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Coexisting conditions > GI > Flashcards

GI Flashcards

1
Q

What do diffuse esophageal spasms mimic?

A
  • Mimics angina
    • if they come in for a scope for this, they have probably already seen a cardiologist
  • most often occur in elderly
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2
Q

Upper Endoscopy:

sedation goal?

type of anesthesia?

What do you need to have?

A
  • Goal: to avoid apnea
    • avoid oversedation
    • have entire airway setup ready just in case
  • TIVA- propofol
    • maybe with fentanyl and/or lidocaine to decrease cough/gag with scope
  • Bite block, before sedation
  • Ambu bag
  • airway setup
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3
Q

A little about how this works…

A
  • Pt will be positioned on side
  • Surgeon will flood stomach with irrigation while scoping
  • Will suction stomach out before removing scope
  • both irrigation and suction happen through this scope wand thingie
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4
Q

What does ERCP stand for?

What is it used for?

A
  • Endoscopic Retrograde Cholangio-pancreatography
  • used to diagnose and treat conditions of the bile ducts
    • gallstones
    • inflammatory strictures
    • leaks (from trauma and surgery)
    • cancer
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5
Q

How does an ERCP “work?”

Duration of procedure?

Type of anesthesia?

Concern?

A
  • ERCP combines the use of X-rays and an endoscope
  • duration is 30 min to 2 hours
  • TIVA if short case, GA if case is more complicated
  • Concern for aspiration, extubate wide awake with full airway protective reflexes back.
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6
Q

What is chronic peptic esophagitis?

surgery?

A
  • “heartburn”
  • retrosternal discomfort relieved by antacids
  • if persistant and severe, may require surgery
    • Nissen fundoplication
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7
Q

What are some anesthetic considerations for a pt with chronic peptic esophagitis?

A
  • Pretreatment with aspiration/RSI meds
  • antibiotics
  • NG or OG inserted for surgery
    • keep to gravity
    • use NG if it will need to remain post-op
  • N/V post op- zofran
  • pain management
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8
Q

How can the Nissen fundoplication be done?

Anesthesia type?

A
  • Open or laparoscopic
  • Laparoscopic is more commone
    • 5 small incisions
    • one for laparoscope, the other 4 to retract and manipulate
  • General anesthesia
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9
Q

What is the Roux en y surgery?

A
  • bypass procedure that creates a stomach pouch out of a small portion of the stomach and attaches it directly to the small intestine, bypassing a large part of the stomach and duodenum
    • laparoscopic most common
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10
Q

What should you consider with an obese patient?

A
  • Positioning- ramping for intubation
  • airway may be difficult
  • RSI
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11
Q

Anesthesia considerations for Hiatal hernia?

A
  • RSI- premeds
  • implications depend on severity of the signs and symptoms
    • Ex. does the patient sleep sitting up?
  • awake extubation
  • OG
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12
Q

Anesthesia considerations for achalasia?

A
  • Risk of aspiration
    • pre-induction decompression
    • may place NG to suction
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13
Q

What is peptic ulcer disease?

Signs and symptoms?

A
  • Mucosal alteration of the esophagus, stomach or duodenum due to increased gastrin and HCl production
  • S/S
    • midepigastric pain, relieved by food or antacids
    • hemorrhage resulting in chronic anemia
    • Gastric outlet obstruction
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14
Q

What is gastric outlet syndrome?

A
  • obstruction at the pyloris exiting stomach
  • If pt retains >300 ml 30 minutes after drinking 750 ml of saline
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15
Q

What are the treatments for PUD?

What are the anesthetic implications of these treatments?

A
  • H-2 antagonists and anticholinergics are used to treat PUD more than surgery
    • pyloroplasty and/or vagotomy
  • Anesthetic implications:
    • H-2 antagonists may inhibit CYP450
    • nasogastric suctioning
    • RSI
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16
Q

What is UC?

A
  • inflammation of colonic mucosa
    • rectum and distal colon
  • most common in women age 25-45 and Jewish origin
  • diarrhea, cramping, abdominal pain
  • low grade fever, fatigue, weight loss during exacerbations
17
Q

What is crohn’s disease?

What are some extracolonic features of this disease?

A
  • Inflammation of all layers of the bowel
  • leads to fistula development
  • Extracolonic features
    • arthritis
    • calcium oxalate (renal and gallstones due to increased absorption of oxalate by the colon
    • decreased albumin-protein loss via diseased bowel
18
Q

What are the anesthetic considerations for Inflammatory bowel disease?

A
  • Fluid and electrolyte management
  • avoid nitrous oxide
  • supplemental (stress dose) steroids may be indicated
  • anticholinesterases increase intraluminal pressure
    • stay on lower end of dosing
    • try to get 3-4 twitches back before reversing
19
Q

What do carcinoid tumors cause?

what is the treatment?

A
  • Carcinoid tumors secrete corticotropic hromones, GHRF, and cause cushing syndrome
  • Carcinoid syndrome
    • cutaneous flushing
    • bronchospasm
    • hypotension
    • diarrhea
  • treatment
    • somatostatin analogue octreotide
    • resection of tumor by surgery
20
Q

What are some anesthesia considerations for a patient with a carcinoid tumor?

A
  • continue the octreotide
    • can interfere with insulin release; exacerbate diabetes
    • short half life, must be given continuously
    • binds to receptor sites on the tumor to decrease symptoms
  • bronchospasm of carcinoid tumor can be resistant to treatment
    • Octreotide 100-200 mcg IV
    • histamine blockers and ipratropium
  • avoid histamine releasing drugs
  • avoid ketamine
  • avoid catecholamines b/c they release seratonin
  • Arterial line necessary d/t hemodynamic variables
21
Q

What are some concerns for acute and chronic pancreatitis?

A
  • Acute
    • can have major organ involvement
      • ARDS
      • renal failure
      • GI hemorrhage
      • DIC
    • shock- hypovolemia seen even in mild pancreatitis
      • fluid management very important
  • Chronic
    • DM results from loss of endocrine function
    • malnutrition
    • opioids used for pain control
22
Q

Where does GI bleeding often originate from?

A
  • Most often from the upper GI tract
  • Bleeding from the lower GI tract (diverticulosis or tumor) accounts for 10-20%, commonly older patients
23
Q

What are some concerns regarding a patient with a GI bleed?

A
  • low H&H
  • hypotension and tachycardia (if blood loss exceeds 25% of total blood volume)
  • must replace fluid volume, which may make anemia more obvious
  • If esophageal vericies are bleeding, considered a full stomach
24
Q

Appendicitis:

symptoms

treatment/considerations

A
  • Pain, N/V, dehydration, anorexia
    • preload with fluids
  • Surgical treatment
    • may need RSI d/t slow digestion experienced by anybody in pain
    • antibiotics
    • avoid N2O
25
Q

Anesthesia considerations for bowel obstruction

A
  • No metochlopramide- avoid agents that increase gastric motility
  • no N2O
  • RSI
  • Low albumin
  • require fluid volume replacement and electrolyte corrections
  • OGT to suction or gravity
26
Q

What are the anesthetic considerations for a patient with cholecystitis?

type of surgery?

A
  • Laparoscopic approach
    • insufflation will increase intra-abdominal pressure
    • insufflation can interfere with ventialtion; reverse trendelenberg position will help
    • impacts cardiovascular system and venous return
    • high intra-abdominal pressure causes concern for reflux (OG tube)
  • ETCO2 will increase- d/t ventilation changes and the insufflated CO2 into the abdomen
    • decrease TV, increase RR
  • Opioids can cause spincter of Oddi spasm whenever dealing with the gallbladder
    • Can improve with Naloxone, glucagon, or NTG
    • Don’t actually use naloxone ever
    • NTG may be better for a diabetic patient

Coexisting conditions (34 decks)

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