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AP Summer > GI Pathophysiology > Flashcards

GI Pathophysiology Flashcards

1
Q

True or false: this was the worst lecture all year

A

True

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2
Q

What is responsible for vasoconstriction of arterial blood flow to the G.I. tract?

A

Sympathetic nervous system

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3
Q

What two things enhance mechanical activity of the GI tract?

A

Distention and parasympathetic nervous system stimulation

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4
Q

What is the normal pH range for gastric fluid?

A

1-3.5

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5
Q

What are some symptoms of vagal stimulation during an abdominal procedure?

A 
Bradycardia
Decrease contractility
Vasodilation
Decreased blood pressure
Increased bowel mobility
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6
Q

What can you do when there is vagal stimulation during an abdominal procedure?

A

Tell the surgeon to quit dicking around

Give glycopyrrolate

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7
Q

What two things put the patient at high risk for aspiration pneumonitis?

A

Volume > 25 mL

pH < 2.5

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8
Q

What is the relationship between the pH and volume and severity of aspiration pneumonitis?

A

Dose-dependent relationship in the severity of AP for both volume and acidity that reaches the lung

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9
Q

What are some potential reasons for reduced airway reflexes and thus increased risk for perioperative AP?

A

Pregnancy, obesity, GERD, MS, MD, MG, ALS, (Stroke)

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10
Q

What are some methods for reducing the risk of regurgitation and pulmonary aspiration?

A 
RSI
Increase emptying
Decrease volume and acidity
NG/OG tube
H1 and H2-blockers
Minimize intake
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11
Q

What are the fasting guidelines for clear liquids in adults and children?

A

Adults >3 hours

Kids >2 hours

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12
Q

What are the ASA fasting recommendations for breastmilk and nonhuman milk/light meals preoperatively?

A

Breast milk >4 hrs

Light meals >6 hrs

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13
Q

Why is gum not allowed preoperatively?

A

It increases gastric volume and decreases pH

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14
Q

How could gum potentially be helpful post-op?

A

Prevent post-op ileus

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15
Q

What is peristalsis?

A

Wavelike movements of the bowel in a forward direction

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16
Q

How long is the average adult esophagus?

A

8 inches or 20 cm

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17
Q

What is the purpose of the upper esophageal sphincter?

A

Prevents aspiration of gastric contents into the lung and swallowing of air

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18
Q

What effect do most anesthetic agents have on UES tone?

What is the exception?

A

Most anesthetic agents decrease you UES tone

Ketamine increases

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19
Q

What is zenker’s diverticulum?

A

Diverticulum of the mucosa of the pharynx just above the cricopharyngeal muscle

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20
Q

What type of maneuver cannot be performed on patients with a zenker’s diverticulum?

A

Selleck (cricoid pressure)

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21
Q

What leads to gastroesophageal reflux?

A

Decrease in lower esophageal sphincter tone

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22
Q

What is the resting pressure of lower esophageal sphincter tone?
At what point is LES pressure problematic?

A

Normal: 15-30 mmHg
Problem: <10 mmHg

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23
Q

What is barrier pressure?

A

Difference between gastric pressure and LES pressure

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24
Q

What effect does cricoid pressure have on LES tone?

A

Decreases

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25
Q

List some factors that decrease LES tone

A 
Inhaled anesthetics
Opioids
Anticholinergic
Propofol 
Beta blocker
Hiatal hernia
Pregnancy
Obesity
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26
Q

List some factors that increase LES tone

A 
Anti-cholinesterase
Cholinergic
Acetylcholine
Metoclopramide
Histamine
Serotonin
Metoprolol
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27
Q

What is an EGD?

A

Esophagogastroduodenoscopy

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28
Q

What is heartburn?

A

Incompletely closed lower esophageal sphincter allows acidic stomach contents to reflux into the esophagus

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29
Q

What is gastroesophageal reflux disease (GERD)?

A

When reflux occurs frequently or is bothersome

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30
Q

What is Barrett’s esophagus?

A

Regular reflux of stomach acids irritates the esophagus, which may lead to histological changes and progress to malignancy

31
Q

What is achalasia?

A

The LES does not relax properly

32
Q

What is true of all general anesthetics in patients with achalasia?

A

RSI

33
Q

What is esophageal stricture?

A

A narrowing of the esophagus

34
Q

What are the risk factors for esophageal cancer?

A

Smoking, heavy drinking, chronic reflux

35
Q

What is esophageal varices?

A

Dilated veins in the distal esophagus are at risk for serious bleeding

36
Q

What is the main cause of esophageal varices?

A

Portal hypertension

37
Q

What is the treatment for portal hypertension and hepatic encephalopathy?

A

TIPS Transjugular intrahepatic portosystemic shunt

38
Q

In the event of an upper G.I. perforation early diagnosis and surgical management within what timeframe is best?

A

Within 12 hours

39
Q

Upper GI perforation is associated with what mortality if delayed 24 hours?
….48 hours?

A

24 hrs –> 50%

48 hrs –> 90%

40
Q

What is the function of the stomach?

A

Food storage and initial digestion

NOT Nutrient absorption

41
Q

How is the stomach innervated?

A

Vagus

42
Q

What is the pyloric sphincter?

A

Opening from the stomach into the small intestine

43
Q

What is the surgical treatment option for GERD and hiatal hernias?

A

Nissen fundoplication

44
Q

What is a nissen fundoplication?

A

When the upper portion (fundus) of the stomach is wrapped around the lower esophagus

45
Q

What happens to FRC, PIP, PaCO2, and PaO2 during Laparoscopic procedures?

A

Decrease FRC
Increase PIP
Increase PaCO2
Decrease PaO2

46
Q

At what intra-abdominal pressure is there a decrease in venous return?

A

> 15

47
Q

Why is there a potential for shoulder pain during laparoscopic procedures?

A

Referred pain from stimulation to the phrenic nerve

48
Q

Where does most digestion and absorption occur?

A

Small intestine

49
Q

Parasympathetic simulation will have what effect on small intestine activity?

A

Increased activity

50
Q

How much chyme is produced on a daily basis?

A

1 to 2 L/day

51
Q

What effect do hypokalemia, peritonitis and laparotomy have on small intestine activity

A

All decrease activity for up to 48 hours

52
Q

What is celiac disease?

A

Autoimmune disorder that destroys the villi in the small intestines

Causes a reaction to eating gluten

53
Q

What is Crohn’s disease?

A

Autoimmune inflammatory bowel disease

54
Q

How much can the gallbladder store?

A

50mL

55
Q

Opioid effect what structure in the gallbladder?

How can this affect be reversed?

A

Sphincter of oddi

Reversed with glucagon or narcan

56
Q

What is cholelithiasis?

A

Gallstones can lead to rupture

57
Q

What are some potential causes of pancreatitis?

A

Alcohol abuse, blockage, trauma, autoimmune, hyperparathyroidism cystic fibrosis

Propofol can cause at high doses

58
Q

What is one of the most common causes of emergency abdominal surgery?

A

Appendicitis

59
Q

What is an ERCP?

A

Endoscopic retrograde cholangiopancreatography

-View the entrance of the common bile duct

60
Q

Where are water and electrolytes absorbed?

Where is feces stored?

A

The colon

61
Q

Colonic secretions have what type of pH?

A

Alkaline

62
Q

What type of inflammatory bowel disease usually begins in the rectal area and may involve the entire large intestine?

A

Ulcerative colitis

63
Q

What is diverticulosis?

A

Small pouches in the lining off the colon, or large intestine, that bulge outward through weak spots

64
Q

What is diverticulitis?

A

When the patches of diverticulosis become inflamed

65
Q

What are some complications associated with diverticulosis?

A

Bleeding, abscess, perforation, peritonitis, fistula, obstruction

66
Q

What is important to know about carcinoid tumors?

A

They secrete hormones

67
Q

60% of carcinoid syndrome cases present as what?

A

Carcinoid heart disease

-Right sided involvement (Tricuspid regurge and pulmonary valve involvement)

68
Q

What is important for the management of carcinoid syndrome?

A 
Block histamine and serotonin receptors
Avoid histamine releasing drugs
Fluid resuscitation
Monitor electrolytes and glucose
Octreotide-somatostatin infusion
69
Q

What are the life-threatening causes of agitation during a MAC case?

A

Hypoxemia
Hypovolemia
Local toxicity
Cerebral hypoperfusion

70
Q

What are the four categories used to gauge the depth of a MAC case?

A

Responsiveness
Airway
Spontaneous ventilation
Cardiovascular

71
Q

What effect does glucagon have on the sphincter of oddi?

A

Relaxes it

72
Q

What are some of the pros and cons for using ketamine during MAC anesthesia?

A

Pros: Analgesia, CV stability
Cons: Patient may move, hallucinate, drool

73
Q

Why might glycopyrrolate be given in conjunction with ketamine?

A

To control secretions

AP Summer (24 decks)

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