GI/hepatobiliary Flashcards
In order to achieve maximum effectiveness, when should an antacid be given?
15-30 minutes before surgery
Which med is most effective in reducing the risk associated with reflux immediately prior to surgery?
Oral sodium citrate
What is the laparoscopic assisted splenectomy position?
Right lateral decubitus
All of the following drugs increase the risk for gastric reflux except: A.) Pancuronium B.) Tricyclics antidepressants C.) Sodium nitroprusside D.) Atropine
Pancuronium
Which drugs increase the LES pressure and reduce the risk of gastric reflux?
Edrophonium and alpha adrenergic agents
Which of the following factors does not increase the risk for gastric aspiration?
- reverse trendelenberg position
- lithotomy
- smoking
- pregnancy
reverse trendelenberg position
During laparoscopic surgery on a healthy patient, what hemodynamic effect would you expect to see as a result of insufflation of the abdomen to a pressure of 12-15mmHg?
Decrease in CO…CVP increases, LV function, SVR and MAP decrease with insufflation of the abdomen. Higher insufflation pressures (>25cm H2O or 18mmHg) can cause severe compression of the major abdominal veins, which reduces venous return, preload, CO and BP more significantly
Per Nagelhout (page 722): an IAP of 20-25 cmH2O leads to increased CO and CVP secondary to changes in the volume of the venous return of blood. An IAP greater than 30-40 cmH2O may lead to decreased CVP and CO secondary to reduced right ventricular preload.
You are preparing to induce a patient undergoing GA for resection of a carcinoid tumor. If possible, all of the following drugs should be avoided in this patient except:
- vecuronium
- atracurium
- morphine
Vecuronium
Drugs that release histamine can result in a profound histamine reaction when combined with vasoactive peptides such as bradykinin and serotonin that the tumors releases into the circulation
T/F in a patient with a small bowel obstruction, metoclopramide and an H2 antagonist are useful pre-induction agents.
False
Reglan causes perforation in a SBO
These patients tend to be severely alkylotic and hypovolemic. Fluid is often sequestered in the abdomen, resulting in hypotension that makes ketamine and Etomidate good choices for induction
A patient is in steep trendelenberg position during a lap chole.The patient suddenly exhibits a decrease in O2 saturation, subcutaneous crepitation over the chest, and an increase in ETCO2. The first step you should take is:
A.) epi 100 mcg IV
B.) begin chest compressions
C.) tell the surgeon to turn off the insufflator
D.) hyperventilate the patient
tell the surgeon to turn off the insufflator
—> the symptoms listed describe a pneumothorax, with entry of the CO2 used for abdominal insufflation entering the lungs. The appropriate immediate measures are to cease insufflation of the abdomen, discontinue N2O if its being utilized, increase ventilation, and call for assistance.
Which of the following is not a branch of the celiac trunk? A.) common hepatic artery B.) superior mesenteric artery C.) left gastric artery D.) splenic artery
superior mesenteric artery
The use of which inhalation agent during laparoscopic procedures can potentially increase the risk associated with CO2 emboli by diffusing into small emboli, making them larger and more hazardous?
Nitrous oxide (N2O)
Which of the following meds would not potentially relieve spasm of the sphincter of Oddi? (Pick 2)
- fentanyl
- meperidine
- succiylcholine
- morphine
Fentanyl and morphine
Opioids, can produce spasm of the sphincter of Oddi, which can make performance of a cholangiogram difficult. Meperidine is considered to be less likely to cause spasm of the sphincter of Oddi than other opioids. Drugs that have been used to treat the spasm include small amounts of naloxone, glycopyrrolate, and atropine
What treatment modality should you give the highest priority in the care of a patient with acute pancreatitis?
A.) administration of nitrate to relax the sphincter of Oddi
B.) administration of H2 antagonists
C.) administration of narcotics
D.) aggressive hydration
aggressive hydration
-> aggresive hydration with IVFs is of the utmost importance. Because of the hypovolemic that is associated with pancreatitis, patients may need as much as 10L of IVF. The patients is placed on NPO status to rest the pancreas. H2 antagonists are administered to help suppress pancreatic secretion even further. Opioids may be required to control abdominal pain. If the patient exhibits necrotizing pancreatitis, prophylactic antibiotics are administered. If the cause is cholelithiasis, the gallstones should be removed within the first 1-3 days of the onset of symptoms.
Which of the following are the most common causes of pancreatitis? A.) alcoholism B.) penetrating upper abdominal trauma C.) gallstones D.) hypoparathyroidism
alcoholism and gallstones—> account for 60% of all cases of pancreatitis. Gallstones are presumed to block the ampulla of Vater, resulting in pancreatic ductal hypertension. Abdominal trauma can result in pancreatitis, but it is typically blunt abdominal trauma, not penetrating trauma that causes it. Acute pancreatitis is occasionally associated with patients with AIDS and those with hyperparathyroidism and the hypercalcemia that accompanies it. Pancreatitis also occurs in 1-2% of patients that undergo an endoscopic retrograde cholangiopancreatoography
Which lab finding is a characteristic of acute pancreatitis?
Elevated serum amylase
Lipase levels are also often elevated
What surgical procedure would you expect to have the highest risk for the development of acute pancreatitis postoperatively?
Cardiac thoracic surgery (particularly after CPB)
A patient who is severely ill from chronic ulcerative colitis is presenting for colon resection. You know that this patient’s lab work would likely reveal: A.) decreased albumin level B.) thrombocytopenia C.) hyperkalemia D.) hyponatremia
decreased albumin level
In patients with active ulcerative colitis, there can be an increase in the erythrocyte sedimentation rate, platelet count, and a decrease in hemoglobin. In patients who are severely ill, the serum albumin level will rapidly decline, and there may be leukocytosis.
Patients with ulcerative colitis are at risk for the development of: A.) carcinoma of the colon B.) ankylosis spondylitis C.) liver disease D.) all of the above
D.) all of the above
Induction of GA for which of the following procedures carries the highest risk for aspiration? A.) zenkers diverticulectomy B.) airway management for epiglottis C.) tonsillectomy D.) parathyroidectomy
zenkers diverticulectomy
Here we have herniation of mucosa through the posterior hypopharyngeal wall. Patients experience dysphasia, coughing, and regurgitation of undigested food as a result. Weight loss and ASPIRATION PNA are seen in the more severe cases. If the diverticula is positioned above the cricoid cartilage, cricoid pressure becomes useless as a tactic for reducing the risk of aspiration.
*** RSI is always indicated **
Chronic ingestion of large quantities of calcium containing antacids and milk for the treatment of peptic ulcer disease may lead to all of the following EXCEPT: A. Decreased BUN B. Alkalosis C. Polyuria D. Skeletal muscle weakness
Decreased BUN
All of the following medications should be avoided in a patient with carcinoid tumor, EXCEPT: A. Atracurium B. Thiopental C. Succinylcholine D. Etomidate
Etomidate
Hypotension is the one serious complication associated with this disorder and should be avoided- Etomidate is best for avoiding hypotension
S/s that may be seen with acute pancreatitis include all of the following EXCEPT:
A. Hypocalcemia
B. Hyponatremia
C. Disseminated intravascular coagulopathy
D. Adult respiratory distress syndrome
Hyponatremia
S/s most frequently associated with pancreatitis are: severe epigastric pain that radiates to the back, nausea, vomiting, diarrhea, anorexia, fever, chills, tachycardia, respiratory distress, peritonitis, and hemodynamic instability
Patients with which of the following comorbitities may be more likely to experience Mendelson’s syndrome? (Chose 2) A. GERD B. Myocardial infarction C. Hiatal hernia D. Renal failure
GERD and Hiatal hernia
Mendelson’s Syndrome is the aspiration of acidic gastric contents by a patient during some type of AMS
GERD is treated surgically in all of the following situations EXCEPT: (chose 2)
A. The need for increasing doses of PPI without relief of symptoms
B. The presence of a Mallory-Weiss tear
C. An esophageal erosion, ulceration or stricture
D. Recurrent of symptoms despite medical therapy
B. The presence of a Mallory-Weiss tear and D. Recurrent of symptoms despite medical therapy
—> Mallory-Weiss tear is a source of GIB, not GERD. GERD is chronic, so symptoms are expected to recur
Which of the following medications should be avoided during cholangiogram secondary to causing spasm in the sphincter of Oddi? (Chose 2) A. Fentanyl B. Narcan C. Glucagon D. Morphine
Fentanyl and Morphine
Persistent vomiting from hypertrophic pyloric stenosis is likely to lead to which of the following: A. Hypochloremic metabolic acidosis B. Hyperchloremic metabolic alkalosis C. Hypochloremic metabolic alkalosis D. Hyperchloremic metabolic acidosis
C. Hypochloremic metabolic alkalosis
Vomiting removes both hydrochloride acid and K+ in large quantities
What is milk alkali syndrome?
Hypercalcemia
Alkalosis
Elevated BUN
From daily ingesting large quantities of calcium containing antacids and milk.
