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Flashcards in GI/Liver Deck (57)
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1

What are the guidelines for NPO status pre-operatively in a healthy patient?

no chewing gum or candy after midnight
clear liquids up to 2 hours before
breast milk up to 4 hours before
light meal, milk or formula up to 6 hours before

(only really applicable in ASA class 1 or 2 patients)

2

What are some factors that make a patient at high risk for aspiration?

age extremes
ascites or ESLD
metabolic disorders like DM, ESRD or hypothyroid
hiatal hernia/GERD
mechanical obstruction like intestinal obstructions or pyloric stenosis
prematurity
pregnancy
obesity
neurologic disease

3

What kinds of patients are at the GREATEST risk of aspiration?

high anxiety pre-op
obesity
pregnancy (esp after 14 weeks)
hiatal hernia

4

What are some common treatments for aspiration prophylaxis?

h2 antagonists
sodium citrate (bicitra)
reglan
omeprazole

5

H2 Antagonists -- special considerations?

act as competitive antagonists at the H2 receptors at the gastric parietal cells to decrease acid secretion

best if given the night before surgery and then repeated 1 hour before surgery

ex. cimetidine and famotidine

6

metoclopramide -- special considerations

acts as a dopamine antagonist to increase pressure at the lower esophageal sphincter to speed up gastric emptying

prevent or alleviates N/V

CONTRAINDICATED in intestinal obstruction

7

sodium bicitrate (bicitra) -- special considerations

its a non-particulate antacid used to raise gastric pH (30 mL of volume which may contribute to aspiration risk)

give it 15 minutes before surgery and it will last for 3 hours

not indicated if the patient has no risk factors for aspiration, per ASA

8

What are some physiologic risk factors for aspiration pneumonitis?

pH 25 mL in 70 kg patient

9

What are the manifestations of aspiration pneumonitis?

potentially the only sign intra-op might be a persistent desat with the tube definitely in the right place

bronchospasm, cyanosis, tachycardia, dyspnea

10

how are aspiration syndromes characterized?

by volume aspirated, type of material aspirated, pH of the material

11

What is the treatment for Barrett's Esophagus?

H2 blockers, PPIs, nissen fundoplication

12

what are S&S of barrett's esophagus?

dysphagia, reflux esophagitis, heartburn, LES dystonia, weight loss

13

How would you modify the anesthetic plan in the case of a patient with Barrett's Esophagus?

prepare for an RSI

14

What are the S&S of a hiatal hernia?

retro-sternal discomfort
reflux after meals

15

What is the usual cause of peptic ulcer disease?

H. Pylori

16

What are some typical treatments for peptic ulcer disease?

H2 antagonists, PPIs, antimicrobial therapy, antacids

17

Who is at high risk for a peptic ulcer?

chronic NSAID use, age 45-60, ETOH

18

What are the S&S of peptic ulcer disease?

vomiting blood
epigastric pain
abdominal tenderness and rigidity
perforation
weight loss
anorexia
metabolic disturbances

19

What are some examples of malabsorption syndromes?

celiac's disease
protein malabsorption syndromes
fat malabsorption syndromes
small bowel perforation or obstruction

20

What is the clinical significance of malabsorption syndromes?

metabolic disturbances that change electrolytes and fluid status

21

What are some S&S of malabsorption syndromes?

unexplained weight loss
fatty stools
diarrhea
anemia
fatigue
Vit K deficient
bleeding
edema/ascites

22

What is the clinical significance of Crohn's disease pre-anesthetically?

deficient in multiple vitamins and minerals such as B12, phosphorous, folic acid, zinc, iron, K+

hypoalbuminemia

anemia

23

What are the S&S of ulcerative colitis?

intermittent bloody diarrhea
fever/malaise
anorexia
abdominal pain
weight loss

24

What are some anesthetic considerations for a patient with large colon dysfunction, such as Crohn's and uclerative colitis?

patient may be on chronic steroids and would require a stress dose pre or intra op

prepare for immune suppression r/t meds and higher infection risk

25

What is carcinoid syndrome?

a small tumor that has originated in the GI tract or bronchi and will produce hormones that can be secreted in the blood and cause systemic effects

26

What are some S&S of carcinoid syndromes?

cutaneous flushing, diarrhea, palpitations, bronchospasm, dyspnea, hypotension, hypertension, orthostasis

*may want to consider a 12 lead EKG if there are S&S of a dysrhythmia

27

What is the problem with having a carcinoid syndrome?

the tumors secrete hormones such as bradykinin, serotonin, dopamine and and histamine

28

What are some helpful lab values when taking care of a patient with severe GI or liver disease?

Hct, albumin, serum electolytes, BUN

29

Nutritional deficiencies are associated with what poor outcomes?

prolonged hospital stays
poor wound healing
higher infection rate
respiratory failure
death

30

What is a relatively accurate indicator of malnutrition?

serum albumin