GI Pathophys

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Most common site for PUD obstruction Pyloric canal
Most common site for PUD perforation PANCREAS
Procedure used to decrease stomach acid production VAGOTOMY
Ulcerative Colitis is 3x more common in _____ dz Crohns
Healthy/inflammed areas & occurs in ALL LAYERS of the colon wall Crohns
Continuous inflammation/affects INNER MOST lining Ulcerative Colitis
UC can have EXTRAINTESTINAL symptoms (EIS) involve which systems Musculoskeletal, Eye, Skin, Hepatobiliary, Coag, Pulmonary
in pt with UC what do you need to leave in NG tube
what is key with congenital diaphragmatic hernia EARLY recognition
Congenital Diaphragmatic Hernia is ______, which is more common (Bochdalek hernia) POSTERIOLATERAL
Over production of ___ & ____ lead to erosion of protective mucosal layer of stomach leading to ulcer formation HCL & pepsin
Duodenal & gastric ulcers are associated with what bacteria Heliobacter Pylori (gram-negative)
2nd most common caused of ulcer after H. Pylori NSAIDS
TRIPLE THERAPY for H. pylori PPIs, Clarithromycin, Amoxicillin
what is a GRAHAM patch Part of the OMETUM is sewed over the ULCER perforation
developmental discontinuity of the diaphragm that allows abdominal viscera to herniate into the chest Congenital Diaphragmatic Hernia
The other 2 % of CDH is the MORGAGNI hernia and it is located where? Anteriomedial
Initial TX for CDH INTUBATION & ventilation , maintain BP map >50
Where can lines be place for CDH Umbilical Artery & Vein
DOPAMINE, DOBUTAMINE & HYDROCORTISONE are meds used for treatment of CDH FYI
What type of HIATAL HERNIA is the Sliding type (95% asymptomatic): movement of upper stomach into hiatus TYPE I
what type of HIATAL hernia is PARAESPOHOGEAL type: esophogogastric junction remains in place but all or part of STOMACH moves in THORAX TYPE II
Combine features of I & II of hiatal hernia TYPE III hiatal hernia
Other organs, such as the colon or small bowel are contained in the hernia sac by a large paraesophageal hernia TYPE IV hiatal hernia
GERD symptoms are more common in which type of hiatal hernia TYPE I
Fingers placed under rib cage when patient inhales. Inspiration causes the gallbladder to descend onto the finger, causing PAIN MURPHY's SIGN
FLOW of BILE thru the BILIARY TREE Intrahepatic ducts > L/R hepatic ducts > common bile duct (CBD) > CYSTIC duct (coming off gallbladder) Pancreatic Duct (from pancreas) drains into CBD > CBD ends at the DUODENUM with the SPINCTER of ODDI
TRIAD for SYMPTOMS of Gallbladder Dz & confirmation RUQ pain, FEVER, Leukocytosis (>WBC) & confirmed with CT Scan
What ventilator setting is used for insufflation? PCV
if placed in STEEP trendelenburg what do you need to check TUBE placement -> right main stem
CO2 levels are usually ____ higher than actual patients 5 mmHG
primarily the continuous transductal secretion of 2.5 liters of clear, colorless, bicarbonate-rich (pH 8.3) pancreatic juice per day EXOCRINE function of the PANCREAS (acinar cells)
what is the principal function of the PANCREATIC juice duodenal alkalization to promote optimal activity of pancreatic enzymes
Released in response to FATS & Proteins to help digest CCK-PZ (cholecystokinin-pancreozymin)
Causes the pancreas to release BICARB SECRETIN
responsible for the conversion of large ingested proteins into smaller peptides and amino acids in there preparation for intestinal absorption TRYPSINOGEN
Regulation of plasma glucose level through the release of glucagon and insulin ENDOCRINE function of the PANCREAS
Endocrine cells of the pancreas reside where in the PANCREAS? ISLETS of LANGERHANS
Pancreatic islet ALPHA cells secrete what? GLUCAGON
Pancreatic islet BETA cells secrete what? INSULIN
Pancreatic islet DELTA cells secrete what SOMATOSTATIN (GH-relasing inhibitory factor) > controls plasma levels of insulin & glucagon & gastrin
regulation of body energy by controlling carbohydrate metabolism chief ENDOCRINE function of pancreas
hormone of energy storage by decreasing blood glucose levels, increasing protein synthesis, decreasing glycogenolysis, decreasing lipolysis, and increasing glucose transport into cells are FUNCTIONS of what? INSULIN
increasing blood glucose levels thru stimulation of GLYCOGENOLYSIS, GLUCONEOGENSIS, and LIPOLYSIS GLUCAGON
Most common cause of PANCREATITIS ETOH abuse
Main cause of DEATH in pancreatitis MODS
what pain med should be AVOID with sever pain with ACUTE PANCREATITIS MORPHINE
Tx for ACUTE PANCREATITIS Immediate circulatory & electrolyte resuscitation
LAB indicative of ACUTE PANCREATITIS C-reactive Protein ( >150mg/L with 72 hours)
Steatorrhea, pancreatic calcification, and diabetes mellitus are classic diagnostic criteria for what condition? Chronic pancreatitis
Jaundice, ascites, esophageal varices, coagulopathy, pericardial & pleural effusions are the clinical picture of someone with? chronic pancreatitis
which lab values are low with chronic pancreatitis LOW ALBUMIN & MAGNESIUM
Carpopedal spasm can be caused by decreased levels of IONIZED calcium -> watch ECG for LENGTHENED QT intervals FYI
4-2-1 rule 4ml/kg/hr – first 10 kg, 2ml/kg/hr 10-20kg, 1ml/kg/hr >20kg
Bowel prep can account for up to how much fluid loss 1500 cc
1:1 replacement with COLLOIDs & ______ HESPAN (NS + hetastarch))/HEXTEND (LR + hetastarch)
slow-growing malignancies composed of enterochromaffin cells (Kulchitsky cells) and are most commonly found in the GI tract Carcinoid Tumors
Common locations for CARCINOID Tumors Appendix 45%, Jejuno-ileum 28%, Rectum 16%, Duodenum 4%
Most IMPORTANT humoral agents secreted by CARCINOID tumor HISTAMINE, SERONTONIN, KININ Peptides
Elevated levels of 5-HIAA in urine (5-hydroxyindoleacetic acid) can diagnose carcinoid Serotonin is metabolized by aldehyde dehydrogenase and monoamine oxidase (MAO) to 5-HIAA
Increased levels cause vasoconstriction or vasodilation; thus both HTN & HYPOtn, INCREASED gut motility, vomiting, bronchospasm, hyperglycemia & prolonged drowsiness SEROTONIN Efx
predominantly in patients with gastric or foregut carcinoids and may be due to the presence of histidine decarboxylase in normal gastric mucosa HISTAMINE secretions
probably responsible for the bronchospasm seen in some carcinoid patients, and it also may be the cause of flushing HISTAMINE secretions
produced by the action of proteolytic enzymes, called KALLIKREINS -> triggered by SNS stimulation KININ (bradykinin) secretions
which vaconstictor is PREFERRED NEO > ephedrine
produce profound vasomotor relaxation, causing severe hypotension and flushing, probably via increased nitric oxide synthesis, bronchospasms (ESP in asthmatics & in the presence of cardiac dz KININ
Episodic flushing r/t to which 2 humeral agents KININs, HISTAMINE
Bronchoconstriction of carcinoid syndrome is cause by which humeral agents SEROTONIN, BradyKININ, SubsP
HYPOtn of carcinoid syndrome is caused by which humeral agents KININS & HISTAMINE
HTN of carcinoid syndrome is caused by which humeral agents SEROTONIN
Carcinoid + ______ involvement decreases overall survival CARDIAC
cardiac S/S in CARCINOID syndrome Pulmonic & tricuspid valve thickening & stenosis, endocardial fibrosis
Therapeutic treatment for Carcinoid symdrome OCTREOTIDE (sandostatin)- blunts the vasoactive & bronchoconstrictive efx of the tumor products
Severe flushing with associated dramatic changes in blood pressure (BP), cardiac arrhythmias, bronchoconstriction, and mental status changes Clinical Manifestations of CARCINOID
MOST affective treatment for CARCINOID TUMORS complete surgical excision of the tumor
type of ANESTHESIA for these patients GETA to avoid sympathectomy associated with neuraxial
LABS need for carcinoid CMP, Blood Count, Liver function panel, BG, ECG, urinary 5-HIAA
ART line for CARCINOID case? MANDATORY
MEDS to avoid in CARCINOID case KETAMINE, SUCC, EPHEDRINE, Morphine, Thiopental, Pancuronium, atracurium
Primary & secondary choice for MUSCLE relaxants in carcinoid VEC then ROC
Best choice of OPIOD in carcinoid case FENTANYL
INH agents preferred for carcinoid case DES preferred but others will work (NITROUS ok)
which MED is used to treat HYPOtn refractory to OCTREOTIDE APROTININ (kallikren inhibitor)
nonbilious postprandial emesis that becomes more projectile with time, a palpable pylorus, and visible peristaltic waves clinical symptoms of Pyloric Stenosis
surgical procedure to fix pyloric stenosis Pyloromyotomy
Fluid, electrolyte, and acid-base balance should becorrected prior to anesthesia for pyloric stenosis FYI
INTUBATE ASAP, stomach emptied BEFORE induction, MODIFIED RSI, extubated awake FYI

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