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Anesthesia II > GI/Liver > Flashcards

GI/Liver Flashcards

1
Q

When can liberal fasting guidelines be used?

A

In healthy patients

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2
Q

How soon before surgery can a patient have a sip of water or oral liquid medication?

A

Up to 1 hour before surgery

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3
Q

People who are aspiration risks

A 
Age extremes (70)
Ascites
Collagen vascular diseases
Metabolic disorders (DM, hypothyroid, ESRD)
Mechanical obstruction
Prematurity
Pregnancy
Neurologic diseases
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4
Q

People with greatest aspiration risk

A

Pregnant
Morbidy obese
Hiatal hernia
Pre-op anxiety

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5
Q

Medications for aspiration prophylaxis

A

Anxiolytics
H2 receptor antagonists
Sodium citrate (Bicitra)– acts as a buffer
Metoclopramide (Reglan) - increase gastric motility and increases sphincter tone
Omeprazole (Prilosec)– will decrease acidity

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6
Q

H2 Antagonist that gives the best result

A

Famotodine (Pepcid)

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7
Q

Examples of H2 antagonists

A

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotodine (Pepcid)

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8
Q

How do H2 antagonists work?

A

Reduce acid secretion by competitively binding to H2 receptors on parietal cells.

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9
Q

When should H2 antagonists be given?

A

Night before surgery and repeated 45-60 minutes before surgery

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10
Q

How does metoclopramide (Reglan) prevent aspiration?

A

By preventing and alleviating nausea

MOA: Dopamine antagonist which increases lower esophageal sphincter tone and increases gastric emptying

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11
Q

When is metoclopramide (Reglan) contraindicated?

A

In a bowel obstruction

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12
Q

When do we give meds like H2 blockers, reglan, and bicitra?

A

If the person has risk factors for aspiration**

We do not give these meds to patients routinely

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13
Q

When before surgery to you give bicitra?

A

15 minutes before surgery, and it lasts 1-3 hours.

Increases gastric volume and can cause nausea.

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14
Q

When would we do Sellick’s maneuver?

A

During RSI (for someone at high risk of aspiration and we can’t do an awake intubation)

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15
Q

Complications of Sellick’s maneuver

A

Esophageal rupture and cricoid ring fracture

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16
Q

How to perform Sellick’s maneuver

A

Apply light downward and cephalad pressure (10N) in the awake pressure, and increase pressure as the patient drifts to sleep (20-44N).

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17
Q

Risk factors for aspiration pneumonitis (Mendelson Syndrome)

A

Gastric volume > .4mL/kg (about 25mL for a 70kg patient)

Gastric pH < 2.5

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18
Q

Severity of aspiration pneumonitis depends on

A

pH
Volume
Contents of the gastric material aspirated

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19
Q

S/S of aspiration pneumonitis

A

Resp distress with bronchospasm
Dyspnea
Cyanosis
Tachycardia

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20
Q

Why does Barrett’s esophagus place a person at risk for aspiration?

A

Because the esophagus becomes less functional, causing dysphagia. Person also obviously has very bad GERD, as this is what caused the disease in the first place.

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21
Q

S/S of hiatal hernia

A

Retro-sternal discomfort

Burning after meals

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22
Q

Where does peptic ulcer disease most commonly occur?

A

Antrum of stomach
or
Duodenal bulb

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23
Q

Causes/risk factors for peptic ulcers

Also s/s of peptic ulcers

A

H. Pylori
Age 45-60
Chronic NSAID use
Steroid use

S/S:
Epigastric pain
Vomiting
Hematemesis or melena in acute hemorrhage
Perforation
Abdominal tenderness/rigidity
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24
Q

S/S of malabsorption syndromes

A 
Unexplained weight loss****
Diarrhea
Steatorrhea
Vit. K deficiency
Bleeding dyscrasias
Anemia
Fatigue
Edema/ascites
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25
Q

Differences between Crohn’s and UC

A

Crohn’s

  • Vit/mineral deficiencies (B12, mag, folic acid, zinc, iron, and potassium)
  • protein loss (decreased serum albumin)
  • anemia

UC

  • Intermittent blood diarrhea (hooray!)
  • fever/malaise
  • Abd pain
  • Risk of colon CA
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26
Q

What is carcinoid syndrome?

A

Carcinoid tumors (which release hormones), arising from the appendix, pancreas, or bronchi, secrete substances into the GI tract and systemic circulation, causing an array of symptoms.

S/S:
Flushing
Diarrhea
Bronchospasm
Dyspnea
Hypo/hypertenion
Orthostatic hypotension)
Palpitations
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27
Q

Substances released by carcinoid tumors in carcinoid syndrome

A

Bradykinin
Histamine
Serotonin
Dopamine

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28
Q

Malnutrition is associated with these complications

A

Prolonged hospital stay
Wound infection/abcess
Resp failure
Death

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29
Q

Albumin level less than ___ in the general surgical population is indicative of malnutrition

A

3.5

Also weight loss greater than 10% in 6 months is also indicative of malnutrition

30
Q

Albumin level less than ___ is a major predictor of morbidity

A

2.1

31
Q

The liver is a reservoir of blood representing ___-___% of total blood volume

A

10-15%

32
Q

Two scoring methods of liver insufficiency

A

MELD Score

Child-Turcotte-Pugh Score

33
Q

MELD Score

A

For ESLD

Looks at Bilirubin, creat, INR, and if you’re on dialysis)

34
Q

Child-Turcotte-Pugh Score

A 
Looks at:
Bilirubin
Encephalopathy
Albumin
Ascites
PT/INR
Primary biliary cirrhosis
35
Q

5-nucleotidase

A

A lab more specific to the biliary tract

36
Q

Which liver lab can individually test liver function?

A

None of them! They need to be looked at together and with the patient’s condition in general

37
Q

Why does cholestatic disease causing bleeding problems?

A

Bile salt must be secreted into the GI tract for vit K absorption. Lack of vitamin K causes a deficiency of clotting factors dependent on Vit K for synthesis.

38
Q

How do you treat bleeding in someone with cholestatic disease?

A

Give Vit K

Give FFP if emergency surgery

39
Q

Expected blood flow findings in cholestatic disease

A

Increased portal venous pressure and decreased flow
Peripheral vasodilation
Increased CO

40
Q

This is the most common blood borne infection in the US

A

Hep C

41
Q

Drug for Hep B

A

Interferon

42
Q

Drugs for Hep C

A

Interferon

Ribavirin

43
Q

Non-Alcoholic Fatty Liver Disease is defined as fat accumulation exceeding __% and can lead to ____

A

5%
cirrhosis
(the fat causes a degree of hapatocyte necrosis, accumulating inflammatory cells and causing cirrhosis)

44
Q

Risk factors for non-alcoholic fatty liver disease

A

Obesity and NIDDM

45
Q

Non-alcoholic fatty liver disease is asymptomatic but the person will have elevated ____

A

liver enzymes (AST/ALT)

46
Q

What can reverse elevated liver enzymes in non-alcoholic fatty liver disease

A

Weight loss (even as much as only 5 pounds)

47
Q

An alcoholic may become tremulous __-__ hours after their last drink

A

6-8 hours

48
Q

Hallucinations and grand mal serizures may occur __ hours after ETOH withdrawal.

A

24 hours

49
Q

How do you treat DTs?

A

Benzodiazepines

most of our anesthetics will abate most of the s/s of alcohol withdrawal

50
Q

Cirrhosis is most commonly caused by

A

Alcoholism, Hep C, and fatty liver disease

51
Q

CV changes with cirrhosis

A

Low SVR and high CO
(sepsis-like)
Pulmonary vessels dilate, but then become stiff, causing R heart failure

52
Q

S/S of cirrhosis

A 
Portal HTN
Esophageal varices
Ascites and edema
Coagulation disorders
Hepatic encephalopathy
Endocrine disorders
Intrapulmonary shunting and V:Q mismatch
Hypoxemia due to intra-pulmonary vascular dilations
53
Q

In liver disease, you have problems with these phases of clotting

A

Hemostasis
Coagulation
Fibrinolysis
(all three stages!)

54
Q

These clotting factors are reduced in liver failure

A

2, 5, 7, 9, 10
Abnormal fibrinogen present
PT/INR are elevated
Pts have thrombocytopenia

55
Q

Why are platelets fucked up in liver disease?

A

Normally, the liver makes thrombopoietin, which results in the formation of megakaryocytes in the BM. Also, toxins build up in the bleed, messing with plt function.

End result is decreased plts, fucked up plts, and increased bleeding time.

56
Q

Vitamin K is needed for the synthesis of

A

Factors 2, 7, 9, & 10

Proteins C&S

57
Q

Who develops Vit K deficiency?

A 
People with:
TPN
Biliary obstruction
Pancreatic insufficiency
Malabsorption
GI obstruction
Rapid GI transit
58
Q

These coag levels will increase due to Vit K deficiency

A

PT/PTT

59
Q

What are coumadin and heparin used for?

A

Coumadin
- DVT, PE, A-fib, prosthetic valves, and MI

Heparin
- anti-coagulation for vascular cases and cardio-pulmonary bypass (CPD)

60
Q

How does coumadin work?

A

It competes with binding sites for Vit K in the liver, resulting in the decrease of Vit-K dependent clotting factors (2,7,9,10)

61
Q

How does heparin work?

A

Interacting with anti-thrombin III (Factor Xa) and Thrombin (factor IIa)

62
Q

Normal prothrombin time (PT)

A

10-12 sec

Tests factors 1, 2, 5, 7, 10

63
Q

Normal bleeding time

A

3-10 minutes (tests platelet function)

64
Q

Normal PTT

A

25-35 seconds

Tests factors 1, 2, 5, 7, 9, 10, 11, 12

65
Q

Treatments for Barrett’s esophagus

A

H2 Blockers
PPIs
Nissen Fundoplication

66
Q

Peptic ulcers and bleeding

A

80% stop on their own
10% will die
Rebleeding will increase mortality 10x
Accounts for 5% of ED admissions

67
Q

Gastric ulcer and peptic ulcer s/s

A

Gastric:

  • Pain
  • Anorexia
  • Weight loss
  • Metabolic derangements

Peptic:

  • Epigastric pain
  • Vomiting
  • Hematemesis or melena
  • Perforation
  • Abdominal tenderness/rigidity
68
Q

Aspiration pneumonitis is also called

A

Mendelson Syndrome

69
Q

We see a lot of malabsorption syndromes following this type of surgery

A

Gastric bypass

70
Q

Autoimmune hepatitis is treated with

A

Corticosteroids and AZT

71
Q

Left untreated, fatty liver disease can lead to

A

cirrhosis

72
Q

Usually, a ___% increase in Creatinine indicates a corresponding decrease in GFR

A

50%

Anesthesia II (11 decks)

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