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
