GI Disturbances & Anesthesia - Quiz 4 Flashcards
1
Q
Which nerve innervates the Nasopharynx?
A
Trigeminal Nerve
2
Q
Which Nerve innervates back 1/3 of Tongue & Oral Pharynx?
A
Glossopharyngeal Nerve
3
Q
Which Nerve innervates the Tongue Base & Inferior Epiglottis?
A
Superior Laryngeal Nerve (SLN)
4
Q
Which Nerve innervates the Vocal Cords distally?
A
Recurrent Laryngeal Nerve (RLN)
5
Q
Which Nerve controls the Larynx & Trachea?
A
Vagus Nerve
6
Q
Where is the Esophagus located?
A
From the Pharynx (C6) to the stomach
3 Zones - Upper/Lower Esophageal Sphincter & Esophageal Body
7
Q
What is the Esophageal Wall made of?
A
Outer Longitudinal Layer
Inner Circular Muscle Layer - Smooth & Striated
Mucosal Lining - Squamous & Columnar Epithelium
8
Q
What are the Diaphragm Crus?
A
Tendinous structures that extends below diaphragm to vertebrae - the right crus is where the Esophagus passes thru
9
Q
What kind of muscle makes up the External Coat of the Esophagus?
A
Upper - Skeletal Muscle
Middle - Skeletal & Smooth Muscle
Lower - Smooth Muscle
10
Q
What is on the outside of the Esophageal External Muscular Coat?
A
Adventitia - collagen connective tissue w/ fibroblasts
11
Q
Which Nerve Plexus is in between the muscle layers of the Esophagus?
A
Myenteric Plexus of Auerbach - parasympathetic vagus nerve
12
Q
Where does the Esophagus get its blood supply?
A
Cervical Esophagus - Inferior Thyroid Arteries
Thoracic Esophagus - Aorta Esophageal Bronchial Arteries
13
Q
What are the Intrinsic Nerve Plexuses of the Esophagus?
A
Auerbach Plexus & Meissner Plexus
Esophagus to Anus
14
Q
What are the Extrinsic Nerve Plexuses of the Esophagus?
A
- Myenteric Plexus - Sympathetic Modulator
- Cranial Nerves IX, X, and XI - Parasympathetic - Esophageal Contraction & LES Relaxation
15
Q
When are the Upper & Lower Esophageal Sphincters Closed?
A
At Rest
16
Q
What Stimulates the Upper Esophageal Sphincter?
A
Inspiration
Distention
Gagging
Valsalva
Gastric Acid
17
Q
What reduces Upper Esophageal Tone?
A
Distention
Belching
Vomiting
18
Q
What is the Normal Lower Esophageal Sphincter tone?
A
20 mmHg
19
Q
How does Swallowing affect the Esophagus?
A
Starts Peristalsis
↓LES Tone during Peristalsis
20
Q
What Increases Lower Esophageal Sphincter Tone?
A
Eating a Meal & Increased Abd. Pressure via Vagal Pathways
21
Q
What should be evaluated for pts. w/ Dysphagia?
A
Identify Underlying Cause w/ Barium Swallow or Upper Endo
22
Q
How does Chronic ETOH affect the Esophagus?
A
Impaired Peristalsis
LES Hypotonia
Auerbach Plexus Degeneration
Mallory Weis Tear from yacking
23
Q
What is Achalasia?
A
LES cant relax during swallowing & no peristalsis
24
Q
What can cause Achalasia?
A
DM
Stroke
ALS
Amyloidosis
Scleroderma
25
How is Achalasia treated?
Heller Myotomy & Pneumatic Balloon
26
What is Barretts Esophagus?
When the normal Squamous epithelium changes to metaplastic columnar epithelium
27
What causes Barretts Esophagus?
GERD
Chronic ETOH
Smoking
Will eventually lead to Carinoma
28
What happens in GERD?
LES fails to function properly and lets stomach contents reflux into esophagus
29
Which meds are used to manage GERD?
PPIs & H2 Blockers
30
What causes a Hiatal Hernia?
Weak Diaphragm that lets part of the stomach move up into thoracic cavity
31
What are the different types of Hiatal Hernias?
Type I - Sliding
Type II, III, and IV - Paraesophageal
32
What are symptoms of a Hiatal Hernia?
Restosternal Pain or Burning after Meals
33
What condition are pts. w/ a Hiatal Hernia predisposed to?
Peptic Esophagitis
34
How are Hiatal Hernias Treated?
Surgery - Endoclip & Nissen Fundoplication
35
How are Esophageal Diverticula Classified?
By Location
* Zenker - Upper Esophagus
* Traction - Mid-Esophagus
* Epiphrenic - Near LES
36
What are the risks associated w/ Esophageal Diverticula?
Aspiration
Need 2 Separate Surgeries
37
What is the concern when giving Daunorobucin, Doxorubicin, or Adriamycin for Esophageal Carcinomas?
Chemo-Induced Cardiomyopathy
38
What can happen when treating a pt w/ Esophageal Carcinoma with Bleomycin?
Pulm. Fibrosis
Oxygen Toxicity
Restrictive Defect
39
What are the Incisionless Procedures used for Esophageal Surgery?
Esophyx & Natural Orifice Transluninal Endoscopic Surgery (NOTES)
40
How is the Ivor-Lewis Repair done for Esophageal Cancer?
Anterior Abd. Incision & Right Thoracotomy
41
How is the Ivor-Lewis McKeown-Type Repair done for Esophageal Cancer?
1. Right Neck Incision
2. Remove Diseased Esophagus
3. Anastamose Stomach to Cervical Esophagus
42
What are the Intra-Op Complications of Esophageal Cancer Surgery?
Hemorrhage & Hypotension
Trach/Bronch Injury
RLN Injury
Arrythmias
43
What are the Post-Op Complications of Esophageal Cancer Surgery?
Anastamotic Leak
CV & Respiratory Problems
Post-Op Tumor Recurrence
Mediastinitis
Sepsis
44
What are the two sections of the Stomach?
**Fundus**
Thin, Upper Abd., Food Storage
**Distal Stomach**
Thick, Releases Chyme, Food Mixing
45
What is the difference b/t the stomach and duodenum?
**Stomach**
Size of Open Hand & Varied Position
**Duodenum**
12 Fingers/25 cm Long & Fixed Retroperitoneal Position
46
What are the different parts of the Gastric Wall?
* Serosa - External Layer
* Outer Longitidunal Muscles
* Middle Circular Muscles
* Inner Oblique Muslces
* Musclaris Mucosae
* Submucosa
* Mucosa
47
What releases Gastric Acid and how is it mediated?
Gastric Acid released by Parietal cells
&
Mediated By
Vagal Stimulation - Acetylcholine
Gastrin Release - G Cells
Histamine
48
What does the Fundic Mucosa of the Stomach do?
Secretes mucus to make a protective layer from the acid
49
What stimulates Pepsinogen Production?
Sight & Smell of Food
50
What suppresses Gastrin Release?
Luminal Acid - Negative Feedback Loop
51
What are ways to control Gastric Acid Secretion?
H2 Blockers
**PPIs - Most effective antisecretory**
Anticholinergics - Minor Effect
Surgery - Vagotomy (Not Primary Treatment)
52
Besides acid secretion & digestion, what are the other Gastric Functions?
Protection again foreign ingestions
Thermoregulation - warms/cools ingested things
Vitamin B12 Absorption
53
Where does the Stomach receive its Blood Supply?
4 Arteries - R/L Gastric & Gastroepiploic Arteries
54
Which nerves Innervate the Stomach?
Right Posterior Celiac Branch of Vagus Nerve
&
Left Anterior Hapatic Branch of Vagus Nerve
55
What is Peptic Ulcer Disease
Too much Acid & Pepsin breaking down stomach's mucous layer
56
What causes Peptic Ulcer Disease?
H. Pylori - Main Cause
NSAIDs
Steroids
ETOH
Smoking
Stress
Radiation
57
What are the risks when using Oral Antacids to treat Peptic Ulcer Disease?
Acid Rebound
Milk-Alkali Syndrome
Hypercalcemia
Muscle Weakness
Hypophosphatemia
Osteoporosis
58
What does Sucralfate do to help with Peptic Ulcer Disease?
Binds to Ulcer
↑Mucous Layer
↑Healing
No side effects
59
What is a secondary med therapy used to prevent ulcers for pts who need NSAIDs?
Misoprostol - Synthetic Prostaglandin
60
Most Gastric Neoplasms are Malignant with 95% being \_\_\_\_\_\_\_\_\_
Most Gastric Neoplasms are Malignant with 95% being **Adenocarcinoma**
61
What are the Late Symptoms of Gastric Cancer?
Anorexia & Weight loss
62
What are the treatments for Gastric Cancer?
Gastrectomy
Omentectomy
Splenectomy
Lymph Node Dissection
63
What is the Billroth II Gastrojejunostomy?
Partial Gastrectomy, then the non involved part of the stomach is connected to the first part of the jejunum
64
What are the Exocrine Functions of the Pancreas?
Adjusts duodual pH by secreting clear juice w/ a pH of 8.3 and is made up of Na+, K+, Bicarb, and Chloride
65
What are the Pancreas' Endocrine Functions?
Make Insulin & Glucagon
66
What are symptoms of Pancreatitis?
Abd Pain
N/V
Fever
Jaundice
Hypotension
Ilius
Radiographic Stomach Distortion
67
What are causes of Pancreatitis?
ETOH Abuse
Trauma
Ulcer Penetration
Infection
Biliary Tract Disease
Drugs
68
How is Pancreatitis treated?
NG Suction
Fluids
Pain Control
Nutrition
Common Bile Duct Exploration
69
What is invovled w/ Chronic Pancreatitis?
Abd. Pain
Pancreatic Calcification
Steatorrhea (Oily Stool)
Diabetes
70
What are the Surgeries for Pancreatitis?
Drain Pseudocyst
Pancreatojejunostomy
Peustow Procedure
71
Why is the cure rate for Pancreatic Cancer so low?
Must be diagnosed extremely early
Long Extensive Procedures
Serious Post Op Complications
72
What is the Whipple Procedure?
Complex operation to remove Pancreas Head, Duodenum, and Gallbladder
73
The biliary tract is what the Liver excretes through, what is the tract made of?
Hepatic Ducts
Gallbladder
Cystic Duct
Common Bile Duct
74
What regulates the Gallbladder to contract & empty bile into the duodenum?
Primary - Cholecystokinin & Intraluminal acids and fats from the Duodenum
Secondary - Vagal stimulation
75
What are the Functions of Bile?
* Emulsify and helps absorption of fats & fat-soluble vitamins
* Makes pathway for bilirubin, drugs, toxins, and IgA
* Maintains Duodenal Alkalization
76
What happens w/ Cholecystitis?
Cystic Duct Obstruction
Juandice = Complete Obstruction
Severe Epigastric pain that radiates to right abd.
77
What is Murphy's Sign in regards to Cholecystitis?
Breathing in causes pain
78
What will a patient's lab values look like if they have Cholecystitis?
↑Bilirubin
↑Amylase
↑Alkaline Phosphatase (ALP)
↑WBC
79
What can happen if the Gallbladder is perforated?
Peritonitis
Local Tenderness
Ileus
80
What needs to be ruled out before Diagnosing Cholecystitis?
Cardiac Event
Dehydration
Ileus
Perf'd Gallbladder = emergent Ex-Lap
May need Gallbladder U/S
81
Cholecystitis is obstruction of the cystic duct. Cholelithiasis & Choledocholithiasis is obstruction of which duct?
Common Bile Duct
Similar Symptoms
82
What is the Charcot Triangle?
Signs of Ductal Obstuction
Fever + Chills + Upper Quadrant Pain
83
What are the Anesthesia Considerations for a Cholecystectomy?
N/V
Post-Op Pain
Peritonial Irritation d/t CO2 Insufflation
Volume Restoration
↓Venous Return
Bradycardia
Hypotension
84
What are the lengths of the different parts of the small intestine?
Duodenum - 20cm
Jejunum - 100cm
Ileum - 150cm
Connected by Mesentery
85
What are the Functions of the Small Intestine?
Digestion & Absorption
86
What does Trypsin & Chymotrypsin from the Pancreas do?
Proteolytic enzymes that break down proteins into small peptides
87
\_\_\_\_\_\_\_ splits amino acids one at a time, while _____ & _____ free the end amino acid products.
**Carboxypeptidase** splits amino acids one at a time, while **Aminopeptidase & Dipeptidase** free the end amino acid products
88
What happens to lipids once they enter the digestive system?
Pancreated Lipase & Bile breaks them down into Free Fatty Acids & Monoglycerides
Bile is the middle man that holds the fat until lipase break them down
89
What happens to Carbs once they enter the Digestive System?
1. Broken down to Simple Sugars/Monosaccharides
2. Pancreatic Amylase break them down to Oligosaccharides
3. Brush Border Enzymes (Dextrinase & glucoamylase) futher break down those Oligosaccharides
90
What are the types of Small Intestine Diseases?
Malabsorption - Fat/Protein/Gluten/Celiac Sprue
Maldigestion
Upper GI Bleed
Small Bowel Obstruction
91
Which arteries supply blood to the Large Intestine?
Superior & Inferior Mesenteric Arteries
Internal Iliac Artery
92
How long is the Colon?
3 - 5 Feet
93
What makes up the Large Intestinal Wall?
Longitudinal Muscle & Outpouchings / Haustrations
94
What are the Functions of the Large Intestine?
* Peristalsis
* Bacterial Digestion
* Absorption - Vitamins B, K, Water, Na+, Cl-
* Defecation
95
What are the types of Large Intestine Diseases?
IBD - Crohn's, Ulcerative Colitis
Diverticulitis/losis
Abd. Compartment Syndrome
Colon Polyps, Cancer, Volvulus
Ischemic Bowel
Appendicitis
96
What is the difference b/t Ulcerative Colitis & Crohn's?
Ulcerative occurs continuously throughout the Large Intestinge
Crohn's occurs at different parts of the colon, skipping some segments
97
What are symptoms of Crohn's Disease?
Chronic Diarrhea
Abd Pain
Fever
Fatigue
Rectal Bleed
98
How is Crohn's Treated?
Anti-Inflammatory Agents
Steroids
ABX
Immune Modifiers
Surgery
(Diet has no Effect either way)
99
Which anesthetic agent should be avoided for Intestinal Surgery?
N2O - can expand the bowel
100
Which organ is the Largest Lympathic Organ and is where Lymphocyte Proliferation and Immune Response happens?
Spleen
| (Considered Non-Vital)
101
What are the Spleen's Functions?
Destroys & Recycles old RBCs, Iron, & Globin and stores Functional RBCs, releasing them during hemorrhages
102
When are Spelenctomies Indicated?
ITP
Hodgkin's
Leukemia
Sick Cell Disease
Splenic Trauma
Thalassemia
Hemolytic Anemia
