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Foundations II > GI Disturbances > Flashcards

GI Disturbances Flashcards

1
Q

Esophagus originates where?

A

The level of the sixth cervical vertebra

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2
Q

Esophageal Wall Consists of:

A

Outer longitudinal Layer

Inner Circular Layer

Mucosal Lining

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3
Q

Why does GI cancer metastasize so quickly:

A

Large amount of lymphatic tissue

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4
Q

Blood supply to the esophagus

A

Inferior Thyroid Arteries (supply cervical esophagus)

Aorta Esophageal branches of bronchial arteries (supply thoracic esophagus)

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5
Q

Innervation of the GI Tract

A

Intrinsic: (2 interconnected plexuses)

1) Myenteric (Auerbach Plexus)
2) Submucosal (Meissner Plexus)

*Continuum that extends from esophagus to anus

_Extrinsic: _

1) Sympathetic (act on myenteric to modulate rather than control)
2) Parasympathetic (Cranial nerves IX, X, XI)
- Cause esophageal contractions and relaxation of LES
3) Somatic

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6
Q

Resting State of Esophagus

A

UES and LES closed at rest

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7
Q

What excites the UES

A
  • Inspiration
  • Esophageal Distention
  • Gagging
  • Valsalva Maneuver
  • Acidity of Gastric Contents
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8
Q

UES tone is reduced by:

A
  • Distention
  • Belching
  • Vomiting
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9
Q

Normal LES Tone:

A

20- 30 mmHg

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10
Q

What is Achalasia and what is the primary concern?

A

Failure of LES tone to relax during swallowing accompanies by a lack of peristalsis

***Huge aspiration Risk***

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11
Q

Barret Esophagus

A

Occurs secondary to chronic GERD, ETOH abuse, smoking

Closely associate with esophageal CA

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12
Q

GERD (Definition and Treatment)

A

Failure of LES to function properly allowing stomach contents to reflux

Therapy: PPIs and H2 blockers

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13
Q

Hiatal Hernia (Definition, types, symptoms)

A

Weakness in the diaphragms that allows a portion of the stomach to migrate up into the thoracic cavity.

Type 1(sliding)- upper portion of stomach pops up through (GE junction)

Type 2 (Paraesophageal)- esophagus in place but portion of stomach comes up

Type 3 (Mixed)- Combines I&II

Type 4- Stomach and other organs (small bowel)

Retrosternal pain of a burning quality common after means, treated surgically

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14
Q

What is the most dangerous Esophageal Diverticula?

A

Zenker (upper esophagus)–> big aspiration risk

  • Epiphrenic (LES)
  • Traction (mid esophagus)
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15
Q

Does daunorubicin and doxorubicin cause cardiomyopathy or pulmonary fibrosis

A

Causes cardiomyopathy

These meds are used in hte treatment of Esophageal CA, do a cardiac workup if taking these

Also: Bleomycin causes pulmonary fibrosis which is a restrictive disease

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16
Q

Anesthetic Consideration for Esophageal Disease

A
  • History of GERD: plan for aspiration precautions–> possibly RSI
  • ETT warranted–> protects airway
  • Emergence just as important as induction for risk of aspiration–> fully awake
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17
Q

During Esophageal Surgery what Intraoperative Complications can occur?

A
  • Arrythmias
  • Hypotension
  • hemmorhage
  • RLN injury–> affect ability to cough and increases risk of aspiration pna
  • Tracehobronchial tree injury
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18
Q

Anatomical Parts of the Stomach

A
  • Fundus
           uppper abdomen/ primary job is storage (4 hours)
  • Distal Stomach
           thick walled, mixing of food, slow release of chyme through pyloric sphincter into duodenum
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19
Q

Acid Release Cascade

A

G-cell (located in the submucosa) is activated by stretch receptors–> secretes Gastrin into circulating system

This mobilizes ECL cells to release histamine

Histamine stimulates parietal cells to secrete HCL acid

**This whole process is vagally mediated** (acetylcholine)

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20
Q

Pharmacologic Gastric Acid Control

A

H2 antagonists- Shut down histamin preventing release of HCL via parietal cells

  • Cimetidine
  • Ranitidine

PPIs- directly block the proton pump (parietal cell)

  • Omeprazole
  • Prostaglandin
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21
Q

Other Functions of the Stomach

A

Barrier against pathogens

Thermoregulation

Vitamin B12 absorption (intrinsic factor)

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22
Q

Blood Supply of Stomach

A

4 Major Arteries

R/L gastric arteries

R/L gastroepiploic

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23
Q

Innervation of the Stomach

A

Major is Autonomic

Two branches of the vagus nerve

  • Right posterior (celiac) branch
  • Left anterior (hepatic) branch
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24
Q

Peptic Ulcer Disease

A

Erosion of the protective mucous layer of the stomach and duodenum

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25
Q

Most associated cause of PUD

A

Helicobacter Pylori

  • overuse of NSAIDS, steroids
  • Excessive etoh consumption
  • Stress
  • smoking

*originates from the imbalances of the aggressive forces and the mucosal defense forces

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26
Q

Treatment of PUD

A
  • Erradication of H. Pylori
  • High dose PPI’s
  • Sucralfate
  • Endoscopy
  • Surgery

*Surgical treatment no longer considered primary

27
Q

Milk Alkali Syndrome

A

Occurs with treatment of PUD with antacids

  • Hypercalcemia
  • Alkalosis
  • Elevated BUN

Manifests as skeletal muscle weakness and polyuria

Also hyophosphatemia secondary to large amounts of aluminum containing anatacids

28
Q

Adverse effects of H2 Antagonists

A

Can alter CYP-450 system and prolong the effects of meds that depend on this system

H2 works on ECL cell

PPI works on Parietal cell

29
Q

Gastric Neoplastic Disease- what type is most common

A

Majority is malignant, and 95% of them are adenocarcinoma, 4% lymphoma

30
Q

S/S of Gastric Neoplastic Disease

A
  • Anorexia
  • Weight loss
31
Q

Surgical Treatment of Gastric Carcinoma

A

Total or subtotal gastrectomy

Omentectomy, lymph node dissection, and splenectomy depending on extent

  • Gastrectomy
  • Billroth II (Gastrojejunostomy)
32
Q

Pancreas General Facts

A
  • Secretes 1500-3000ml of pancreatic juice daily
  • pH 8.3
  • Principle fuction is to adjust duodenal pH
  • Promotes function of pancreatic enzymes
  • Acid and Fats stimulate release of secretin causing HCO3- to neutralize acidic chyme
33
Q

Acute Pancreatitis

A

Patient are extremely ill with severe abdominal pain, fever, nausea, vomiting, jaundice, hypotension, ileus

Common causes

ETOH abuse

Direct or indirect Trauma

Infection

Perforation

34
Q

Management of Acute Pancreatitis

A
  • NG suction
  • MIVF
  • Anticipate respiratory problems/ ARDS
  • Analgesia
  • Nutrition
  • expect calcium imbalances
35
Q

Surgical Therapy for Pancreatitis

A

Drainage of pseudocyst

Pancreatojejunostomy

Puestow Procedure

**Severe major surgery**

36
Q

Cure Rate of Pancreatic CA

A

5%

37
Q

Procedure for Pancreatic CA

A

Whipple Procedure/ Pancreatoduodenectomy

38
Q

Gall Bladder

A

Pear Shaped, holds 30-50cc of bile

39
Q

Bile 3 Main Functions

A
  1. Emulsify and enhance fat and fat soluble vitamin absorption
  2. Provide an excretory pathway for bilirubin, drugs, toxins, IgA
  3. Maintain duodenal alkalization
40
Q

Cholecystitis

A

Acute obstruction of the Cystic Duct

  • Severe midepigastric pain, often radiates to right abdomen
  • Murphy sign- inspiration accentuates the pain
  • Jaundice suggests complete obstruction of the cystic duct]

*s/s often mimic MI so r/o cardiac event with serial enzymes and ECG

41
Q

Cholelithiasis

A

Acute obstruction of the common bile duct

  • symptoms simliar to cholecystitis
  • charcot triangle- fever, chills, upper quadrant pain
42
Q

Cholecystectomy anesthetic considerations

A
  • Post-op pain
  • Nausea and vomiting
  • Pain in upper left shoulder from CO2
  • High aspiration risk
  • Decreased venous return from increased intraabdominal pressure secondary to CO2 insufflation
43
Q

Length of Portions of the Intestinal Tract

A

Duodenum ~20cm

Jejunum ~100cm

Ileum~ 150cm

44
Q

What breaks down proteins

A

enzymes (trypsin and chymotrypsin)

45
Q

What breaks down lipids

A

Lipase (pancreatic lipase)

46
Q

What breaks down carbohydrates

A

amylase

47
Q

Absorption of food occurs through what process

A

Diffusion

**Villi have a very large surface area**

48
Q

Diseases of the Small Intestine

A

Malabsorption Syndromes

  • celiac
  • fat/ protein malabsorption

Maldigestion

  • Deficient pancreatic secretion

Upper GI bleed

Small bowel obstruction

49
Q

How long is the Large Intestine

A

Colon 3-5 feet long

50
Q

What are haustrations

A

Numerous outpouchings found in the colon wall

51
Q

Blood supply of the Large Instestine

A

Superior Mesenteric Artery

Infererior Mesenteric Artery

Internal Iliac Artery

52
Q

How many Liters of water does your colon absorb daily

A

1-2 liters

53
Q

Differences of Crohns and Ulcerative Colitis

A

Crohns

can happen all throughout colon

large family history link

Inflammatory disease (antiinflammatories, steroids)

Multiple surgeries

Ulcerative Colitis

typically in descending and small part of transverse

ulcerative disease, loss of haustria

54
Q

Anesthesia Considerations of Intestinal Surgery

A
  • Aspiration risk
  • Fluid and electrolyte imbalance
  • History of steriod use (pre-op coverage, adrenal insufficiency)
  • Aviod Nitrous oxide
  • TPN
  • Bowel prep- dehydrated further
  • Discern NG vs. OG
  • RSI- consider full belly
55
Q

Splenectomy

A
  • ITP, TTP
  • Hodgkins disease
  • Lymphoma
  • Sickle cell disease
56
Q

3 Important Things for Laparascopic Abdominal Surgery

A
  1. Foley or void prior
  2. Drop OG to decompress stomach
  3. Antibiotics
57
Q

Drugs that decrease LES increasing the risk of aspiration

A
  • anticholinergics
  • dopamine
  • thiopental
  • opioids
  • propofol
  • trycyclic antidepressants
  • sodium nitroprusside
58
Q

Drugs that increase LES and decrease the risk of aspiration

A
  • metoclopramide
  • prochlorperazine
  • edrophonium
  • neostigmine
  • pancuronium
  • alpha-adrenergic agents
  • antacids

*Succ increases LES but also increases gastric pressure during fasiculations*

59
Q

Gold Standard method of airway management

A

ETT

60
Q

Hallmark manifestations of cholelithiasis

A
  • fatty food intolerance
  • right upper quadrant pain

(formation of gall stones)

61
Q

Symptoms of cholecystitis

A

Inflammation of cystic duct or gall bladder

  • pain that resembles cholelithiasis
  • leukocytosis
  • fever
  • abdominal muscle guarding
  • rebound tenderness
62
Q

Two most common causes of Acute Pancreatitis

A

Cholelithiasis and alcohol abuse accounts for 60-80% of all cases

63
Q

What acid base balance is typically seen with pyloric stenosis

A

Metabolic Alkalosis (vomiting all their acid out, along with electrolyte disturbances)

64
Q
A

Foundations II (2 decks)

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