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AP Summer Final > GI Disorders > Flashcards

GI Disorders Flashcards

1
Q

How much fluid does the GI tract produce per day?

How much fluid is not absorbed?

A

9L

only 100 ml

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2
Q

Where does parasympathetic stimulation from the spinal cord originate?

A

Medulla

S2 - S4

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3
Q

What occurs when you distend the bowels?

What drug do you give to correct the effects?

A

Bradycardia → Vasodilation → Hypotension

Glycopyrrolate

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4
Q

What secretions are alkaline from greatest to least?

saliva
gastric fluid
bile
pancreatic fluid
small intestine
colon

A

pancreatic fluid
colon
bile
small intestine
saliva
gastric fluid

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5
Q

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

A

25ml

2.5

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6
Q

What increases risk of aspiration pneumonitis? (5)

A

Pregnancy
GERD
Myasthenia gravis
Stroke
ALS (paralysis of throat)

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7
Q

How do you prevent aspiration pneumonitis? (5)

A

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

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8
Q

What are fasting guidelines for clear liquids for:

children
adults

A

2 hours

3 hours

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9
Q

What does the ASA recommend for fasting with:

breast milk
formula and light meals

A

4 hours

6 hours

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10
Q

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

A

Pregnancy
Bowel obstruction
Diabetes (peritonitis)

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11
Q

What causes ileus after surgery? (6)

A

Pain
Sympathetic hyperactivity
Opioids
Electrolyte imbalances
Immobility
Intestinal wall swelling

I POISE

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12
Q

How long is the esophagus?

A

8 inches

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13
Q

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

A

upper esophageal sphincter

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14
Q

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

What occurs as a result?

A

decrease, except ketamine

increase risk of aspiration

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15
Q

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

What is contraindicated?

A

Zenker’s diverticulum

NO CRICOID pressure

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16
Q

What is depicted?

A

Zenker’s Diverticulum

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17
Q

_____ in lower esophageal pressure leads to gastroesophageal reflux.

A

Decrease

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18
Q

What is the resting pressure in the lower esophageal sphincter?

When does GERD become an issue?

A

30 mmHg

<10 mmHg

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19
Q

What is barrier pressure?

What does cricoid pressure do to barrier pressure?

What does Sux do to these pressures?

A

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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20
Q

What anesthetic related drugs decrease LES tone? (4)

A

Inhaled agents
Opioids
Anticholinergics (glyco)
Propofol

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21
Q

What other drugs decrease LES tone? (4)

A

Beta-blockers
Ganglion blockers
Antidepressants
Glucagon

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22
Q

What drugs increase LES tone? (7)

A

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

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23
Q

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

A

Serotonin
Histamine
Pancreatic polypeptide

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24
Q

What drugs do not change LES tone? (3)

A

H2-receptor antagonists (cimetidine)

Nondepolarizing muscle relaxants

Propranolol

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25
Q

What is esophagogastroduodenoscopies useful for? (6)

A

Banding
Biopsy
GERD
Ulcers
Dilation
Ultrasound

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26
Q

What is heartburn caused by?

A

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

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27
Q

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

A

Barrett’s Esophagus

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28
Q

What is depicted?

A

Barrett’s esophagus

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29
Q

What is achalasia?

A

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

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30
Q

What are risk factors for esophageal cancer? (3)

A

Smoking
Heavy drinking
Chronic reflux

31
Q

What’s depicted?

A

esophageal varices caused by portal HTN

Note: Can be present in cirrhosis. These are at serious risk for bleeding.

32
Q

What is the treatment for esophageal varicies?

A

Banded and clamped.

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

33
Q

What is Transjugular Intrahepatic Portosystemic Shunt for? (4)

A

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

BATH

34
Q

What is the morbidity and mortality rate for upper GI perforations?

When is surgical management best?

What does GI perfs lead to?

A

High, serious complication

within 12 hours

BAG (bile, acid, gastric contents) → Sepsis

35
Q

Label the parts of the stomach: (5)

A
36
Q

What is gastritis?

How does it manifest? (2)

A

Any condition that results in the disruption of gastric mucosal lining coming into contact with tissue.

Hematemesis
Blood in stool (black stool)

37
Q

What is gastroparesis and what does it lead to?

When is it common?

A

Delayed stomach emptying → increased stomach fluid

Diabetics, but can also occur from blockage at distal end of stomach, cancer, or stroke.

38
Q

What psychiatric diseases are associated with gastroparesis? (4)

A

Depression
Anorexia
Bulimia
Psychotropic drugs

39
Q

What neurologic diseases are associated with gastroparesis? (4)

A

Multiple sclerosis
Stroke (brainstem)
Amyloid neuropathy
Vagal injury

40
Q

What other conditions are associated with gastroparesis? (8)

A

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

GGLLPPPH

41
Q

What are symptoms of pyloric stenosis? (3)

Which gender is impacted more?

A

Projectile vomiting
Constant hunger
Weight loss

males

42
Q

What is depicted?

What is it used to treat?

A

Fundiplication

GERD, done laparoscopically

43
Q

What are anesthetic drugs for gastric bypass? (3)

A

Subcu heparin for prophylaxis

IV tylenol or Toradol

Precedex

44
Q

What are anesthetic considerations for laparoscopy? (2)

What is the pressure that can decrease venous return?

A

Full stomach precautions

No N2O

> 15 mmHg

45
Q

What are complications of laparoscopy? (8)

A

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

46
Q

Where does most digestion and absorption occur?

A

Small intestine

47
Q

How much chyme is produced in a day.

How long does it take to pass?

A

1 - 2 L/day

3 - 5 hours

48
Q

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

A

Hypokalemia
Peritonitis
Laparotomy

49
Q

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

A

Celiac disease

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

50
Q

What is Crohn’s disease? (3)

A

IBS

Autoimmune disorder

Occurs from mouth to end of rectum

51
Q

Label:

A
52
Q

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

A

choledocholithiasis

Do not confuse with cholelithiasis.

53
Q

What factors cause pancreatitis? (6)

A

Alcohol abuse
Blockage
Trauma
Autoimmune
Hyperparathyroid
Cystic fibrosis

abatch

54
Q

What drug increases the risk of pancreatitis?

A

propofol

55
Q

How does appendicitis occur?

A

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

56
Q

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

A

ERCP

endoscopic retrograde cholangiopancreatography

57
Q

What must you consider during ERCP relating to drugs?

A

NO NARCOTIC because constricts the sphincter of oddi

58
Q

What is depicted?

A

ERCP

59
Q

How is this performed?

A

ERCP

60
Q

What is this called?

A

Sphincterotomy

61
Q

What is the site for absorption of water and electrolytes?

A

colon

62
Q

Label

A
63
Q

What is a colonoscopy good to check? (6)

A

Adhesions
Colitis
Appendicitis
Polyps
Cancer
Diverticulitis

capcad

64
Q

Where is Crohn’s disease usually confined to?

Where is ulcerative colitis generally found?

A

the ilieum

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

65
Q

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

What are its complications? (6)

A

Diverticulosis

Bleeding
Abscess
Perforation
Peritonitis
Fistula
Obstruction

fab pop

66
Q

What is important to know about carcinoid tumors?

A

Secrete hormones that are inactivated by the liver.

However, those arising in mid gut can lead to HTN.

67
Q

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

A

Serotonin -> HTN
Histamine
Catecholamines
Bradykinins
Prostaglandins

68
Q

What can bradykinins cause? (3)

A

Flushing
Bronchospasm
Hypotension

69
Q

How do you anesthetically manage carcinoid syndrome? (5)

A

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

70
Q

What is considered an ideal MAC? (4)

A

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

71
Q

What are life threathening risk of MAC? (4)

A

Hypoxemia
Hypoventilation
Local toxicity
Cerebral hypoperfusion

72
Q

What are less ominous risks of MAC? (7)

A

Full bladder
Temperature
Nausea
Nasal cannula
Itching
Positioning
Tourniquet

fit pnnt

73
Q

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

A

Propofol
Glyco
Benadryl
Ketamine
Viscous lidocaine

Fentanyl
Glucagon for ERCP
Dexmedetomidine
Naltrexone–used in ICU to reverse bowel immobility

AP Summer Final (7 decks)

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