Term
| State path through GI system beginning with stomach |
|
Definition
| Stomach--pyloris--duodenum--jejunem--ilium--ascending--tranvers-e-decending colon. |
|
|
Term
| What percentage of resting CO does the liver receive? |
|
Definition
|
|
Term
| Blood supply to the liver |
|
Definition
| 70% from portal vein. 30% from portal artery. Gets ~50% of 02 from each. Both have terminal branches that empty and mix in liver sinusoids. Empties into the central vein of each lobule and then the vena cava |
|
|
Term
|
Definition
| Inversely related to splanchic SVR. If hepatic artery flow increases,flow decreases in the portal vein. The reciprocal is also true. |
|
|
Term
| The portal triad consists of? |
|
Definition
| The bile duct, hepatic arteriole, and portal venule |
|
|
Term
|
Definition
| When bile is not flowing into the intestine, it is diverted to the gall bladder where it is dehydrated and stored. |
|
|
Term
|
Definition
| tissue macrophages efficiently scavenge bacteria that get into portal venous blood through breaks in the intestinal epithelium, thus preventing invasion of the systemic circulation. |
|
|
Term
| Bile production and its constituents |
|
Definition
| 400-800cc/day. Contains water, bile acids, cholesterol, phospholipids, and bilirubin |
|
|
Term
|
Definition
| Digestion and absorption of fats and fat-soluble vitamins in the small intestine. Many waste products, including bilirubin, are eliminated from the body by secretion into bile and elimination in feces. |
|
|
Term
| Bile secretion and cholesterol |
|
Definition
| Provides route of excretion for cholesterol. Gall stones are made of cholesterol. Bile acids breakdown 500mg cholesterol/d |
|
|
Term
|
Definition
| emulsification of fat globules, formation of micelles- aggregates of fatty molecules made soluble for transport by bile acids. Also absorbs and transports fat soluble vitamins |
|
|
Term
|
Definition
| Release stimulated by fat in duodenum. Causes contractions of gall bladder and common bile duct to release bile into gut |
|
|
Term
|
Definition
| This hormone is secreted in response to acid in the duodenum. It simulates biliary duct cells to secrete bicarbonate and water. |
|
|
Term
|
Definition
| from an ingested meal enters the small intestine, acid and partially digested fats and proteins stimulate secretion of cholecystokinin and secretin. |
|
|
Term
| Main physiologic role of bilirubin |
|
Definition
| Antioxidant. Biliverdin reduces to bilirubin via biliverdin reductase. When bilirubin is oxidized, it becomes biliverdin again. slide20 |
|
|
Term
|
Definition
| AKA unconjugated, indirect. Is water soluble. Released into plasma, is bound to albumin until becoming unbound in the liver. |
|
|
Term
|
Definition
| AKA direct. Is water insoluble. Is conjugated in the liver to glucuronic acid or sulfate and secreted in bile. In large intestine becomes urobiligen, then stercobiligen, and oxidzed to stercobilin and excreted in feces. Some excreted in urine as urobilin |
|
|
Term
|
Definition
Direct: up to 0.3mg/dl
Indirect: 0.1-1 mg/dl |
|
|
Term
|
Definition
| Cytochrome p450. Oxidation, reduction, dealkylation. More suseptible to age and hepatic disease |
|
|
Term
|
Definition
| Conjugation with hydrophilic compounds. |
|
|
Term
|
Definition
| dependent on rate of delivery, intrinsic metabolic clearance, and biliary excretion |
|
|
Term
| Intrinsic metabolic clearance |
|
Definition
| a) high clearance drugs: efficiently metabolized, clearance approaches rate at which they traverse the liver; eg: lidocaine. b) low clearance drugs: independent of blood flow, more dependent on free fraction; eg: diazepam, thiopental |
|
|
Term
| Parenchymal liver disease |
|
Definition
| viral, steatohepatitis, hepatic cirrhosis, fulminant hepatic failure ( ESLD) |
|
|
Term
| Cholestatic liver disease |
|
Definition
| intrahepatic and extrahepatic biliary obstruction |
|
|
Term
|
Definition
Can be viral, drug or toxin related
Hepatitis A, B, C, D, and E are all variants. Most of the reported cases are Hep B, then Hep A, and Hep C
Patients can become chronically infected with Hep B, C, or D
Infections may be asymptomatic or may cause non-specific flu-like symptoms or jaundice. |
|
|
Term
|
Definition
May be sexually transmitted, or among IV drug abusers, and oral fecal contamination.
Virus is shed in stool for 14 to 21 days before jaundice sets in
Patients are no longer infectious 21 days after onset
IgM antibodies detectable at onset and usually disappear within 60 to 120 days
IgG antibodies achieve high titers during convalescence and persist indefinitely, conferring immunity |
|
|
Term
|
Definition
Transmitted primarily through percutaneous inoculation of infected serum or blood products
Also sexually transmitted and can be transmitted to the fetus during pregnancy |
|
|
Term
|
Definition
Transmitted via parenteral routes (blood transfusions, occupational exposure to blood/blood products, IVDA
Progression to chronic Hep C and cirrhosis is the most common indication for liver transplant |
|
|
Term
|
Definition
Occurs only in patients with Hepatitis B
Transmitted via the percutaneous route |
|
|
Term
| Symptoms of hepatic disease |
|
Definition
| Icterus, Palmar erythema, Spider angiomas, Gynecomastia, Ascites, Peripheral edema |
|
|
Term
| Symptoms of hepatobiliary disease |
|
Definition
| Fatigue, Anorexia, N/V, Biliary colic, Pruritus, Fever, Dark colored urine, Light colored stools |
|
|
Term
|
Definition
| AST/ALT are sensitive indicators of viral hepatitis.AST and ALT increase 7 to 14 days before onset of jaundice and begin to decrease shortly before jaundice develops. Alkaline phosphatase is not increased unless cholestasis develops at a later phase. Increased gamma globulins suggest chronic active hepatitis rather than active viral hepatitis |
|
|
Term
|
Definition
| With chronic Hep C, administration of interferon combined with ribavirin is the preferred treatment. Liver transplantation is a consideration when patients develop encephalopathy and coagulation abnormalities |
|
|
Term
|
Definition
With chronic Hep C, administration of interferon combined with ribavirin is the preferred treatment
Liver transplantation is a consideration when patients develop encephalopathy and coagulation abnormalities |
|
|
Term
|
Definition
Halothane hepatitis: severe post op hepatitis
Symptoms ( usually 3-6 days post op): fever, N/V, chills, maculopapular rash, jaundice
Risks: prior exposure to halothane, obesity, hispanic ethnicity |
|
|
Term
|
Definition
Long term elevation of liver enzymes and evidence of hepatocyte inflammation on liver bx
Usually greater than 6 months of disease
May be caused by virus, drugs, Wilson’s disease, alpha-1-antitrypsin deficiency, or early primary biliary cirrhosis and primary sclerosing cholangitis
S/S are fatigue, malaise, mild abdominal pain.
Extrahepatic manifestations are common and include arthralgias, arthritis, glomerulonephritis, skin rashes, amenorrhea, and thyroiditis |
|
|
Term
|
Definition
| Cirrhosis shares the same nondiagnostic signs as hepatitis, but other findings can include: palmar erythema, spider nevi, gynecomastia, testicular atrophy, and evidence of portal hypertension. Cirrhotic liver is enlarged |
|
|
Term
|
Definition
| There are different types of cirrhosis: alcoholic, post-necrotic, primary biliary, hemochromatosis, Wilson’s disease, alpha-1—antitrypsin deficiency, and nonalcoholic steatohepatitis |
|
|
Term
|
Definition
| AST/ALT ratio of at least 2:1,decreased albumin, prolonged PTT, increased AST and ALT. Folate deficiency can be seen as megablastic anemia |
|
|
Term
|
Definition
Characterized by a shrunken liver containing regenerating nodules
Commonly caused by chronic viral hepatitis |
|
|
Term
| Primary Biliary Cirrhosis |
|
Definition
Most often in women 30 to 50 years of age
Autoimmune mechanism
Treatment is ursodiol to decrease bile acid toxicity |
|
|
Term
|
Definition
Large amounts of iron deposited in hepatocytes, resulting in scarring and cirrhosis
Iron deposits in the pancreas and heart muscle are associated with CHF and DM
There is a bronze discoloration of the skin and hepatosplenomegaly is common
Tx is by removal of excess iron (phlebotomy) before cirrhosis develops |
|
|
Term
|
Definition
Hepatolenticular degeneration.Autosomal recessive disorder due to a gene defect that codes for copper binding, leading to a total body copper increase
Neurologic dysfunction from copper toxicity manifests as tremors, gait disturbances, and slurring of speech
Hepatic dysfunction (fatigue, jaundice, ascites, splenomegaly, gastroesophageal varices) develop
Hemolytic anemia is an associated sign
Pathognomonic sign is the Kayser-Fleischer ring (a thin brown crescent of pigmentation at the periphery of the cornea
Lab findings include increased urinary copper excretion
Tx with chelating drugs that bind copper and urinary excretion |
|
|
Term
|
Definition
Fat accumulation associated with obesity, hyperlipidemia, and diabetes mellitus
Usually follows poor diabetic control or rapid weight loss
TX: controlled weight loss |
|
|
Term
|
Definition
| Massively dilated submucosal veins that permit passage of splanchnic venous blood from the high-pressure portal venous system to the low-pressure thoracic veins. When bleeding does occur, variceal hemorrhage is usually from the distal esophagus or proximal stomach, |
|
|
Term
|
Definition
| Transjugular intrahepatic portosystemic shunt (TIPS) is a possible intervention when patients are refractory to endoscopic therapy. Hepatic encephalopathy develops in some patients after this procedure and is refractory to tx. |
|
|
Term
|
Definition
| Ascites that is refractory to diuresis can be managed with a LeVeen Shunt that routes ascitic fluid SQ from the peritoneal cavity to the IJ through a one way valve. LeVeen Shunts have many complications that limit their use (peritonitis, rupture of esophageal varices, and DIC) |
|
|
Term
| Propranolol in liver disfunction |
|
Definition
| Propanolol produces sustained lowering of portal venous pressures |
|
|
Term
|
Definition
| Consists of fever, leukocytosis, abdominal pain, and decreased bowel sounds. Cirrhosis likely facilitates this process by permitting enteric organisms to enter the systemic circulation via the portosystemic collaterals, thereby bypassing the major reticuloendothelial system in the liver. Despite antibiotic therapy, mortality is about 50% |
|
|
Term
| Systemic circulation in cirrhosis |
|
Definition
Hyperdynamic circulation characterized by increased cardiac output (due to vasodilating substances such as glucagon; increased intravascular volume, decreased viscosity of blood secondary to anemia. Cardiomyopathy seen as CHF occurs in alcoholic cirrhosis. Megaloblastic anemia is frequent and is due to antagonism of folate by alcohol rather than dietary deficiencies. Thrombocytopenia is likely
BBB in alcoholic cardiomyopathy |
|
|
Term
| Systemic circulation in cirrhosis |
|
Definition
Hyperdynamic circulation characterized by increased cardiac output (due to vasodilating substances such as glucagon; increased intravascular volume, decreased viscosity of blood secondary to anemia. Cardiomyopathy seen as CHF occurs in alcoholic cirrhosis. Megaloblastic anemia is frequent and is due to antagonism of folate by alcohol rather than dietary deficiencies. Thrombocytopenia is likely
BBB in alcoholic cardiomyopathy |
|
|
Term
| Arterial hypoxemia in cirrhosis |
|
Definition
Despite the frequent presence of hyperventilation due to accumulation of ammonia, PaO2 values of 60-70 mmHg are common in patients with cirrhosis due to impaired diaphragmatic movement because of ascitic fluid accumulation.
In addition, R to L intrapulmonary shunts may develop in the presence of portal vein hypertension
May be associated with pneumonia |
|
|
Term
|
Definition
50-70% of cirrhotic patients
Due to: decreased cerebral energy, impaired BBB, altered neurotransmission
Documentation of mental obtundation, asterixis (flapping motion of hands at the wrists caused by intermittent loss of extensor tone) and fetor hepaticus (fecal-fruity odor of the breath)
Can cause dementia, spastic paresis, cerebellar degeneration, extrapyramidal movements |
|
|
Term
| WERNICKE-KORSAKOFF SYNDROME |
|
Definition
| Neuropsychiatric disorder caused by thiamine deficiency commonly associated with chronic alcohol abuse and characterized by confusion, ataxia, and nystagmus |
|
|
Term
| IDIOPATHIC HYPERBILIRUBINEMIA |
|
Definition
occurs if there are defects before the conjugation steps in hepatocytes
The most common type is Gilbert Syndrome, inherited as an autosomal dominant trait caused by decreased or absent glucuronyl tranferase enzyme (enzyme that catalyzes the conjugation steps to make bilirubin water soluble). Benign Postoperative Intrahepatic Cholestasis may occur when surgery is prolonged and hypotension, arterial hypoxemia and need for blood transfusions is present. Jaundice appears 2-3 days postop and may last 2-3 weeks. Liver function other than plasma bilirubin is normal |
|
|
Term
|
Definition
| Signs and symptoms of acute cholecystitis include nausea, vomiting, fever (38 – 39 degrees C), severe abdominal pain, and right upper quadrant tenderness. Dark urine and scleral icterus may be present |
|
|
Term
| Drugs cleared highly by first pass effect |
|
Definition
| Diazepam, Digitalis, Propanolol, Meperidine, Aminophylline, and Lidocaine |
|
|
Term
| Vitamin K supplementation |
|
Definition
| Vitamin K does not correct prothrombin in the presence of hepatocellular damage. It does, however, if there is biliary obstruction. |
|
|
Term
|
Definition
| Amount of mac needed to block ANS. MAC 1.7-2. |
|
|
Term
| Bilirubin excretion in liver dysfunction |
|
Definition
| Increases in unconjugated bilirubin result from liver parenchymal disease. Conjugated bilirubin is the direct fraction, and it increases in biliary tract obstruction. |
|
|
Term
|
Definition
| Is determined by perfusion pressure minus splanchnic vascular resistance. Volatile anesthetics decrease hepatic blood flow by decreasing hepatic perfusion pressure. Surgical incisions also decrease hepatic blood flow—in fact, the closer the surgical site to the liver, the greater the reduction in blood flow. |
|
|
Term
| Effects of anesthesia on liver perfusion pressure |
|
Definition
| Volatile anesthetics decrease hepatic perfusion pressure by decreasing blood pressure and increasing hepatic vascular resistance through the release of catecholamines. We can maximize hepatic perfusion BY MAINTAINING BLOOD PRESSURE! |
|
|
Term
| Intraop blood product replacement in liver disease |
|
Definition
Because most patients are hypovolemic and anemic, PRBCs are often administered 1 unit/unit EBL.
FFP may be required to correct coagulation factor deficiencies.
Citrate toxicity readily occurs due to impaired metabolism
IV Calcium may be needed to reverse negative inotropic effects and bleeding associated with decreased ionized calcium |
|
|
Term
| Opioid pharmokinetics in liver disease |
|
Definition
prolonged t ½
reduced protein binding |
|
|
Term
| Benzo pharmokinetics in liver disease |
|
Definition
prolonged t ½
reduced protein binding
increased free fraction of the drug |
|
|
Term
| Pharmokinetics of IV anesthesia in liver disease |
|
Definition
thiopental: low extraction ratio due to ↓protein binding
others: high extraction ratio |
|
|
Term
| Pharmokinetics of NMB in liver disease |
|
Definition
rocuronium and vecuronium ( primary biliary; secondary renal
atracurium and cisatracurium ( hoffman)
mivacurium ( plasma esterases) |
|
|
Term
|
Definition
Hepatocellular Injury:
AST
ALT
LDH
GST( Glutathione S-transferase
Cholestasis :
Alkaline phosphatase
GGT( Gamma glutamyl transferase)
Liver Excretory Capacity : Bilirubin ( direct/indirect
Synthesis : albumin, coagulation |
|
|
Term
|
Definition
| Are rarely specific, and can be normal even though substantial liver dysfunction exists |
|
|
Term
|
Definition
Serum bilirubin: (0.3–1.1 mg/100cc)
Protein bound (indirect reacting/unconjugated) normal values are 0.2-0.7 mg/100cc, and cannot be excreted by the kidneys, while conjugated (direct reacting) bilirubin (normal 0.1-0.4 mg/100cc) may appear in the urine.
Jaundice appears when serum bilirubin exceeds 3 mg/100cc. If serum bilirubin is abnormal, there is no correlation between its level and the severity of disease. |
|
|
Term
| Measurement of serum transaminases |
|
Definition
may not be specific to liver disease because the heart, lung, and skeletal muscle also contain transaminases. Elevated transaminases may be seen because of skeletal muscle damage. However, if transaminases are elevated > or = 3x normal there is a high likelihood of acute hepatocellular damage
Commonly measured transaminases: Glutamic oxalacetic transaminase: SGOT, Glutamic pyruvate transaminase: SGPT, Lactate dehydrogenase (LDH)
SGPT is more specific for the liver than SGOT |
|
|
Term
|
Definition
| is widely distributed in the body, including the liver, heart, skeletal muscles and erythrocytes. The isoenzyme-5 fraction of LDH is specific for hepatocytes |
|
|
Term
| Serum alkaline phosphatase |
|
Definition
| enzyme is present in bile duct cells. Even slight degrees of biliary obstruction are manifested by elevations of 3x normal serum enzyme concentrations. alkaline phosphatase levels help differentiate between biliary obstruction and hepatocellular damage. Elevations of alkaline phosphatase not only accompany hepatocellular disease but also skeletal muscle damage from many sources, such as surgery and trauma |
|
|
Term
|
Definition
| the liver is the source of albumin and hepatocellular damage results in decreased serum albumin (normal 3.5-5.5 gm/100cc). Albumin < 3.5 leads to ascites because free water goes from an area of lower to higher oncotic pressure (osmolality) |
|
|
Term
|
Definition
This control emanates from the enteric or intrinsic nervous system, which contains as many neurons as the spinal cord. the myenteric plexus exerts control primarily over digestive tract motility.
b) the submucous plexus senses the environment within the lumen, regulating gastrointestinal blood flow and controlling epithelial cell function. Connects to CNS via PSNS |
|
|
Term
| Ach in the entereic nervous system |
|
Definition
| excitatory, stimulating smooth muscle contraction, increases in intestinal secretions, and dilation of blood vessels. Norepinephrine is almost always inhibitory and opposite that of acetylcholine. |
|
|
Term
|
Definition
| Stimulated by presence of food, especially protein. Binds to parietal cells and with histamine and Ach, stimulates acid secretion. Promotes growth of gastric mucosa |
|
|
Term
| Zollinger-Ellison Syndrome |
|
Definition
| Excessive secretion of gastrin. The hallmark of this disease is gastric and duodenal ulceration due to excessive and unregulated secretion of gastric acid. Most commonly, hypergastrinemia is the result of gastrin-secreting tumors (gastrinomas), which develop in the pancreas or duodenum. |
|
|
Term
|
Definition
| it is released in response to acid in the small intestine, and stimulates the pancreas and bile ducts to release bicarbonate base, which neutralizes the acid. |
|
|
Term
|
Definition
| C6 to GE junction. UES : resting tonic contraction pressure: 15-60 cm H2O; tone reduced by anesthetics. LES: resting tone: 10-15 cm H2O; affected by gastrin and intrinsic plexus ; about 3 cm long. LES: cardiac sphincter |
|
|
Term
| Things that increase LES tone |
|
Definition
Acetylcholine, Anticholinesterases, Succcinylcholine, Alpha agonists, Antacids, Reglan, Gastrin, Serotonin, Histamine, Metoprolol.
Incomplete relaxation with swallowing
Achalasia : sphincter constriction
TX: botox injections, esophageal myotomy, esophageal dilatation
Anestheisa: MAC |
|
|
Term
| Things that decrease LES tone |
|
Definition
| Inhaled anesthetics ( except ketamine), Opioids, Anticholinergics, Thiopental, Beta agonists, Ganglion blockers, TCAs, Secretin, Glucagon, Pregnancy, obesity, hiatal hernia |
|
|
Term
| Drugs that cause no change in LES tone |
|
Definition
H2 blockers
NMDR
Propanolol |
|
|
Term
|
Definition
Ineffective esophageal clearance : MS, myasthenia
Diminished salivation
Low barrier pressure: difference between LES pressure and intragastric pressure; 15-30 cm H2O
↑ IGP =↑LES pressure ( in healthy individuals)
But if LES tone is decreased and IGP remains ↑, reflux occurs
TX: neutralize gastric acid, decrease acid production, improve motility, correct incompetent LES |
|
|
Term
|
Definition
1 in 10 GERD patients
Abnormal cell growth
Pre-malignant lesion
1-5% develops adenocarcinoma
Tx: acid neutralization, decrease gastric acid production, improve motility, correct incompetent LES |
|
|
Term
|
Definition
| The underlying defect leading to esophagitis is a decrease in resting tone of the LES. |
|
|
Term
|
Definition
| (upper esophagus, high risk for pulmonary aspiration), traction diverticulum (mid-esophagus), and epiphrenic diverticulum (near the LES). |
|
|
Term
|
Definition
| pH<2.5 and gastic volume>25 cc . Can predispose you to aspiration pneomonitis |
|
|
Term
|
Definition
Portion of the stomach migrating through the hiatus of the diaphragm
Retrosternal pain: burning sensation
Does not always accompany decreased LES tone
Sliding: LES intact; weak herniation; symmetrical migration; GERD while lying down
Paraesophageal: asymmetrical migration; GERD throughout the day |
|
|
Term
|
Definition
40N!. Single handed cricoid pressure: thumb & middle finger on either side and index finger above; prevents lateral
movement. Must apply before they lose consciousness |
|
|
Term
|
Definition
| secrete an alkaline mucus that protects the epithelium against shear stress and acid |
|
|
Term
|
Definition
| secrete hydrochloric acid |
|
|
Term
|
Definition
| secrete pepsin, a proteolytic enzyme |
|
|
Term
|
Definition
| secrete the hormone gastrin |
|
|
Term
|
Definition
|
|
Term
| Factors that increase gastric emptying |
|
Definition
| gastric distention, reglan, neostigmine, propanolol, NaHCO3, cigarette |
|
|
Term
|
Definition
| Decreased gastric motility with increased small intestine tone. Sometimes with reverse peristalsis in the proximal small intestine |
|
|
Term
|
Definition
| While this is occurring, the antrum of the stomach contracts while the fundus and cardia relax. Glotis is closed |
|
|
Term
|
Definition
The diaphragm is contracted sharply downward to create negative pressure in the thorax, which facilitates opening of the esophagus and distal esophageal sphincter.
Simultaneously with downward movement of the diaphragm, the muscles of the abdominal walls are vigorously contracted, squeezing the stomach and thus elevating intragastric pressure.
With the pylorus closed and the esophagus relatively open, the route of exit is clear. |
|
|
Term
| Chemoreceptor Trigger Zone |
|
Definition
lies under the floor of the fourth ventricle. Electrical stimulation of this center does not induce vomiting, but administration of emetogenic drugs does . The chemoreceptor trigger zones function as emetic chemoreceptors for the vomition centers - chemical abnormalities in the body (e.g. emetic drugs, uremia, hypoxia and diabetic ketoacidosis) are sensed by these centers, which then send excitatory signs to the vomition centers.
Many of the antiemetic drugs act at the level of the chemoreceptor trigger zone. |
|
|
Term
|
Definition
| hx of PONV & motion sickness, female, non-smoker, opioids |
|
|
Term
|
Definition
| muscarinic, histaminic, 5HT3, and dopaminergic receptors involved. suture lines and hemodynamics are jeopardized, ↑IOP or ↑ ICP; can aggravate pain |
|
|
Term
| PONV and surgical manipulation |
|
Definition
| extraocular muscle traction, middle ear manipulation, peritoneal or intestinal irritation or testicular traction |
|
|
Term
|
Definition
H+ ions are generated within the parietal cell from dissociation of H2O. The OH- formed combines with CO2 to form HCO3-cataylzed by carbonic anhydrase.
Bicarbonate is transported out in exchange for chloride.
Cl- and K+ ions are transported into the lumen, while H+ is pumped out of the cell into the lumen, in exchange for K+ through the action of the proton pump; potassium is thus effectively recycled.
Accumulation of osmotically-active hydrogen ion generates an osmotic gradient across the membrane that results in outward diffusion of water - the resulting gastric juice is 155 mM HCl and 15 mM KCl with a small amount of NaCl. |
|
|
Term
|
Definition
Examples include cimetidine (Tagamet HB), ranitidine (Zantac 75), famotidine (Pepcid AC) and nizatidine (Axid AR).
These drugs, particularly cimetidine, are among the most widely prescribed drugs . Antihistamines that engage H1 receptors (e.g. those used to treat colds) have no effect on acid secretion. |
|
|
Term
|
Definition
| Acid secretion is absolutely dependent on function of the H+/K+ ATPase or the proton pump . Drugs that non-competively bind and inactivate the ATPase include omeprazole (prilosec) , lansoprazole (prevacid), esomeprazole (nexium), rabeprazole (aciphex) and pantoprazole (protonix |
|
|
Term
|
Definition
Non-occlusive ischemia results from systemic conditions such as circulatory shock, sepsis or cardiac insufficiency.
Occlusive ischemia refers to conditions that directly disrupt gastrointestinal blood flow such as strangulation, volvulus or thromboembolism. |
|
|
Term
|
Definition
The intrinsic barrier is composed of the epithelial cells lining the digestive tube and the tight junctions that tie them together.
The extrinsic barrier consists of secretions and other influences that are not physically part of the epithelium, but which affect the epithelial cells and maintain their barrier function.
Mucus, bicarbonate, cytokines, prostaglandins E2 and prostacyclin (cytoprotective), NO |
|
|
Term
|
Definition
| H pylori ulcers typically occur in the duodenal bulb, whereas NSAID ulcers usually occur in the stomach. Prostaglandins (that are inhibited by NSAIDs) normally protect the GI mucosa from damage by maintaining mucosal blood flow and increasing mucosal secretion of mucus and bicarbonate |
|
|
Term
| Gastrinoma (Zollinger-Ellison Syndrome) |
|
Definition
| is a gastrin-secreting malignant tumor that develops in the pancreas or duodenum and accounts for approximately 0.1% of peptic ulcers. Release of gastrin stimulates histamine release and the production of HCL. Intractable abdominal pain, diarrhea, and multiple gastric ulcers are present. 20-30% of patients with gastrinomas have other features suggesting multiple endocrine neoplasia type 1 (MEN type 1) |
|
|
Term
|
Definition
Often associated with antibiotic therapy, bowel obstruction, uremia, CHF and intestinal ischemia
Clinical manifestations include: fever, watery diarrhea, dehydration, hypotension, cardiac dysrhythmias, skeletal muscle weakness, intestinal ileus, and metabolic acidosis |
|
|
Term
|
Definition
Inflammatory disease of the colonic mucosa that primarily affects the rectum and distal colon. Mostly affects women between the ages of 25-40
Intermittent diarrhea and cramping abdominal pain
Fatigue, low grade fever, and weight loss occur during exacerbations of the disease, also dehydration
Chronic inflammation predisposes these patients to colon carcinoma, and these patients may need a colectomy |
|
|
Term
| Ulcerative Colitis Treatment |
|
Definition
Despite lack of evidence of efficacy, these patients are often on low-dose corticosteroids
Immunomodulatory drugs such as azathioprine and mercaptopurine are appropriate for long-term treatment of some patients
Pancreatitis occurs in 15% of patients treated with these drugs, and bone marrow suppression is a risk |
|
|
Term
|
Definition
Ileal and colonic involvement (granulomatous ileocolitis) in about 50% of patients, and the remainder is restricted to the small intestine (regional enteritis)
Cause is unknown, and the peak incidence is 30 years of age
Chronic inflammation of all the bowel layers, often leading to fistula development between diseased intestinal loops and adjacent structures. Rectal fissures, rectocutaneous fistulas, or perirectal abscesses occur in as many as 50% of patients
Renal stones and gallstones are common accompanying problems
Anemia is likely and may be due to chronic hemorrhage, iron deficiency, vitamin B12 deficiency, or folate deficiency
Decreased plasma albumin concentrations reflect protein loss through diseased bowel mucosa |
|
|
Term
| Anesthesia for inflammatory bowel |
|
Definition
In the presence of bowel distention, avoid N20
If the patient has been on corticosteroids, there must be extra supplementation to cover the stress of surgery
Hydrocortisone 100 mg IVP |
|
|
Term
|
Definition
Mucosal and submucosal herniations through the muscularis propria, occur most often in patients with low-fiber diets
Most often involve the sigmoid colon and cause symptoms of abdominal pain. Mild diverticulitis manifests with left-sided lower abdominal pain, low-grade fever, anorexia and nausea. Fistula formation is most commonly from the sigmoid colon to the bladder |
|
|
Term
|
Definition
| Hypokalemic, hypochloremic alkalemia or acidemia characterize intestinal obstruction. Respiratory acidosis occurs secondary to abdominal distention and consequent hypoventilation, lactic acidosis, Suctioning or vomiting of acidic intragastric contents lead to metabolic alkalosis and alkalemia |
|
|
Term
|
Definition
| pancreatic autodigestion, increased serum amylase levels, N&V, dyspnea, fever, Excruciating mid-epigastric pain that radiates to the back, Sitting and leaning forward decreases the pain, hypocalcemia, Sequestration of large fluid volumes in the peripancreatic space, hemorrhage, and decreased SVR contribute to HOTN |
|
|
Term
|
Definition
| Characterized by postprandial epigastric pain that radiates to the back, and development of diabetes, Serum amylase is usually normal, Steatorrhea, |
|
|
Term
|
Definition
Arise from enterochromaffin tissues and are typically found in the GI tract (stomach, appendix, jejunem, ileum, colon, rectum) but may also occur in the bronchi and lungs
Carcinoid cells secrete a variety of amine and neuropeptide hormones including serotonin, histamine, prostaglandins, corticotropin, and kallikrein
Bronchial carcinoids can produce an excess of corticotrophic hormone and growth hormone-releasing factor, and they may present as Cushing Syndrome or acromegaly.
Measurements of the serotonin metabolite 5-hydroxyindoleacetic acid in a 24-hour period may be useful for confirming the diagnosis |
|
|
Term
|
Definition
flushing involving the face and neck, diarrhea, asthma, flushing from circulating catecholamines and may be associated with hypotension and bronchospasm
Symptoms also related to site of metastasis
Acute cardiorespiratory events (SVT, HTN, HOTN) are most common following embolization of liver metastases or surgical manipulation of the tumor
Right-sided heart valve distortion from metastases may occur, whereas the left heart is spared, perhaps reflecting the ability of the pulmonary parenchymal cells to inactivate vasoactive substances |
|
|
Term
| Anesthesia for Carcinoid Syndrome |
|
Definition
Avoidance of drugs that cause histamine release, especially at high doses (meperidine, mivacurium, atracurium) is beneficial
Octreotide bolus 100 to 200 micrograms is the treatment of choice for bronchospasm or hypotension in these patients as opposed to epinephrine
Labetolol can be used to treat hypertension |
|
|
Term
| Drugs that promote Carcinoid Syndrome |
|
Definition
| Drugs reported to promote carcinoid crisis include histamine, dopamine, norepinephrine, and epinephrine |
|
|
