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ACVECC 2024 > GI & Pancreas > Flashcards

GI & Pancreas Flashcards

1
Q

Reasons for anorexia for D2 post-op splenectomy:

A
  • Lack of gastrocolic reflex
  • Lack of motilin stimulation (by fat)
  • Lack of CCK stimulation (by protein)
  • Peritoneal inflammation -> decrease slow waves => NO production
  • Opioids interrupting MMC
  • Pain (?)
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2
Q

What are the 4 phases of MMCs?

A

I. Period of quiescence
II. ↑ AP and smooth muscle activity
III. Peak electrical activity and mechanical activity (lasts 5-10 minutes)
IV. Declining activity that leads back to phase I

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3
Q

Functions of the MMC are interrupted by:

A

Meals
Drugs: narcotics, atropine, alpha-2 agonist
Stress
Bacterial toxins e.g. Campy CdtB toxin

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4
Q

Main role of myenteric plexus:

A

Stimulation increases peristalsis

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5
Q

Main role of submucosal plexus:

A

Help with mixing: local segmental intestinal secretion, absorption and contraction of submucosal muscle

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6
Q

Gastrin
Stimuli for secretion
Site of secretion
Action

A

Stimuli for secretion:
- Protein
- Gastric distention
- (Acid inhibits release)
Site of secretion: G cells (located in: stomach, duodenum)
Actions:
Stimulates:
- Gastric acid secretion (parietal cells)
- Stimulates pepsinogen (chief cells)
- Mucosal growth/repair

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7
Q

Cholecystokinin
Stimuli for secretion
Site of secretion
Action

A

Stimuli for secretion:
Protein
Fat and its byproducts
Acid
Site of secretion: I cells (duodenum, jejunum, ileum)
Actions:
Stimulates:
- Pancreatic enzymes + bicarb secretion
- GB contraction to digest fat
- Relaxation of sphincter of Oddi
- Growth of exocrine pancreas

Inhibits:
- Appetite
- Gastric acid secretion
- Gastric emptying: gives time for digestion

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8
Q

Gastric Inhibitory Peptide (GIP)
Stimuli for secretion
Site of secretion
Action

A

Stimuli for secretion:
PROTEIN
Fat
Carbohydrate
Site of secretion: K cells (duodenum + jejunum)
Actions:
Stimulates: insulin release

Inhibits:
- Gastric acid secretion
- Gastric emptying

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9
Q

Vasoactive Intestinal Peptide (VIP)
Site of secretion
Main action

A

Site of secretion: enteric nerves
Main action
- increase water + electrolyte secretion from pancreas & gut
- relaxes smooth muscle (via NO)

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10
Q

Motilin
Stimuli for secretion
Site of secretion
Action

A

Stimuli for secretion: FAT
Acid
Nerve
Site of secretion: M cells & ECL cells (throughout)
Actions:
Stimulates:
- Gastric motility
- Intestinal motility

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11
Q

Secretin
Stimuli for secretion
Site of secretion
Action

A

Stimuli for secretion: Acid
Fat
Site of secretion: S cells (duodenum, jejunum)
Actions:
Stimulates:
- Pepsin secretion
- Pancreatic & biliary bicarb secretion
- Growth of exocrine pancreas

Inhibits: gastric acid secretion

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12
Q

Somatostatin
Stimuli for secretion
Site of secretion
Action

A

Stimuli for secretion: acid
Site of secretion: D cells (pancreatic islets, stomach, SI)
Actions: Inhibits:
- Secretion of: gastrin, VIP, GIP, secretin and motilin
- Pancreatic exocrine secretion
- Gastric acid secretion
- Gastric motility
- GB contraction
Absorption of aa and triglycerides

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13
Q

Ways to help improve motility:

A
  • Drugs
  • Early ambulation
  • Early controlled enteral nutrition
  • Multi-modal analgesia
  • GIT decompression
  • Judicious IVFT to limit bowel oedema
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14
Q

4 functions of the exocrine pancreas:

A

Acinar cells secrete:
1) zymogens (digestion)
2) antibacterial proteins (regulate SI flora)

Ductal cells secrete:
1) bicarb + water to neutralise duodenal pH
2) pancreatic intrinsic factor (aid with B12 handling in distal ileum)

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15
Q

What are the pathophysiologic mechanisms of diarrhoea? (4)

A

1) Osmotic diarrhoea -Excess luminal osmoles drawing fluid into the intestinal lumen
2) Secretory diarrhoea - Net increase in intestinal fluid secretion. either through ↑secretion or ↓absorption
3) altered permeability - Mircoscopic/macroscopic damage to epithelial cells or their junctions. Risk of translocation of bacteria
4) Deranged motility -
Either ↑ peristaltic contractions or ↓segmental contractions

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16
Q

Risk factors for R&A site breakdown

A
  • pre-op peritonitis
  • intestinal FB
  • serum albumin < 25g/L
  • intra-op hypotension
17
Q

Define primary peritonitis

A

spontaneous inflammatory condition in absence of underlying intrabdominal pathology

18
Q

define secondary peritonitis

A

consequence of preexisting septic or aseptic pathologic intraabdominal condition

19
Q

define tertiary peritonitis

A

recurrent or persistent intra-abdominal infection after previous surgical and antimicrobial therapy for secondary bacterial peritonitis

20
Q

recommended lavage volume for septic peritonitis

A

200-300mL/kg

21
Q

Pattern of gastric necrosis in GDV:

A

Fundus -> body

22
Q

why do ventricular arrhythmias occur in 40% of GDV cases?

A
  • Coronary blood flow reduced by 50% (experimentally), myocardial ischemia – may establish ectopic foci of electrical activity
  • Circulating cardiostimulatory substances – epinephrine
  • Circulating cardioinhibitory substances – pro-inflammatory cytokines (TNF-a, IL-1)
23
Q

What lactate level makes gastric necrosis more likely in GDV?

A

> 6

24
Q

Higher survival associated with lactate < ____ in GDV?

A

4

25
Q

Define intra-abdominal hypertension:

A

a sustained or repeated pathologic increase in intraabdominal pressure of > 12mmHg

26
Q

Increases in IAP are due to: (4)

A
  1. ↓ in abdominal wall compliance
  2. ↑ in intraluminal content
  3. ↑ in abdominal content
  4. ↑ capillary leak
27
Q

Define Abdominal compartment syndrome (ACS)

A

= sustained pathologic increase in intraabdominal pressure > 20 mmHg, that is associated with new organ failure or dysfunction.

28
Q

Proposed mechanism in which glutamine improves outcomes: (5)

A
  • Anti-inflammatory functions by downregulating cytokines and inhibiting NFkB
  • Tissue protection via heat shock protein expression, inhibition of apoptosis, maintenance of gut barrier integrity
  • Antioxidant synthesis -> glutathione
  • Attenuation of inducible nitric oxide synthase
  • Preserve metabolic functions - ↑insulin sensitivity, ↑production of ATP
29
Q

List the electrolyte derangements seen with re-feeding syndrome:

A

Hypophosphataemia
Hypomagnesemia
Hypokalemia, hyponatraemia
Hypocalcemia
Vit deficiencies (thiamine)
Hyperglycemia

30
Q

Define refeeding syndrome:

A

the metabolic derangements that result after refeeding a patient with prolonged anorexia or malnutrition.

31
Q
A

ACVECC 2024 (14 decks)

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