Quiz 1/Hepatobiliary and GI Disturbances Flashcards
T/F: Local and general anesthesia depress sensation of the upper airway innervation.
TRUE
What nerve controls the nasopharynx?
Trigeminal nerve
What nerve controls the posterior third of tongue and oral pharynx?
Glossopharyngeal nerve
T/F: The superior laryngeal nerve innervates the base of the tongue and inferior epiglottis to the vocal cords.
TRUE
What nerve controls the vocal cords distally?
Recurrent laryngeal nerve
The superior laryngeal nerve controls what?
Cricothyroid Thyroid Muscle
What pathology of the oropharynx will increases aspiration of pneumonia?
- Pharyngeal tumor
- Cerebral vascular accident
- metabolic toxin
Where does the esophagus begin and end?
- originate pharynx
- approximately the sixth vertical vertebra
- End at the stomach
What layers tissue make up the esophagus?
-Outer longitudinal layer
-Inner circular muscular layer
*Smooth and striated muscle
-Mucosal Lining
*Squamous epithelium
*Except for distal 1-2 cm which is
composed of columnar epithelium.
Where does the esophagus pass through diaphragm?
Right crus
List the type of tissue encountered from esophageal wall from inner to outer?
- Epithelium
- Basement membrane
- Lamina propria
- Muscularis mucosa
- Submucosa
- Muscularis propria
- Regional lymphatics
- Thoracic duct
The inferior _________ arteries supply the ______ esophagus.
thyroid, cervical
T/F: The aorta esophageal branches of the bronchial arteries supply the thoracic esophagus.
TRUE
What are the two intrinsic plexuses for the esophagus?
- Auerbach plexus (Myenteric)
- Meissner Plexus (submucosal)
What are the extrinsic factors of the esophagus?
- Sympathetic
- Parasympathetic
- Somatic
What increases tone ot the upper esophagus sphincter?
- inspiration
- esophageal distention
- gagging
- valsalva maneuver
- acidity of gastric contents
What decreases tone of the upper esophagus sphincter?
- Distention
- Belching
- Vomiting
Name the common esophageal disorders?
- dysphagia
- chronic alcoholism
- achalasia
- barrett esophagus
- GERD
- Hiatal Hernia
- esopageal diverticula
- esophageal carcininome
What do you do for dysphagia?
- Find the underlying cause.
* Barium contrast studies
* Upper endoscopy
What is the pathology of chronic alcoholism for esophageal disorder?
- Impaired esophageal peristalsis
- LES hypotonia
- Degeneration of the auerbach plexus
- Mallory Weis Tear
Achalasia is the _______ of the ______ esophageal sphincter tone to relax during swallowing accompanied with a lack of peristalsis.
failure, lower
Achalasi developes secondary to which chronic disease state?:
-Diabetes
-stroke
-amyotrophic lateral sclerosis
-connective tissue diseases (amyloidosis /
scleroderma)
All the above.
What is Barrett esophagus?
Normal squamous epithelium changes to metaplastic columnar epithelium
T/F: Gastroesophageal Reflux Disease occurs when normal lower esophageal sphincter (LES) functions properly permitting stomach contents to reflux into the esophagus and possibly the pharynx.
FALSE
What is the treatment for GERD?
- Proton Pump inhibators (PPI)
- Histamine-2 (H2) - blocking agents
T/F: Hiatal hernia occurs when the stomach partially comes through a weakened abdominal wall in the upper left quadrant.
FALSE,
Hiatal hernia occurs due to a weakness in the diaphragm that allows a portion of the stomach to migrate upward into the thoracic cavity.
What is the surgical technique for a hiatal hernia?
Nissen fundoplication
What are the three classification of a esophageal diverticula?
-Zenker (Upper Esophagus)
-Traction (Middle esophagus)
Epiphrenic (Lower esophagus)
What are the causes of esophageal carcinoma?
- Advanced age
- Cachectic
- Malnourised
- Chronic disease
- Alcohol
- tobacco use
- Hx of chemotherapy
Daunorubicin and/or doxorubicin/adriamycin may have what affect on a person?
Cardiomyopathy due to chemotherapy
Bleomycin may have what affect on a person?
pulmonary fibrosis due to chemotherapy
What are some of the anesthesia consideration for a person that has esophageal disease?
- Plan for aspiration prophylaxis for induction and emergence
- Mandates a ET tube placement for a sealed airway
- Rapid sequence with cricoid pressure
- Prior to extubation the patient is fully capable of maintain airway.
A malnourished esophageal diseased patient who has lost 10 percent of total body weight should wait how many days before going to the OR?
10 days
What are the two section of the stomach?
- Fundus
- Distal stomach
Where is the duodenum located?
Pyloric sphincter to the ligament of treitz.
What are the layers of the gastric wall?
- Serosa (External Layer)
- Smooth muscle
- Muscularis mucosae
- Submucosa
- Mucosa
What does the chief cell produce in the gastric mucosa?
-Chief cell produces pepgenosin which is then converted to pepsin. (Chief cell secondarily produces lipase.
What does the G cell produce in the gastric mucosa?
-G cell produces gastrin
T/F: G cells produce gastrin which mobilize the ECL cell that creates histamine which stimulates the parietal cell to release hydrochloric acid.
TRUE
Acid release in the gastric mucosa is mediated by?
- vagal stimulation (acetylcholine)
- Gastrin release
- Histamine
T/F; Gastrin is released by G cells in response to gastric distention.
TRUE
What are H2 antagonists and what do they do?
- cimetidine and ranitidine
- shut down histamine release from ECL cells
What are H+/K+ inhibitors and what do they do?
- Omeprazole and prostaglandins
- stops the parietal cell from production of acid
What do anticholinergic agents do in controlling the gastic acid secretion?
-minor effect on parietal cell secretion
What is the effect of a vagotomy?
diminshes parietal cell response to gastrin and histamine.
What arteries supply blood to the stomach?
- Right and Left gastric arteries
- Right and Left gastroepiploic arteries
Innervation of the stomach comes from where?
- Right posterior
- Left anterior (hepatic) branch
T/F: Innervation of the stomach does not come from the vagus nerve
FALSE
List the common stomach disorder/diseases?
- Peptic ulcer Disease
- Gastric ulcer Disease
- Gastric neoplastic disease
What are some of the causes of a peptic ulcer?
- Helicobacter pylori bacterium (Major)
- Overuse of medicaiton of ASA,NSAIDS, and corticosteroids
- Alcohol
- tobacco
- STRESS
- radiation therapy (receiving)
Oral antacids are used for the treatment of peptic ulcers but may have what side effects?
- Rebound in gastric acid secretions
- Milk-alkali syndrome
- Acute hypophosphatemia
What can H2 receptor antagonists drugs do?
- Blocks secretion of hydrochloric acid
- promotes healing of duodenal ulcres
- Alteration of cytochrome P-450 enzyme in the liver. (Prolongs medication that requires enzyme for metabolism)
T/F: Proton pump inhibitor is NOT the most antisecretory agent.
False
What is the pharmacology therapy of peptic ulcer disease?
- Sucralfate
- Antibiotics
- Misoprostol
What does sucralfate do?
- Aluminium salt of sulfated sucrose
- binds to ulcer
- Increases gastric mucous layer
- helps in healing
- devoid of side effects
What does misoprostol do?
- Synthetic prostaglandin
- Secondary therapy to prevent ulcers in patient requiring NSAIDS
What are late signs/symptoms of gastric neoplastic disease?
- Anorexia
- Weight loss
T/F: Gastritis associated with gastric mucosal acidosis is associated with increased peri-operative morbidity and mortality.
TRUE
The pancreas has both a _______ and ______ function.
Endocrine, Exocrine
What are some things to remember about the exocrine function of the pancreas?
- Secretes 1500-3000cc/day
- Clear, colorless liquid with a pH of 8.3
- Ionic composition is Na, K, bicarb, chloride
- Principle function is to adjust duodenal pH
- Promotes optimal function of pancreatic enzymes
What are some things to remember about the endocrine function of the pancreas?
-Direct (non-ductal) production of insulin and glucagon to meet physiologic need
T/F: Presence of acid in duodenum cause release of Cholecystokinin.
FALSE (release of SECRETIN)
T/F: Presence of fats in duodenum cause release of cholecystokinin.
TRUE
Secretin causes release of __________ secretions CCK causes secretion of ________.
bicarbonate, enzymes
What are the S/S of ACUTE pancreatitis?
- abd. pain
- fever
- nausea
- vomiting
- jaundice
- hypotension
- ileus
- external distortion of stomach on radiographs
What are the causes pancreatitis?
- Alcohol abuse
- direct of indirect trauma
- ulcerative penetration from adjacent structures
- infectious processes
- biliary tract disease
- metabolic disorders
- drug side effect
What is the management of acute pancreatitis?
- Nasogastric suction
- maintenance of intravascular volume
- anticipation of respiratory insufficiency
- analgesia
- nutritional support
- common bile duct exploraton
What are the S/S of chronic pancreatitis?
- Incapacitating upper abdominal pain radiating to the back.
- Pancreatic calcification
- Steatorrhea
- 40% have diabetes from loss of pancreatic function
What are common causes of chronic pancreatitis?
- Chronic alcoholism
- Chronic, significant biliary tract disease
- Long term effects of pancreatic injury
What are the surgical procedure of pancreatitis?
- Drainage of pseudocyst
- Pancreatojejunostomy
- Puestow procedure
The composition of gallstones are ________ cholesterol crystals and ________bilirubinate.
Hydrophobic, Calcium
What is the anatomy of the biliary tree?
- Excretory conduit for the liver
- Composed of:
- Intrahepatic ducts
- Right and left hepatic ducts
- common hepatic duct
- gallbladder
- cystic duct
- common bile duct
What causes the sphincter of Odi to dilate?
Glucagon
How much does the gall bladder hold of bile?
30 - 50 cc
T/F: Regulation of the gall bladder emptying is due to cholecystokinin.
TRUE
_______ stimulation also plays a role - secondary to cholecystokinin.
Vagal
What function does bile serve?
- emulsify and enchance absorption of ingested fats and fat-soluble vitamins
- Provide an excretory pathway for bilirubin, drugs, toxins, and immunoglobulin A (IgA)
- Maintain duodenal alkalization
What is Murphy’s sign?
Inspiratory effort accentuates the pain in cholecystitis
What obstruction goes with cholecystitis?
-cystic duct
What obstruction goes with cholelithiasis/choledocholithiasis?
-Common bile duct
What is observed with Charcot Triagle?
- Fever
- Chills
- upper quadrant pain
What is Charcot Triagle indicative of?
Cholelithiasis for acute ductal obstruction
What type of pain will be most seen with cholecystectomy post op?
Left shoulder pain
What anesthesia consideration should be considered for a cholecystectomy?
- Post op pain
- N/V
- Peritoneal irritation from CO2
- Intravascular volume restoration
What anesthesia consideration should be considered for a laparoscopic surgery?
- aspiration
- altered ventilatory dynamic caused by large volumes of CO2
- Decrease venous return due to high intra abdominal pressure/pt position
- Manipulation of abd. viscera may cause bradycardia and hypotension
- Venous CO2 embolism
What consist of the small intestine?
- Duodenum (20cm long)
- Jejunum (100cm long)
- ileum (150cm long)
What are the three major classes of nutrients that enter the digestion in the small intestine?
- Proteins
- lipids (fats)
- carbohydrates
Digested food passes into the blood vessels in the wall of the intestine through ________.
diffusion
The inner wall of the small intestine is lined with simple _________ epithelial tissue.
columnar
T/F: Plicae circulares are permanent structures of the small intestine.
TRUE
Name some of the diseases of the small intestine.
- Malabsorption syndromes
- celiac sprue
- Fat malabsorption
- Protein malabsorption
- Maldigestion syndrome
- deficient pancreatic secretion
- upper GI bleed
- Small bowel obstruction
How long is the large intestine?
3-5 feet
What are the outpouchings throughout the large intestine?
Haustrations
What is the large intestine arterial supply?
- Superior mesenteric artery
- Inferior mesenteric artery
- Internal iliac artery
What vitamin are made in the large intestine?
- K
- B
What diseases come from the large intestine?
- Inflammatory Bowel Disease
- Chrohn’s
- Ulcerative colitis
- Diverticulitis
- Abdominal compartment syndrome
- Colonic polyps
- colon cancer
- colon volvulus
- ischemic bowel
- appendicitis
T/F: Ulcerative colitis usually occurs in the proximal part of the large intestine.
FALSE (Usually happens distally in the large intestine)
T/F: Chrohn’s can occur any where in the large intestine.
TRUE
What are anesthesia considerations for intestinal surgery?
- TEMPERATURE greater 36 Celsius
- aspiration risk
- fluid and electrolyte status
- Hx of steroid use
- avoid NO2
- TPN
- Bowel prep
- Malnutrition and anemia
- Post op ileus
The spleen is also known as the _______ in a fetus.
Hematopoietic organ
T/F: The spleen is the largest lymphatic organ.
TRUE
