pancreatic fluid
colon
bile
small intestine
saliva
gastric fluid

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High risk of aspiration pneumonitis if volume > ____ ml and pH < _____.

25ml

2.5

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What increases risk of aspiration pneumonitis? (5)

Pregnancy
GERD
Myasthenia gravis
Stroke
ALS (paralysis of throat)

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How do you prevent aspiration pneumonitis? (5)

Minimize intake
Increase gastric emptying
Reduce gastric volume/acidity
RSI
Proseal LMA

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What are fasting guidelines for clear liquids for:

children
adults

2 hours

3 hours

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What does the ASA recommend for fasting with:

breast milk
formula and light meals

4 hours

6 hours

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What are physiologic states that decrease GI emptying and increase risk of aspiration? (3)

Pregnancy
Bowel obstruction
Diabetes (peritonitis)

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What causes ileus after surgery? (6)

Pain
Sympathetic hyperactivity
Opioids
Electrolyte imbalances
Immobility
Intestinal wall swelling

I POISE

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How long is the esophagus?

8 inches

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What prevents aspiration of gastric contents into the lungs and the swallowing of air?

upper esophageal sphincter

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What do most anesthetic agents do to upper esophageal sphincter tone?

What occurs as a result?

decrease, except ketamine

increase risk of aspiration

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What is a diverticulum of the mucosa of the pharynx just above the cricopharyngeal muscle?

What is contraindicated?

Zenker’s diverticulum

NO CRICOID pressure

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What is depicted?

Zenker’s Diverticulum

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_____ in lower esophageal pressure leads to gastroesophageal reflux.

Decrease

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What is the resting pressure in the lower esophageal sphincter?

When does GERD become an issue?

30 mmHg

<10 mmHg

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What is barrier pressure?

What does cricoid pressure do to barrier pressure?

What does Sux do to these pressures?

Difference between gastric pressure and LES pressure.

Decreases thus leading to decreased LES tone since there is no change in gastric pressure.

Increases gastric pressure leading to increase in LES tone.

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What anesthetic related drugs decrease LES tone? (4)

Inhaled agents
Opioids
Anticholinergics (glyco)
Propofol

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What other drugs decrease LES tone? (4)

Beta-blockers
Ganglion blockers
Antidepressants
Glucagon

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What drugs increase LES tone? (7)

Anticholinesterases (Neostigmine)
ACh
Alpha-adrenergic agonists
Antacids
Cholinergics
Metoclopramide
Metoprolol

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What hormones, etc. increase LES tone? (3)

Serotonin
Histamine
Pancreatic polypeptide

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What drugs do not change LES tone? (3)

H2-receptor antagonists (cimetidine)

Nondepolarizing muscle relaxants

Propranolol

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What is esophagogastroduodenoscopies useful for? (6)

Banding Biopsy GERD Ulcers Dilation Ultrasound

What is heartburn caused by?

An incompletely closed LES allowing acid to reflux into the esophagus.

What is the regular reflux of stomach acid irritating the esophagus which may lead to malignancy?

Barrett's Esophagus

What is depicted?

Barrett's esophagus

What is achalasia?

LES does not relax and results with difficulty swallowing and regurgitation of food.

What are risk factors for esophageal cancer? (3)

Smoking Heavy drinking Chronic reflux

What's depicted?

esophageal varices caused by portal HTN ## Footnote Note: Can be present in cirrhosis. These are at serious risk for bleeding.

What is the treatment for esophageal varicies?

Banded and clamped. Blake tube is placed in the stomach to tamponade if there is an emergency.

What is Transjugular Intrahepatic Portosystemic Shunt for? (4)

Treat portal HTN Bleeding or liver injury Hepatic encephalopathy Acute hepatic dysfunction BATH

What is the morbidity and mortality rate for upper GI perforations? When is surgical management best? What does GI perfs lead to?

High, serious complication within 12 hours BAG (bile, acid, gastric contents) → Sepsis

Label the parts of the stomach: (5)

What is gastritis? How does it manifest? (2)

Any condition that results in the disruption of gastric mucosal lining coming into contact with tissue. Hematemesis Blood in stool (black stool)

What is gastroparesis and what does it lead to? When is it common?

Delayed stomach emptying → increased stomach fluid Diabetics, but can also occur from blockage at distal end of stomach, cancer, or stroke.

What psychiatric diseases are associated with gastroparesis? (4)

Depression Anorexia Bulimia Psychotropic drugs

What neurologic diseases are associated with gastroparesis? (4)

Multiple sclerosis Stroke (brainstem) Amyloid neuropathy Vagal injury

What other conditions are associated with gastroparesis? (8)

Hypo/hyperthyroidism Lung cancer Liver cirrhosis Portal HTN Post gall bladder removal GERD Gastritis Pancreatic cancer GGLLPPPH

What are symptoms of pyloric stenosis? (3) Which gender is impacted more?

Projectile vomiting Constant hunger Weight loss males

What is depicted? What is it used to treat?

Fundiplication GERD, done laparoscopically

What are anesthetic drugs for gastric bypass? (3)

Subcu heparin for prophylaxis IV tylenol or Toradol Precedex

What are anesthetic considerations for laparoscopy? (2) What is the pressure that can decrease venous return?

Full stomach precautions No N2O \> 15 mmHg

What are complications of laparoscopy? (8)

Pneumothorax Subcutaneious emphazema (bubble wrap) Hypotension Hemorrhage Air embolism Hypothermia N/V Shoulder pain (phrenic nerve to brachial plexus)

Where does most digestion and absorption occur?

Small intestine

How much chyme is produced in a day. How long does it take to pass?

1 - 2 L/day 3 - 5 hours

What will decrease activity of the small intestine for up to 48 hours? (3)

Hypokalemia Peritonitis Laparotomy

What is an autoimmune disorder that destroys the villi in the small intestine that help absorb nutrients leading to malnutrition?

Celiac disease Note: Reaction to eating wheat, barley, rye, and oats.

What is Crohn's disease? (3)

IBS Autoimmune disorder Occurs from mouth to end of rectum

Label:

What are gallstones that lodge inthe the duct blocking the lumen and aggravating the pancreas?

choledocholithiasis Do not confuse with cholelithiasis.

What factors cause pancreatitis? (6)

Alcohol abuse Blockage Trauma Autoimmune Hyperparathyroid Cystic fibrosis abatch

What drug increases the risk of pancreatitis?

propofol

How does appendicitis occur?

When the appendix is blocked by feces, a foreign object, or rarely a tumor.

What procedure views the entrance of the common bile duct to visualize gallstones by x-ray?

ERCP endoscopic retrograde cholangiopancreatography

What must you consider during ERCP relating to drugs?

NO NARCOTIC because constricts the sphincter of oddi

What is depicted?

ERCP

How is this performed?

ERCP

What is this called?

Sphincterotomy

What is the site for absorption of water and electrolytes?

colon

Label

What is a colonoscopy good to check? (6)

Adhesions Colitis Appendicitis Polyps Cancer Diverticulitis capcad

Where is Crohn's disease usually confined to? Where is ulcerative colitis generally found?

the ilieum begins in the rectal area and may involve the entire large intestine

What are small pouches in the lining of the colon, or large intestine, that bulge outward through weak spots? What are its complications? (6)

Diverticulosis ## Footnote Bleeding Abscess Perforation Peritonitis Fistula Obstruction fab pop

What is important to know about carcinoid tumors?

Secrete hormones that are inactivated by the liver. However, those arising in mid gut can lead to HTN.

What are some hormones that are secreted from tumors? (5)

Serotonin -\> HTN Histamine Catecholamines Bradykinins Prostaglandins

What can bradykinins cause? (3)

Flushing Bronchospasm Hypotension

How do you anesthetically manage carcinoid syndrome? (5)

Block histamine and serotonin receptors with benzos Avoid histamine releasing drugs Fluid resuscitation Monitor e-lytes and glucose Octreotide infusion (a somatostatin)

What is considered an ideal MAC? (4)

Purposeful response after painful stimulation Intervention of airway may be required Spontaneous ventilation may be inadequate Cardiovascularity maintained

What are life threathening risk of MAC? (4)

Hypoxemia Hypoventilation Local toxicity Cerebral hypoperfusion

What are less ominous risks of MAC? (7)

Full bladder Temperature Nausea Nasal cannula Itching Positioning Tourniquet fit pnnt

What are common medications given during MAC cases? (9)

Propofol Glyco Benadryl Ketamine Viscous lidocaine Fentanyl Glucagon for ERCP Dexmedetomidine Naltrexone--used in ICU to reverse bowel immobility