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Krista/ 2 Advanced Physical Assessment and foundation of Nursing Anesthesia 2 > Quiz 1/Hepatobiliary and GI Disturbances > Flashcards

Quiz 1/Hepatobiliary and GI Disturbances Flashcards

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1
Q

T/F: Local and general anesthesia depress sensation of the upper airway innervation.

A

TRUE

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2
Q

What nerve controls the nasopharynx?

A

Trigeminal nerve

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3
Q

What nerve controls the posterior third of tongue and oral pharynx?

A

Glossopharyngeal nerve

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4
Q

T/F: The superior laryngeal nerve innervates the base of the tongue and inferior epiglottis to the vocal cords.

A

TRUE

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5
Q

What nerve controls the vocal cords distally?

A

Recurrent laryngeal nerve

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6
Q

The superior laryngeal nerve controls what?

A

Cricothyroid Thyroid Muscle

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7
Q

What pathology of the oropharynx will increases aspiration of pneumonia?

A
  • Pharyngeal tumor
  • Cerebral vascular accident
  • metabolic toxin
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8
Q

Where does the esophagus begin and end?

A
  • originate pharynx
  • approximately the sixth vertical vertebra
  • End at the stomach
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9
Q

What layers tissue make up the esophagus?

A

-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.

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10
Q

Where does the esophagus pass through diaphragm?

A

Right crus

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11
Q

List the type of tissue encountered from esophageal wall from inner to outer?

A
  • Epithelium
  • Basement membrane
  • Lamina propria
  • Muscularis mucosa
  • Submucosa
  • Muscularis propria
  • Regional lymphatics
  • Thoracic duct
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12
Q

The inferior _________ arteries supply the ______ esophagus.

A

thyroid, cervical

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13
Q

T/F: The aorta esophageal branches of the bronchial arteries supply the thoracic esophagus.

A

TRUE

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14
Q

What are the two intrinsic plexuses for the esophagus?

A
  • Auerbach plexus (Myenteric)

- Meissner Plexus (submucosal)

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15
Q

What are the extrinsic factors of the esophagus?

A
  • Sympathetic
  • Parasympathetic
  • Somatic
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16
Q

What increases tone ot the upper esophagus sphincter?

A
  • inspiration
  • esophageal distention
  • gagging
  • valsalva maneuver
  • acidity of gastric contents
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17
Q

What decreases tone of the upper esophagus sphincter?

A
  • Distention
  • Belching
  • Vomiting
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18
Q

Name the common esophageal disorders?

A
  • dysphagia
  • chronic alcoholism
  • achalasia
  • barrett esophagus
  • GERD
  • Hiatal Hernia
  • esopageal diverticula
  • esophageal carcininome
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19
Q

What do you do for dysphagia?

A
  • Find the underlying cause.
    * Barium contrast studies
    * Upper endoscopy
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20
Q

What is the pathology of chronic alcoholism for esophageal disorder?

A
  • Impaired esophageal peristalsis
  • LES hypotonia
  • Degeneration of the auerbach plexus
  • Mallory Weis Tear
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21
Q

Achalasia is the _______ of the ______ esophageal sphincter tone to relax during swallowing accompanied with a lack of peristalsis.

A

failure, lower

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22
Q

Achalasi developes secondary to which chronic disease state?:

-Diabetes
-stroke
-amyotrophic lateral sclerosis
-connective tissue diseases (amyloidosis /
scleroderma)

A

All the above.

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23
Q

What is Barrett esophagus?

A

Normal squamous epithelium changes to metaplastic columnar epithelium

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24
Q

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.

A

FALSE

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25
Q

What is the treatment for GERD?

A
  • Proton Pump inhibators (PPI)

- Histamine-2 (H2) - blocking agents

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26
Q

T/F: Hiatal hernia occurs when the stomach partially comes through a weakened abdominal wall in the upper left quadrant.

A

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.

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27
Q

What is the surgical technique for a hiatal hernia?

A

Nissen fundoplication

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28
Q

What are the three classification of a esophageal diverticula?

A

-Zenker (Upper Esophagus)
-Traction (Middle esophagus)
Epiphrenic (Lower esophagus)

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29
Q

What are the causes of esophageal carcinoma?

A
  • Advanced age
  • Cachectic
  • Malnourised
  • Chronic disease
  • Alcohol
  • tobacco use
  • Hx of chemotherapy
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30
Q

Daunorubicin and/or doxorubicin/adriamycin may have what affect on a person?

A

Cardiomyopathy due to chemotherapy

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31
Q

Bleomycin may have what affect on a person?

A

pulmonary fibrosis due to chemotherapy

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32
Q

What are some of the anesthesia consideration for a person that has esophageal disease?

A
  • 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.
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33
Q

A malnourished esophageal diseased patient who has lost 10 percent of total body weight should wait how many days before going to the OR?

A

10 days

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34
Q

What are the two section of the stomach?

A
  • Fundus

- Distal stomach

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35
Q

Where is the duodenum located?

A

Pyloric sphincter to the ligament of treitz.

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36
Q

What are the layers of the gastric wall?

A
  • Serosa (External Layer)
    • Smooth muscle
  • Muscularis mucosae
  • Submucosa
  • Mucosa
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37
Q

What does the chief cell produce in the gastric mucosa?

A

-Chief cell produces pepgenosin which is then converted to pepsin. (Chief cell secondarily produces lipase.

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38
Q

What does the G cell produce in the gastric mucosa?

A

-G cell produces gastrin

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39
Q

T/F: G cells produce gastrin which mobilize the ECL cell that creates histamine which stimulates the parietal cell to release hydrochloric acid.

A

TRUE

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40
Q

Acid release in the gastric mucosa is mediated by?

A
  • vagal stimulation (acetylcholine)
  • Gastrin release
  • Histamine
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41
Q

T/F; Gastrin is released by G cells in response to gastric distention.

A

TRUE

42
Q

What are H2 antagonists and what do they do?

A
  • cimetidine and ranitidine

- shut down histamine release from ECL cells

43
Q

What are H+/K+ inhibitors and what do they do?

A
  • Omeprazole and prostaglandins

- stops the parietal cell from production of acid

44
Q

What do anticholinergic agents do in controlling the gastic acid secretion?

A

-minor effect on parietal cell secretion

45
Q

What is the effect of a vagotomy?

A

diminshes parietal cell response to gastrin and histamine.

46
Q

What arteries supply blood to the stomach?

A
  • Right and Left gastric arteries

- Right and Left gastroepiploic arteries

47
Q

Innervation of the stomach comes from where?

A
  • Right posterior

- Left anterior (hepatic) branch

48
Q

T/F: Innervation of the stomach does not come from the vagus nerve

A

FALSE

49
Q

List the common stomach disorder/diseases?

A
  • Peptic ulcer Disease
  • Gastric ulcer Disease
  • Gastric neoplastic disease
50
Q

What are some of the causes of a peptic ulcer?

A
  • Helicobacter pylori bacterium (Major)
  • Overuse of medicaiton of ASA,NSAIDS, and corticosteroids
  • Alcohol
  • tobacco
  • STRESS
  • radiation therapy (receiving)
51
Q

Oral antacids are used for the treatment of peptic ulcers but may have what side effects?

A
  • Rebound in gastric acid secretions
  • Milk-alkali syndrome
  • Acute hypophosphatemia
52
Q

What can H2 receptor antagonists drugs do?

A
  • 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)
53
Q

T/F: Proton pump inhibitor is NOT the most antisecretory agent.

A

False

54
Q

What is the pharmacology therapy of peptic ulcer disease?

A
  • Sucralfate
  • Antibiotics
  • Misoprostol
55
Q

What does sucralfate do?

A
  • Aluminium salt of sulfated sucrose
  • binds to ulcer
  • Increases gastric mucous layer
  • helps in healing
  • devoid of side effects
56
Q

What does misoprostol do?

A
  • Synthetic prostaglandin

- Secondary therapy to prevent ulcers in patient requiring NSAIDS

57
Q

What are late signs/symptoms of gastric neoplastic disease?

A
  • Anorexia

- Weight loss

58
Q

T/F: Gastritis associated with gastric mucosal acidosis is associated with increased peri-operative morbidity and mortality.

A

TRUE

59
Q

The pancreas has both a _______ and ______ function.

A

Endocrine, Exocrine

60
Q

What are some things to remember about the exocrine function of the pancreas?

A
  • 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
61
Q

What are some things to remember about the endocrine function of the pancreas?

A

-Direct (non-ductal) production of insulin and glucagon to meet physiologic need

62
Q

T/F: Presence of acid in duodenum cause release of Cholecystokinin.

A

FALSE (release of SECRETIN)

63
Q

T/F: Presence of fats in duodenum cause release of cholecystokinin.

A

TRUE

64
Q

Secretin causes release of __________ secretions CCK causes secretion of ________.

A

bicarbonate, enzymes

65
Q

What are the S/S of ACUTE pancreatitis?

A
  • abd. pain
  • fever
  • nausea
  • vomiting
  • jaundice
  • hypotension
  • ileus
  • external distortion of stomach on radiographs
66
Q

What are the causes pancreatitis?

A
  • Alcohol abuse
  • direct of indirect trauma
  • ulcerative penetration from adjacent structures
  • infectious processes
  • biliary tract disease
  • metabolic disorders
  • drug side effect
67
Q

What is the management of acute pancreatitis?

A
  • Nasogastric suction
  • maintenance of intravascular volume
  • anticipation of respiratory insufficiency
  • analgesia
  • nutritional support
  • common bile duct exploraton
68
Q

What are the S/S of chronic pancreatitis?

A
  • Incapacitating upper abdominal pain radiating to the back.
  • Pancreatic calcification
  • Steatorrhea
  • 40% have diabetes from loss of pancreatic function
69
Q

What are common causes of chronic pancreatitis?

A
  • Chronic alcoholism
  • Chronic, significant biliary tract disease
  • Long term effects of pancreatic injury
70
Q

What are the surgical procedure of pancreatitis?

A
  • Drainage of pseudocyst
  • Pancreatojejunostomy
  • Puestow procedure
71
Q

The composition of gallstones are ________ cholesterol crystals and ________bilirubinate.

A

Hydrophobic, Calcium

72
Q

What is the anatomy of the biliary tree?

A
  • Excretory conduit for the liver
  • Composed of:
  • Intrahepatic ducts
  • Right and left hepatic ducts
  • common hepatic duct
  • gallbladder
  • cystic duct
  • common bile duct
73
Q

What causes the sphincter of Odi to dilate?

A

Glucagon

74
Q

How much does the gall bladder hold of bile?

A

30 - 50 cc

75
Q

T/F: Regulation of the gall bladder emptying is due to cholecystokinin.

A

TRUE

76
Q

_______ stimulation also plays a role - secondary to cholecystokinin.

A

Vagal

77
Q

What function does bile serve?

A
  • 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
78
Q

What is Murphy’s sign?

A

Inspiratory effort accentuates the pain in cholecystitis

79
Q

What obstruction goes with cholecystitis?

A

-cystic duct

80
Q

What obstruction goes with cholelithiasis/choledocholithiasis?

A

-Common bile duct

81
Q

What is observed with Charcot Triagle?

A
  • Fever
  • Chills
  • upper quadrant pain
82
Q

What is Charcot Triagle indicative of?

A

Cholelithiasis for acute ductal obstruction

83
Q

What type of pain will be most seen with cholecystectomy post op?

A

Left shoulder pain

84
Q

What anesthesia consideration should be considered for a cholecystectomy?

A
  • Post op pain
  • N/V
  • Peritoneal irritation from CO2
  • Intravascular volume restoration
85
Q

What anesthesia consideration should be considered for a laparoscopic surgery?

A
  • 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
86
Q

What consist of the small intestine?

A
  • Duodenum (20cm long)
  • Jejunum (100cm long)
  • ileum (150cm long)
87
Q

What are the three major classes of nutrients that enter the digestion in the small intestine?

A
  • Proteins
  • lipids (fats)
  • carbohydrates
88
Q

Digested food passes into the blood vessels in the wall of the intestine through ________.

A

diffusion

89
Q

The inner wall of the small intestine is lined with simple _________ epithelial tissue.

A

columnar

90
Q

T/F: Plicae circulares are permanent structures of the small intestine.

A

TRUE

91
Q

Name some of the diseases of the small intestine.

A
  • Malabsorption syndromes
  • celiac sprue
  • Fat malabsorption
  • Protein malabsorption
  • Maldigestion syndrome
  • deficient pancreatic secretion
  • upper GI bleed
  • Small bowel obstruction
92
Q

How long is the large intestine?

A

3-5 feet

93
Q

What are the outpouchings throughout the large intestine?

A

Haustrations

94
Q

What is the large intestine arterial supply?

A
  • Superior mesenteric artery
  • Inferior mesenteric artery
  • Internal iliac artery
95
Q

What vitamin are made in the large intestine?

A
  • K

- B

96
Q

What diseases come from the large intestine?

A
  • Inflammatory Bowel Disease
  • Chrohn’s
  • Ulcerative colitis
  • Diverticulitis
  • Abdominal compartment syndrome
  • Colonic polyps
  • colon cancer
  • colon volvulus
  • ischemic bowel
  • appendicitis
97
Q

T/F: Ulcerative colitis usually occurs in the proximal part of the large intestine.

A

FALSE (Usually happens distally in the large intestine)

98
Q

T/F: Chrohn’s can occur any where in the large intestine.

A

TRUE

99
Q

What are anesthesia considerations for intestinal surgery?

A
  • 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
100
Q

The spleen is also known as the _______ in a fetus.

A

Hematopoietic organ

101
Q

T/F: The spleen is the largest lymphatic organ.

A

TRUE

Krista/ 2 Advanced Physical Assessment and foundation of Nursing Anesthesia 2 (8 decks)

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