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APA 2 Horvath > hepatobiliary/GI > Flashcards

hepatobiliary/GI Flashcards

1
Q

what are the 4 layers of the esophagus

A
  • outer longitudinal layer
  • inner circular muscular layer(smooth and striated muscle)
  • mucosal lining (squamous epithelium, distal 1-2cm is columnar epithelium)
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2
Q

What is the concern with esophageal surgery?

A

close proximity to aorta

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3
Q

achalasia

A

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

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4
Q

what causes achalasia

A
  • DM
  • stoke
  • Amyotrophic lateral sclerosis
  • connective tissue diseases
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5
Q

what happens to the epithelium in barret esophagus

A

normal squamous epithelium changes to metaplastic columnar epithelium

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6
Q

what causes barrett esophagus

A

chronic exposure to acidic gastric contents - GERD, chronic etoh, smoking

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7
Q

Barrett esophagus is closely associated with ____?

A

esophageal cancer

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8
Q

What medications are used to manage GERD?

A

PPI’s & H2 blockers

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9
Q

Failure of the LES to function properly, permitting stomach contents to reflux into the esophagus and possibly the pharynx is what condition

A

GERD

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10
Q

Weakness in the diaphragm that allows a portion of the stomach to migrate upward into the thoracic cavity is what condition

A

hiatal hernia

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11
Q

retrosternal pain of a burning quality that commonly occurs after meals is a characteristic of what condition?

A

Hiatal Hernia

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12
Q

What are two surgical tx for hiatal hernia

A

nissen & fundoplication

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13
Q

Where is a epiphanic diverticula located

A

near the LES

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14
Q

where is a traction diverticula located

A

mid esophagus

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15
Q

where Is a zenker diverticula located

A

upper esophagus

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16
Q

what is the risk of esophageal diverticula?

A

places the pt at risk for pulm aspiration of regurgitated food and also from food/fluids ingested but sequestered within the pouch

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17
Q

what do chemo drugs such as danunorubicin and doxorubicin cause

A

chemotherapy induced cardiomyopathy

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18
Q

what can bleomycin cause

A

pulmonary fibrosis, restrictive defect, increased potential for O2 toxicity.

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19
Q

anesthetic consideration for extubating a patient with esophageal disease

A

Patient must be fully awake and have demonstrated conscious control of the airway prior to extubation.

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20
Q

anesthetic consideration for intubating a patient with esophageal disease

A
  • ETT to create a sealed airway to prevent the risk from passive regurg and aspiration
  • RSI with cricoid pressure
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21
Q

what types of intraop complications are associated with esophageal cancer?

A
  • hemorrhage
  • injury to the tracheobronchial tree
  • RLN injury
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22
Q

what types of post-op complications are associated with esophageal cancer

A 
anastomic leak; mediastinities; 
pleural effusion, 
pneumonia,
ARDs,
cardiac and functional complications
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23
Q

Post-op tumor recurrence in patients with esophageal cancer:

A

not uncommon in patients undergoing curative resection for esophageal cancer - can be characterized as either loco regional (loco regional lymph node metastases, anastomic recurrence) or distant (hematogenous metastases, pleural or peritoneal seeding).

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24
Q

hematogenous metastases most commonly involve which organs

A

liver, lungs, bones. followed by adrenal glands, brain, and kidneys.

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25
Q

injury to the RLN places a patient at higher risk for?

A

aspiration pneumonia. impairs the ability of the patient to cough.

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26
Q

Mortality rates for esophageal resection have dropped from __% in the 1970s and early 1980s to __% in the late 1980s and early 1990s.

A

12 3

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27
Q

what are the most serious complications of esophageal resection?

A

anastomotic leak, mediastinitis and sepsis, and respiratory failure.

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28
Q

acid secretion of patietal cells depends on which energy pump

A

hydrogen/potassium (H+/K+) powered by ATP

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29
Q

acid release in the stomach is mediated by which three things

A
  • vagal stim (ach)
  • gastrin release (g cells in response to gastric distention)
  • histamine
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30
Q

examples of H2 antagonists

A

cimetidine, ranitidine,

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31
Q

examples of H+/K+ ATP inhibitors

A

omeprazole, prostaglandins

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32
Q

what does vagotomy surgery do

A

diminishes parietal-cell response to gastrin and histamine

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33
Q

How is the gastric system a barrier against ingested pathogens

A

acidic environment, immunosurveillance

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34
Q

how is the gastric system a thermoregulator

A

heats or cools ingested substances

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35
Q

how does vitamin B12 play a role in the gastric system

A

parietal cells secrete intrinsic factor, facilitates ideal vitamin B12 absorption

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36
Q

the stomach is innervated by which nerve

A

vagus (X)

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37
Q

which disease is caused by erosion of protective mucous layer of the stomach and duodenum?

A

peptic ulcer disease

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38
Q

what causes peptic ulcer disease

A
  • helicobacter pylori
  • overuse of NSAIDS, ASA, and corticosteroids
  • excessive etoh, tobacco, stress, radiation therapy
39
Q

associated diseases with PUD

A

cirrhosis, chronic renal failure, zollinger ellison syndrome, hyperparathyroidism, chronic lung disease, chronic pancreatitis

40
Q

what are the 3 components of milk-alkali syndrome

A

hypercalcemia, alkalosis, elevated BUN

41
Q

how does milk-alkali syndrome manifest

A

skeletal muscle weakness and polyuria

42
Q

oral antacids - how does acid rebound happen

A

gastric acid secretion may increase after existing acids are neutralized by calcium containing antacids

43
Q

what do large amounts of aluminum containing antacids do to phosphorus levels

A

cause acute hypophosphatemia which manifests as skeletal muscle weakness and fatigue, pathologic fractures, osteoporosis

44
Q

what drugs are given for PUD?

A

h2’s and PPI’s

45
Q

how do H2 receptors work

A

block secretion of hydrochloric acid, promotes healing of duodenal ulcers.

46
Q

how do h2’s interact w CYP450

A

may cause prolongation of the effects of concurrently administer drugs that rely on hepatic metabolism and elimination. famotidine is the least likely H2 antagonist offender

47
Q

which drug binds to the ulcer, increases the gastric mucous layer, promotes the healing process, and is devoid of side effects?

A

sucralfate

48
Q

what is Misoprostol used for

A

synthetic prostaglandin, secondary therapy to prevent ulcers in patients requiring NSAIDs

49
Q

s/s of gastric neoplasms

A

anorexia and weight loss

50
Q

majority of gastric neoplasms are classified as?

A

adenocarcinoma (95%)

51
Q

which patients is increased gastric mucosal acidosis common in ?

A

critically ill,

pt undergoing prolonged, complex surgical procedure, pt undergoing CPB

52
Q

gastritis associated with gastric mucosal acidosis is associated with

A

increased peri-operative morbidity and mortality

53
Q

The abdominal viscera is particularly at risk to diminished blood flow (ischemia) and break down of the intestinal barrier may occur. Why is this concerning?

A

leads to translocation of bacteria and endotoxins into the bloodstream (sepsis)

54
Q

what is the principle function of the pancreas

A

adjust duodenal pH

55
Q

presence of acid in duodenum cause release of ___

A

secretin

56
Q

presence of fats in duodenum causes release of ____

A

cholecystokinin

57
Q

vagal stim to the pancreas causes release of

A

pancreatic enzymes

58
Q

common causes of acute pancreatitis

A
  • alchohol abuse
  • direct or indirect traume
  • ulcerative penetration from adjacent structures
  • infectious processes
  • biliary tract disease
  • metabolic disorders
  • drug side effect
59
Q

pancreatitis s/s

A

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

60
Q

acute pancreatitis management

A
  • NG suction
  • maintenance of intravascular volume
  • anticipation of resp insufficiency
  • analgesia
  • nutritional support
  • common bile duct exploration
61
Q

s/s of chronic pancreatitis

A

incapacitating upper abd pain radiating to the back (continuous or intermittent in nature)

62
Q

what condition causes steatorrhea

A

chronic pancreatitis

63
Q

40% of patients with chronic pancreatitis have ___ From loss of pancreatic function

A

diabetes

64
Q

common causes of chronic pancreatitis

A
  • chronic alcoholism
  • chronic, significant biliary tract disease
  • long term effects of pancreatic injury
65
Q

pancreatic cancer usually presents with

A

jaundice

66
Q

what do gallstones look lik eon x-ray

A

radiolucent structures

67
Q

regulation of gallbladder contraction is primarily hormonal thru the action of ______ which is released from dudenum and mediated by presence of intraluminal amino acids and fats

A

cholecystokinin

68
Q

what are the three main functions of bile?

A
  • emulsify and enhance absorption of ingested fats and fat-soluble vitamins
  • provide an excretory pathway for bilirubin, drugs, toxins, and IgA
  • maintain duodenal alkalization
69
Q

how do patients present with cholecystitis

A

acute, severe, mid-epigastric pain that often radiates to the right abdomen

70
Q

what is murphys sign

A

inspiratory effort accentuates cholecystitis pain

71
Q

what would you expect labs to look like in someone with cholecystitis?

A

increase in plasma bilirubin, alkaline phosphatase, amylase, and WBC’s

72
Q

gallbladder perforation may cause what 3 things

A

peritonitis, localized tenderness, or ileus

73
Q

complete obstruction of the cystic duct will present as

A

jaundice

74
Q

what is free abdominal air suggestive of

A

ruptured viscus with perf of gallbladder - requires emergency exp lap

75
Q

charcot triangle is indicative of?

A

acute ductal obstruction.

76
Q

charcot triangle symptoms

A

fever, chills, upper quadrant pain, weight loss, anorexia, fatigue.

77
Q

cholecystitis is an acute obstruction of the ___ duct, while cholelithiasis is obstruction of ___ duct

A

cystic , common bile duct

78
Q

increased intra-abdominal pressure causes ____ venous return

A

decreased

79
Q

manipulation of abdominal visera may cause ___Cardia and ____tension

A

brady, hypo

80
Q

laparoscopic surgery’s affect on ventilation

A

altered ventilatory dynamic caused by large volume of intra-abdominal carbon dioxide/hypercapnia

81
Q

what type of embolism does laparoscopic surgery place pt at risk for

A

venous CO2 embolism

82
Q

how does laparoscopic surgery increase risk of aspiration

A

abnormal gastroesophael junction competence from high intra-abdominal pressure

83
Q

where does most digestion take place

A

small intestine

84
Q

proteins and peptides are degraded into

A

amino acids

85
Q

lipids are degraded into

A

fatty acids and glycerol

86
Q

which disease is characterized by “cobble stoning”

A

crohn’s

87
Q

which disease is characterized by pseudopolyps

A

UC

88
Q

Chrons primary effects which part of the digestive track

A

SI and colon

89
Q

which GI disease has a higher risk for smokers

A

chrons

90
Q

which GI disease has a greater cancer risk

A

UC

91
Q

UC effects which part of GI track

A

lower colon and rectum

92
Q

intestinal surgery - avoid which gas

A

nitrous oxide

93
Q

in the fetus, the spleen is a ____ organ

A

hematopoietic

APA 2 Horvath (4 decks)

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