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Fundamental 2 > GI Procedures > Flashcards

GI Procedures Flashcards

1
Q

In what area of the GI does digestion begin?

A

Oropharynx

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2
Q

What are three examples of pathological processes that can affect swallowing?

A
  1. Pharyngeal tumor.
  2. CVA.
  3. Metabolic toxin.
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3
Q

Where is the esophagus located?

A

Begins at C6 and ends at the level of the stomach.

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4
Q

What are the three functional zones of the esophagus?

A
  1. Upper esophageal sphincter (UES)
  2. Esophageal body.
  3. Lower esophageal sphincter (LES).
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5
Q

Where does the esophagus pass through to the abdominal cavity?

A

A space created by the right crus of the diaphragm.

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6
Q

What are the three layers of the esophagus?

A
  1. Outer longitudinal layer.
  2. Inner circular muscular layer.
  3. Mucosal lining.
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7
Q

T/F: The esophagus is more vascular than the trachea and therefore more prone to bleeding?

A

False; trachea is more vascular

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8
Q

What artery is the main blood supply to the cervical esophagus?

A

Inferior thyroid arteries.

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9
Q

What artery is the main blood supply to the thoracic esophagus?

A

Aorta esophageal branches of bronchial arteries.

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10
Q

The extrinsic innervation of the esophagus is largely controlled parasympathetically by what nerves?

A

Cranial nerves IX, X, XI.

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11
Q

Are the UES and LES open or closed at rest?

A

Closed

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12
Q

Excitatory stimulation of UES occurs during what 5 normal body functions?

A
  1. Inspiration
  2. Esophageal distention.
  3. Gagging.
  4. Valsalva maneuver.
  5. Acidity of gastric contents.
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13
Q

UES tone is reduced by what 3 body functions?

A
  1. Distention
  2. Belching
  3. Vomiting.
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14
Q

What is the average velocity if esophageal peristalsis?

A

3-4cm/sec

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15
Q

Does esophageal peristalsis cause high or low pressure?

A

High pressure up to 150mmHg and can cause tears and ruptures

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16
Q

What affect does swallowing have on LES tone?

A

Decreases LES within 1.5-2.5 seconds and last 6-8 seconds

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17
Q

What affect does ingestion of a meal have on LES tone?

A

Increases LES tone via vagal afferent pathways.

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18
Q

What is normal LES tone in mmHg?

A

20mmHg

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19
Q

What 4 things can chronic alcoholism have on esophageal health?

A
  1. impaired esophageal peristalsis.
  2. LES hypotonia.
  3. Degeneration of the Auerbach Plexus (more likely to have tears)
  4. Mallory Weis Tear.
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20
Q

What is achalasia?

A

Failure of the lower esophageal sphincter tone to relax during swallowing accompanied with a lack of peristalsis.

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21
Q

What are 4 chronic disease states that can cause achalasia?

A
  1. Diabetes.
  2. Stroke.
  3. Amyotrophic lateral sclerosis.
  4. Connective tissue diseases
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22
Q

What is Barrett esophagus?

A

Normal squamous epithelium changes to metaplastic columnar epithelium

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23
Q

What is the typical focus of treatment for Barrett esophagus?

A

Acid reduction

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24
Q

What three things are likely the cause of Barrett esophagus?

A
  1. Chronic exposure to acid (GERD).
  2. Chronic alcohol abuse.
  3. Smoking
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25
Q

What other pathology is Barrett Esophagus closely associated with?

A

Esophageal carcinoma (Cancers)

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26
Q

What is the cause of GERD?

A

Failure of the LES to function properly (permits reflux of stomach contents into esophagus).

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27
Q

What is the current medical management therapy for GERD?

A

PPI and H2 blockers.

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28
Q

In GERD, what is more important- decreasing amount of acid or decreasing the level of acidity (increasing pH).

A

Decreasing amount of acid.

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29
Q

Which type of hiatal hernia is characterized by the stomach folding over on itself and passing through the opening?

A

Type 2/ Paraesophageal

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30
Q

Describe a type 1 Hiatal hernia:

A

Esophagus and stomach slide upward through the opening.

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31
Q

What are the primary symptoms of hiatal hernia?

A

Retrosternal pain or burning that commonly occurs after meals.

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32
Q

What is a Nissen fundoplication?

A

Treatment for hiatal hernia by folding stomach over on itself to prevent stomach from being able to move upwards.

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33
Q

What are the 3 classes of esophageal diverticula?

A
  1. Epiphrenic
  2. Traction
  3. Zenker
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34
Q

What are Zenker esophageal diverticula located? Traction?

Epiphrenic?

A

Zenker=upper esophagus
Traction=mid esophagus
Epiphrenic=Near the LES

35
Q

Which type of esophageal diverticula is associated with highest likelihood of aspiration?

A

Zenker because it is closer to the airway.

36
Q

What else causes increased risk of aspiration/airway complications with esophageal diverticular?

A

Not being able to swallow saliva

37
Q

Why are patients with esophageal carcinoma prone to malnourishment?

A

pain/difficulty with swallowing

38
Q

What major complications can arise from daunorubicin/doxoribicin ?

A

Chemotherapy induced cardiomyopathy

39
Q

What major complication can arise form belomycin administration?

A

Pulmonary fibrosis

40
Q

What four anesthesia considerations are required with esophageal disease?

A
  1. Plan for aspiration prophylaxis with induction/emergence.
  2. Mandates use of ETT.
  3. RSI
  4. Patient must be fully awake and demonstrate control of airway prior to extubation
41
Q

For what disease/pathophysiology is an Ivor-Lewis repair done?

A

Esophageal cancer

42
Q

What is the best way to optimize the patient’s health status prior to repairs of obstructive esophageal disease?

A

Admit 1 day early to optimize fluid therapy and electrolytes

43
Q

For esophageal cancer cases, what four things are important for the SRNA to know?

A
  1. It is a large procedure
  2. What positioning entails/is needed
  3. Where the incisions will be
  4. These patient are high risk of hemorrhaging
44
Q

What 5 intraoperative complications for esophagea; resection are important to remember?

A
  1. Arrhythmias
  2. Hypotension
  3. Injury to RLN
  4. Injury to tracheobronchial tree.
  5. Hemorrhage
45
Q

What are the 4 most common post op complications of esophageal resection?

A
  1. anastomotic leak
  2. Mediastinitis.
  3. Sepsis
  4. Resp failure
46
Q

What is the mortality rate for esophageal resection?

A

3%

47
Q

What are the two anatomic sections of the stomach?

A

Fundus and Distal stomach

48
Q

Which anatomic section of the stomach is characterized by thin-walled and distensible?

A

The fundus

49
Q

What is the primary function of the fundus?

A

Storage for about 4 hours

50
Q

What is the primary function of the distal stomach?

A

Slow release of chyme and mixing of food

51
Q

What three things activate acid release via the parietal cells?

A
  1. Vagal stimulation
  2. Gastrin release
  3. Histamine
52
Q

What affect do anticholinesterase drugs have on the stomach?

A

Muscarinic effects increase ACh which increases secretions.

53
Q

What does a vagotomy do for gastric acid secretion?

A

Lysing some of the cells diminishes parietal cell response to gastrin and histamine.

54
Q

What 3 classes of drugs are primarily used to control gastric acid secretion?

A
  1. H2 antagonist
  2. H+/K+ ATP inhibitors
  3. Anticholinergics
55
Q

What supplies blood to the stomach?

A

4 arteries

R and L Gastric arteries, R and L gastroepiploic

56
Q

What are the 7 main causes of Peptic ulcer disease?

A
  1. Chronic over supply of gastric acid and pepsin
  2. H. Pylori
  3. Overuse of ASA or NSAIDs or corticosteroids
  4. Excessive alcohol consumption
    5.tobacco use,
  5. stress, or
  6. receiving
    radiation therapy
57
Q

Which treatment for peptic ulcer disease is associated with acute hypophosphotemia?

A

Aluminum containing antacids

58
Q

Which peptic ulcer pharmacologic therapy binds to ulcer and coats the stomach lining?

A

Sucralfate

59
Q

What are signs and symptoms of Milk-alkali syndrome?

A

Hypercalcemia
Alkalosis
Elevated BUN

60
Q

Which peptic ulcer pharmacologic treatment is associated with prolonged effects of anesthetic drugs?

A

H2 antagonists because of CYP inhibition

61
Q

What is the most effective antisecretory agent for peptic ulcer disease?

A

PPI

62
Q

T/F: Surgical treatment for peptic ulcer disease is considered the first line treatment for patients?

A

False: only once medical therapy is exhausted

63
Q

T/F: Only a very small percentage of gastric neoplasms are malignant?

A

False: Nearly all gastric neoplasms are malignant

64
Q

What is primary exocrine function of pancreas?

A

Adjust duodenal pH

65
Q

What is primary endocrine function of pancreas?

A

Insulin and glucagon production to meet physiologic needs

66
Q

What are S/S of acute pancreatitis?

A

Extremely ill with severe abd pain, fever, nausea, vomiting, jaundice, hypotension, ileus, and external distortion of stomach on radiographs

67
Q

What is management of acute pancreatitis?

A

NG suction, maintain intravascular volume, anticipate resp insufficiency, analgesia,

68
Q

T/F: Pancreatic cancer is highly curable at nearly 95%?

A

False; cure rate is 5% or less

69
Q

Why do patients with biliary blockage/disease become jaundice?

A

Biliary tract is excretory conduit for the liver and it gets backed up and dumps intravascularly.

70
Q

What is the primary control of gallbladder contraction/secretion?

A

Hormonal through the action of cholecystokinin.

71
Q

What are the three main functions of bile?

A
  1. Emulsify and enhance absorption of fats
  2. Provide excretory pathway for bilirubin, drugs, toxins, and IgA
  3. Maintain duodenal alkalization
72
Q

What is Murphy’s sign?

A

Inspiratory effort accentuates pain (cholecystitis)

73
Q

What should be the differential diagnosis with suspected cholecystitis?

A

Cardiac event.

R/O with serial enzymes and EKG

74
Q

What diagnosis is used when removing gall bladder for stones? For ERCPs?

A

Cholelithiasis: Choledocholithiasis

75
Q

What is Charcot triad?

A

Fever, chills, upper quadrant pain. (cholelithiasis)

76
Q

What type of pain medications should be given for Kuhr’s sign (CO2)

A

Not opioids. Torodol is better

77
Q

What is the length of the small intestine sections?

A

Duodenum 20cm.
Jejunum 100cm.
Ileum 150cm.

78
Q

What is the main role of plicae circulares?

A

Increase surface area of small intestine.

79
Q

Anesthetic considerations for small bowel obstruction?

A
  1. RSI

2. OG/NG prior to induction

80
Q

Which three arteries supply blood to the large intestine?

A
  1. superior mesenteric artery.
  2. Inferior mesenteric artery
  3. Internal iliac artery.
81
Q

T/F: Diverticulitis is the simply the presence of diverticulum?

A

False: diverticulosis is simply the presence of diverticulum; whereas, diverticulitis is an inflamed/causing issue

82
Q

In which disease state is the wall thickened and can “cobble stoning” (UC or CD)?

A

Crohn’s disease

83
Q

UC/CD: Which one can present at certain areas in the large intestine and not others (sort of jumps around)?

A

Crohns disease

84
Q

T/F: For intestinal surgery, N2O should be the primary inhaled anesthetic used?

A

False

Fundamental 2 (7 decks)

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