Health Assessment Spring 26 > Exam 4: GI Dz > Flashcards

Exam 4: GI Dz Flashcards

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1
Q

What percentage of total body mass does the GI tract constitute?

A

Approximately 5%

This highlights the relative size of the GI tract in comparison to the entire body.

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2
Q

What are the main functions of the GI tract? (5)

A
  • Motility
  • Digestion
  • Absorption
  • Circulation
  • Excretion

These functions are essential for processing food and nutrients.

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3
Q

List the layers of the GI tract from outermost to innermost.

A
  • Serosa
  • Longitudinal muscle
  • Circular muscle
  • Submucosa
  • Mucosa- where we absorb nutrients

Each layer has specific roles in the function of the GI tract.

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4
Q

What are the components of the mucosa outermost to innermost?

A
  • Muscularis mucosae
  • Lamina propria
  • Epithelium

The mucosa is crucial for absorption and secretion.

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5
Q

Function of the longitudinal muscle layer?

A

Contracts to shorten intestinal segment

This action works with circular muscle layer to move food through the GI tract.

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6
Q

Function of the circular muscle layer?

A

Contracts to decreased lumen diameter

This contraction helps in mixing and propelling contents.

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7
Q

What do the longitudinal muscle layer and the circular muscle layer do together?

A

Work together to propagate gut motility

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8
Q

What plexus innervates GI organs up to the proximal transverse colon?

A

Celiac plexus

This plexus plays a significant role in the autonomic control of the upper GI tract.

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9
Q

What are the different approaches to block the celiac plexus?

A
  • Trans-crural
  • Intraoperative
  • Peritoneal lavage
  • Endoscopic ultrasound-guided

CP blocks often performed for pancreatic or abdominal cancer pain

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10
Q

What plexus innervates the descending colon and distal GI tract?

A
  • Hypogastric plexus

may be blocked for pelvic pain (endometriosis) and pelvic cancers like uterus

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11
Q

The mucosa is composed of:

A
  • Muscularis mucosa, which functions to movethe villi
  • Lamina propria, whichcontains blood vessels & nerve endings
  • immune and inflammatory cells
  • Epithelium, where contents are sensed, enzymes secreted, and nutrients are absorbed
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12
Q

What are the components of the GI autonomic nervous system?

A
  • Extrinisic nervous system
  • Enteric nervous system (independent nervous system, which controls motility, secretions, and blood flow)

These components work together to regulate GI functions.

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13
Q

What are the components of the GI ANS extrinsic nervous system

A
  • SNS is primarily inhibitoryy and decreases GI motility
  • PNS is primarily excitatory and activates GI motility
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14
Q

What are the components of the GI ANS enteric nervous sytem

A
  • Myenteric plexus
  • Submucosal plexus
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15
Q

Effect of SNS on GI motility?

A

Inhibitory

The sympathetic nervous system generally decreases digestive activity.

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16
Q

Effect of PNS on GI motility?

A

Stimulatory

The parasympathetic nervous system enhances digestive processes.

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17
Q

Enteric Nervous system

What controls GI motility via enteric neurons, interstitial cells of Cajal (ICC cells) and smooth muscle cells

A

Myenteric plexus

This plexus coordinates the muscle contractions of the GI tract.
This plexus lies tween the smooth muscle layers

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18
Q

What is the GI pacemaker?

A

Interstitial cells of Cajal (ICC cells)

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19
Q

Enteric Nervous system

What does the submucosal plexus control?

A

Absorption, secretion, and blood flow

This plexus transmits info to the enteric nervous system and CNS

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20
Q

What plexus transmits info to the eneteric nervous system and CNS

A

Submucosal Plexus

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21
Q

What do both the myenteric plexus and submucosal plexus both respond to?

A
  • SNS and PNS stimulation
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22
Q

What is an EGD used to evaluate?

A
  • Scope of the esophagus, stomach, duodenum

This procedure is used for diagnostic purposes in upper GI tract assessment.

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23
Q

Primary anesthesia challenge with EGD?

A
  • Shared airway
    closley monitor airway! usually done without ETT
    usually just a nasal canula with end tidal CO2

This poses airway risks during the procedure due to the need for sedation.

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24
Q

Colonoscopy anesthesia concerns?

A
  • Dehydration (due to bowel prep and NPO status)
    Can be tachy to begin with

These factors must be managed to ensure patient safety.

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25
What does **esophageal manometry** measure?
**Esophageal pressure** and **LES tone** ## Footnote This test assesses the function and pressures of the esophagus and lower esophageal sphincter.- baselines obtained for nissan fundoplications
26
What does a Barium GI series assess?
* Radiologic assessment of **swallowing and GI transit**
27
What does the small intestine manometry measure?
motility of the small intestine
28
What GI diagnostic procedure involves Barium enema allowing for radiologic detection of colon/rectal abnormalities
Lower GI series
29
Three categories of **esophageal disease**?
* Anatomical * Mechanical * Neurologic ## Footnote These categories help classify the various disorders affecting the esophagus.
30
Examples of anatomical esophageal disease?
* Diverticula * Hiatal hernias * Changes associated with GERD
31
Examples of Mechanical esophageal disease?
* Achalasia (difficulty swallowing and moving food foward) * Esophageal spams * Hypertensive LES
32
Examples of neurological esophageal disease?
* Stroke * Vagotomy * Hormone defiencies ## Footnote *many disease states overlap, this is just 3 examples*
33
Most common **esophageal disorders**?
* **Dysphagia**: difficulty swallowing (may bby oropharyngeal or esophageal) * **GERD**: return of gastric contents into pharynx (heartburn, nausea, chronic cough, lump in throat) ## Footnote These conditions are frequently encountered in clinical practice.
34
Difference between **oropharyngeal vs esophageal dysphagia**?
* Oropharyngeal = **initiation issue** * Esophageal = **transit issue** ## Footnote Understanding the type of dysphagia is crucial for diagnosis and treatment.
35
When is opropharyngeal dysphagia common?
* after head and neck surgeries
36
What are the two classifications of esophageal dysphagia?
* Esophageal dysmotility * Mechanical esophageal dysphasia
37
When does esophageal dysmotility occur?
* w/liquids and solids ## Footnote *the esophagus muscles fail to properly move food and liquids to the stomach, often resulting in weak, uncoordinated, or missing contraction*
38
When does mechanical esophageal dysphasia occur?
* w/solid food only ## Footnote *hinders the movement of food down the esophagus, rather than solely a malfunction of the esophageal muscles*
39
Which esophageal disease is a described as a neuromuscular outflow obstruction?
Achalasia
40
Pathophysiology of **achalasia**?
* Lower Esophageal Sphincter fails to relax due to **unopposed cholinergic stimulation** ## Footnote This condition leads to difficulty swallowing and food retention.
41
What is the result of unopposed cholinergic LES stimulation from Achalasia?
* Esophageal dilation and hypermotility * Food unable to move forward
42
Symptoms of **achalasia**?
* Dysphagia * Regurgitation * Heart burn * Chest pain ## Footnote cant pass food down (aspiration risk) may only be able to pass clears and eventually need surgery
43
Diagnostic test for **achalasia**?
* Esophageal manometry and/or esophogram ## Footnote This test provides definitive evidence of the condition.
44
Most effective **nonsurgical treatment** for **achalasia**?
Pneumatic dilation ## Footnote This procedure helps to relieve symptoms by widening the esophagus.
45
Definitive/Best **surgical treatment** for **achalasia**?
Laparoscopic Heller myotomy ## Footnote This surgery involves cutting the muscle at the lower esophageal sphincter.
46
Medical Managment to treat Achalasia?
* Nitrates and CCBs to relax LES
47
Last resort in advanced dz state of achalasia?
* Esophagectomy
48
Where are esophageal spasm likely to occur?
Distal esophagus
49
Esophageal spasms mimic what condition? Dx? Tx?
* Angina *common in elderly* * Dx: esophagram * Tx: NTG, antidepressants, PD-I (phosphodiasterase inhibitors) ## Footnote This can lead to misdiagnosis and inappropriate treatment.
50
What is Esophageal Diverticula?
Pockets in the esophageal wall
51
What is **Zenker diverticulum** associated with? What is it AKA?
* Bad breath from food retention * AKA: pharygoesophageal diverticula ## Footnote This condition can lead to halitosis due to stagnant food- food pockets in airway begins to rot
52
Midesophageal diverticula caused by?
Old adhesions or inflamed lymph nodes
53
Epiphrenic (supradiaphragmatic) diverticula associated with?
* Achalasia
54
Key anesthesia risk with **esophageal diverticula**?
Aspiration risk → RSI indicated ## Footnote Rapid sequence induction is necessary to prevent aspiration.
55
what is a Hiatal Hernia
* Herniation of stomach, through diaphragm, into thoracic cavity
56
Hiatal hernia is commonly associated with what?
GERD ## Footnote herniation of stomach through diaphram, into thoracic cavity
57
Common presentation of **esophageal cancer**?
* Progressive dysphagia * Weight loss *poor survival rates d/t abudnant of lymph nodes prone to metastasis* ## Footnote These symptoms often lead to a late diagnosis.
58
Most common type of **esophageal cancer**?
Adenocarcinoma *often related to GERD, Barretts, Obesity*
59
esophagectomy has a high risk of what kind of injury?
Recurrent laryngeal nerve injury (40% resolve spontaneously)
60
Major anesthesia concern post-**esophagectomy**?
* Lifelong aspiration risk ## Footnote Patients require careful monitoring after this surgery.
61
Primary defect in **GERD**?
* Incompetent gastroesophageal junction *common- occurs in 15% of adults* ## Footnote This defect leads to reflux of stomach contents.
62
Bile reflux is associated with
Barret metaplasia and adenocarcinoma ## Footnote *Bile reflux is the most caustic*
63
GERD Sx:
* Sx: heratburn, dysphagia, mucosal injury
64
GERD reflux contents (4)
* HCl * Pepsin * Pancreatic enzymes * Bile
65
Three mechanisms of **GERD**?
* Gastric distention leading to LES relaxation * LES hypotension * Autonomic dysfunction of GE junction ## Footnote Understanding these mechanisms is crucial for treatment.
66
Normal LES pressure vs **GERD**?
Normal: 29 mmHg vs GERD: ~13 mmHg ## Footnote This significant difference contributes to reflux symptoms.
67
Treatement medications for **GERD**?
* H2 blockers * PPIs * Sodium citrate * Metoclopramide ## Footnote These medications help manage gastric acidity and motility. Nissen Fundoplication gold standard sx to fix GERD
68
Surgical treatments for GERD?
* Nissen fundoplication * Toupet * Dor Fundoplication * LINX
69
Induction technique for **GERD**?
RSI ## Footnote Rapid sequence induction is important to minimize aspiration risk.
70
Preop interventions for GERD
* **H2 blockers:** Cimetidine, Ranitidine (↓acid secretion & ↑gastric pH) * **PPIs** (generally given night before and morning of) * **Sodium Citrate** (PO nonparticulate antacid) * **Metoclopramide** (gastrokinetic) * **RSI indicated**
71
Major intraop **aspiration risk factors**? ## Footnote *Long list (11)*
* Full stomach * Emergent surgery * Difficult airway * Obesity * Pregnancy * Lithotomy * Gastroparesis * DM * Pregnancy * ↑intraabdominal pressure * Autonomic Neuropathy ## Footnote These factors increase the likelihood of aspiration during surgery.
72
ASA Fasting Guidlines
* Clears: 2 hours * Milk: 4 hours * Light foods: 6 hours * Heavy foods: 6 hours
73
What fluids are considered clears:
* Water * Fruit Juice w/out pulp * Black coffee
74
What is considered light foods:
* infant formula * Juice w/ pulp * Vegtables
75
What nerve increases **gastric motility**?
Vagus nerve *PNS stimulates the vagus nerve to increase the number and force of contractions* ## Footnote This nerve is part of the parasympathetic nervous system.
76
What inhibits **gastric motility**?
SNS via splanchnic nerve ## Footnote The sympathetic nervous system reduces digestive activity.
77
Neuro-Hormones increasing **motility**?
* Gastrin * Motilin * *increase the strength and frequency of contractions* ## Footnote These hormones stimulate digestive processes.
78
Hormone inhibiting **motility**?
GIP (Gastric inhibitory peptide) *Inhibits contractions* ## Footnote This hormone plays a role in slowing gastric emptying.
79
Most common cause of **non-variceal upper GI bleeding**?
Peptic ulcer disease ## Footnote This condition is a leading cause of upper GI hemorrhage.
80
Common causes of **peptic ulcer disease**?
* H. pylori * NSAIDs * ETOH ## Footnote These factors contribute to the development of ulcers.
81
Classic symptom of **peptic ulcer disease**?
Burning epigastric pain relieved by meals and exacerbated w/fasting ## Footnote This symptom is characteristic of ulcer pain.
82
Complication of untreated **PUD**?
Perforation ## Footnote This serious complication can lead to peritonitis.
83
Sudden/sever epigastric pain c/b acidic secretions into peritoneum:
Perforation
84
Peptic Ulcer Tx
* Antacids * H2 blockers * PPIs * Prostaglandin analogues (misoprostol) * Cytoprotective agents (sucralfate)
85
H. Pylori tx:
Triple therapy (2 ABX + PPI) x 14 days *amoxicillin + clarithromyxin + omeprazole*
86
Acute symptoms of **gastric outlet obstruction**?
* Projectile vomiting * Dehydration * Hyperchloremic alkalosis ## Footnote These symptoms indicate a blockage in the gastric outlet.
87
Initial treatment for **gastric outlet obstruction**?
* NG tube * IV fluids *Normally resolves in 72 hr* *Eventually will need surgery of pyrloris* ## Footnote These interventions help manage symptoms and stabilize the patient.
88
Treatments for Gastric outlet obstruction:
* Endoscopic stenting * Balloon dilation * Gastrojejunostomy
89
Cause of **Zollinger-Ellison Syndrome**?
Pancreatic tumor (Gastrinoma) causing gastric hypersecretion ## Footnote *50% gastroinomas are cancerous and metastatic at time of dx*
90
S/S of **Zollinger-Ellison Syndrome**?
* PUD * erosive esophagitis * Diarrhea ## Footnote These symptoms are indicative of the syndrome.
91
Anesthesia concern in **Zollinger-Ellison Syndrome**?
High gastric volume → RSI ## Footnote Rapid sequence induction is necessary due to increased aspiration risk.
92
Tx of Zollinger Ellison Syndrome
PPIs and surgical resection of gastrinoma
93
Affected population of ZES?
* Male * 30-50 years old
94
Primary function of the **small intestine**?
Nutrient absorption through segmentation ## Footnote This organ is crucial for the digestion and absorption of nutrients.
95
_______ and ________ coordinate to contract two nearby areas and isolae a segment for the absorption of nutrients
* circular and longitudinal muscles
96
Small intestine dysmotility Reversible causes
* **Mechanical obstruction** (hernias, malignancy, adhesions, and volvuluses) * **Bacterial overgrowth** (leads to alterations in absorptive function) * **Ileus** * **Electrolyte abnormalities**
97
Small intestine dysmotility non-reversible causes:
* **structural:** connective tissue disorders, scleroderma, IBD * **Neuropathic:** pseudo-obstruction c/b neural dysfunction
98
Inflammatory bowel diseases: (2)
* Crohn's * Ulcerative Colitis
99
Affected area in **Ulcerative Colitis**? ## Footnote inflammatory bowel disease
* Colon only (chronic inflammation dz) ## Footnote This condition is limited to the colon and rectum.
100
Sx of Ulcerative Colitis
* Sx: abd pain, n/v, fever, weight loss, diarrhea, bleeding
101
Labs in ulcerative colitis
* ↑Plts, and erythrocyte sedimentation rate * ↓H&H, and↓Ablumin
102
IBD + hemorrhage requiring 6+ units blod in 24-48 hours warrants _______
surgical colectomy
103
_______ is a complication triggered by e-lyte disturbances
**Toxic megacolon** *about 1/2 cases resolve, 1/2 cases require colectomy* *colon perforation is a dangerous complication-mortality rate 15%*
104
Chron's disease most common site
Terminal ilium
105
Crohn's disease usual presentation:
RLQ pain, ileocolitis, and diarrhea
106
Crohn's' disease Sx:
* Weight loss * Anorexia * diarrhea
107
Crohn's disease medical mainstay treatment
* 5-ASA 5-acetylsalicyclic acid *mainstay for IBD and anti-inflammatory*
108
* Crohn's disease medical treatment during flare-ups and other meds:
* Flare-ups: glucorticoids * Others: Abx: rifaximin, flagyl, cipro, purine analogues (immunosuppressant)
109
Last resort treatment for crohn's
Surgery *resected segment should be as conservative as possible (>2/3 SI resection leads to short bowel syndrome)*
110
What do **carcinoid tumors** secrete?
* Serotonin * Histamine * Other vasoactive substances ## Footnote These secretions can lead to carcinoid syndrome.
111
Where do most carcinoid tumors orginate from?
GI tract
112
Symptoms of **carcinoid syndrome**?
* Flushing * Diarrhea * Bronchospasm ## Footnote reacting to excessive serotonin release.
113
Carcinoid syndrome Tx:
* Tx: serotonin antagonist, somatostatin analogues, surgical removal or embolization
114
Preop medication for **carcinoid syndrome**?
Octreotide ## Footnote This medication helps manage symptoms before surgery.
115
Most common causes of **pancreatitis**?
* Gallstones * Alcohol *(60-80% of cases)* ## Footnote These factors are leading causes of acute pancreatitis.
116
What digestive enzyes does the pancreas contain?
* lipase * protease * amylase
117
Mechanism that prevent autodigestion of the pancreas:
* Enzymes packaged in **precursor form** * **Protease inhibitors** to shield tissue from activated enzymes * **low intra-pancreastic calcium** = low minimize trypsin activity
118
Classic symptom of **pancreatitis**?
Epigastric pain radiating to the back ## Footnote This symptom is characteristic of pancreatitis.
119
Sx of acute pancreatitis:
Sx: intense epigastric pain radiating to back, N/V, abd distention, steatorrhea, ileus, fever, tachycardia, HoTN
120
Key labs for **pancreatitis**?
* Elevated amylase * Elevated lipase ERCP - examine biliary and pancreatic ducts - remove stone removal, stent placement ## Footnote These enzymes are typically elevated in cases of pancreatitis.
121
acute pancreatitis treatment:
* NPO * IV hydration * Enteral feeding preferred over TPN (high glucose inhibits healing, and greater risk of infectious complications) * Opiods
122
What tx can examine biliary and pacreatic ducts, and even perform stone removal, stent placement, sphincterotomy for acute pancreatitis?
ERCP (Endoscopic-retrograde cholangiopancreatography)
123
is upper GIB or lower GIB more common
Upper GIB
124
What does orthostatic HoTN in GIB indicate?
HCT < 30%
125
What does melena indicate ## Footnote more common then lower Gi bleed
Bleed is above the cecum *where small intestine meets the colon* ## Footnote This term refers to black, tarry stools indicative of upper GI bleeding.
126
What lab will you see in **upper GI bleed**?
BUN > 40 mg/dL ## Footnote This lab finding can indicate blood loss in the upper GI tract.
127
First-line intervention for **GI bleeding**?
EGD *ulcers - ligated* *ligation of bleeding varicies* ## Footnote This procedure is often the first step in managing upper GI bleeding.
128
Last resort for uncontrolled variceal bleeding
Balloon tamponade
129
Common causes of **lower GI bleeding**? ## Footnote more common in elderly
* Diverticulosis * Tumors * Colitis ## Footnote These conditions are frequent causes of lower gastrointestinal bleeding.
130
lower GIB more common in who?
Elderly population
131
Definition of **ileus**?
Intestinal paralysis without mechanical obstruction ## Footnote This condition can lead to bowel distention and dysfunction.
132
Common causes of **ileus**?
* Electrolyte imbalance * Opioids * Immobility * anticholinergics * pancreatitis ## Footnote These factors can contribute to the development of ileus.
133
Treatment for **ileus**?
* Electrolyte balance * NG suction * Fluids * Mobilize * Enemas ## Footnote These interventions help restore normal bowel function.
134
Neostigmine dose for ileus
2-2.5 mg over 5 min *produces immediate results in 80-90%*
135
What can occur if ileus left untreated?
ischemia and perforation
136
Effect of **volatile anesthetics** on GI?
* Decrease GI motility (further slowed with Anxiety, and opiods) ## Footnote This effect can lead to postoperative complications.
137
First GI segment to recover **postop**?
1-Small intestine 2-stomach (24 hrs) 3-Colon (30-40 hrs) ## Footnote This segment typically resumes function before others.
138
Effect of **nitrous oxide**?
Expands gas → bowel distention ## Footnote This can complicate surgical procedures involving the GI tract.
139
Effect of **neostigmine**?
Increases GI motility ## Footnote This medication is used to counteract opioid-induced constipation.
140
Effect of **sugammadex**?
No significant effect on GI motility ## Footnote This medication is primarily used for reversing neuromuscular blockade.
141
How do opioids reduce GI motility
* Stimulate mu, delta, and kappa receptors * There is an abundance of mu receptors in myenteric and submucosal plexuses, leading to slower GI transit
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