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Terms in this set (50)
The colon is 3-5 feet in length and comprises what? The role of the colon is to ___________________________.
Comprises the appendix, cecum, ascending, transverse, and descending colon, rectum, anus.
Store and expel waste and absorb sodium.
Irritable Bowel Syndrome (IBS) is a spastic or mucous colitis that is associated with what two things?
Associated with frequent mucous covered stool and vasomotor symptoms (tachycardia, headaches, and diaphoresis).
What are the two inflammatory bowel diseases?
Crohn's Disease & Ulcerative Colitis
Crohn's Disease is an inflammatory disease of _______________________________.
Inflammatory disease of all layers of bowel
Crohn's Disease typically involves ____________________ (50%).
Ileum and colon (50%)
Confined to small bowel (25%)
Confined to colon (25%)
What are the two complications associated with Crohn's Disease?
1. Development of fistulas between diseased bowel and adjacent structures
What is the complication associated with UC?
Arthritis during exacerbations
Ulcerative Colitis is a ___________________________, primarily the ___________________________.
Inflammatory disease of colonic mucosa
Primarily rectum and distal colon
Which IBD is characterized by exacerbations and remissions?
With UC there is an increased incidence of what four things?
1. Acute onset of toxic megacolon
2. Ankylosing spondylitis
3. Liver disease
4. Increased risk of colon cancer
With Crohn's Disease there is an increased incidence of what five things?
3. Calcium containing stones (renal and gallbladder)
4. Anemia (d/t poor B12 absorption)
5. Hypoalbuminemia (r/t loss of proteins through diseased bowel)
Anesthetic management of UC and Crohn's includes preoperative evaluation of what four things?
1. Need for steroid coverage
2. Fluid and electrolyte status
3. Nutritional status (may be on long-term TPN)
4. Extra colonic complications (liver disease, arthritis, and anemia)
Avoid N20 in the presence of _______________________.
What is the cause of UC and Crohns?
Cause is unknown
UC is characterized by _____________ ulcerations, while Crohn's is characterized by _____________ ulcerations.
UC = superficial ulcerations
Crohn's = deep ulcerations
What are the signs and symptoms of UC?
Mild to moderate cramping
Low grade fever
Weight loss (during exacerbations)
What are the signs and symptoms of Crohn's?
Moderate to severe cramping
What population has the highest incidence of UC?
What is the peak incidence of Crohn's Disease?
30 years of age
Surgery for which IBD is generally curative?
UC - proctocolectomy with ileostomy
Surgery for Crohn's DOES NOT stop progression of disease
Acute exacerbations may require hospitalizations that will require _________________ and _________________.
Fluid and electrolyte replacement
Bowel rest with parenteral nutrition (Crohn's)
Bowel rest could include an ileostomy
What are the AE of long term TPN use?
Hyper/hypoglycemia, increased CO2 production, hyperchloremic acidosis, renal or hepatic dysfunction
Patient's with which IBD is more likely to be on long term corticosteroids?
Medical treatment of UC and Crohn's is similar and involves what?
1. Sulfazalizine and 5-aminosalicylic acid
2, Corticosteroids during exacerbations
What are the acute causes of pancreatitis?
1. Gallstones (transiently block the ampulla of Vater, leading to pancreatic duct hypertension)
2. Alcohol abuse
What are the three MAJOR DIFFERENCES between UC and Crohn's Disease?
1. Predisposition to cancer with ulcerative colitis
2. Surgical resection is curative with ulcerative colitis and is NOT with Crohn's
3. Nicotine may be protective in ulcerative colitis
Surgery for Crohn's can include what two things?
Ileostomy for bowel rest
Surgery DOES NOT stop progression of disease
What are the chronic causes of pancreatitis?
1. Alcohol abuse in combination with high protein diet
Is acute pancreatitis a precursor to chronic pancreatitis?
NO. Once acute event is resolved, normal pancreatic function is returned and it is unlikely to develop into chronic pancreatitis
What is the pathogenesis of acute pancreatitis?
Pathogenesis involves auto-digestion of pancreas
What are some of the anesthetic considerations for patients with acute pancreatitis?
1. Severe hypovolemia occurs -- large amount of fluid is sequestered in and around pancreas and a large amount of replacement fluids is needed (up to 10L)
2. Rest pancreas via NGT or parenteral feeding
3. Severe pain (opioids)
4. Pleural effusions not uncommon
The pancreas is both a _______________ and _______________ gland.
Exocrine (secretes digestive enzymes) and Endocrine gland (secretes insulin)
What three things are associated with chronic pancreatitis?
1. Chronic epigastric pain (often treated with opioids)
2. Leads to malabsorption and often diabetes
3. Increased incidence of pleural effusions and ascites
Chronic pancreatitis is chronic inflammation of the pancreas that leads to _____________________________.
Leads to permanent destruction of pancreatic tissue
GI bleeding is most often from the upper GI tract. If the bleeding is lower GI, it most often occurs from __________________ or __________________.
Diverticulum or tumors
Peritonitis is usually related to _____________________.
Usually related to perforated viscus
What three things can cause peritonitis?
1. Infectious agent enters peritoneal cavity
2. Aseptic peritonitis occurs as the result of normal bodily fluids irritating the peritoneal cavity
3. Can also be a complication of some diseases
E.g., lupus, porphyria
In a patient with diverticulitis, you are concerned with __________________ and ___________________.
Abscess and fistula
Diverticulosis is often seen in those with _________________.
Often seen in those with low fiber diets
Malabsorption and Maldigestion involves impaired absorption of fat leading to ______________________.
Malabsorption and Maldigestion can result from what two things?
May result from extensive bowel resection or gluten-sensitive enteropathy
Patients with small bowel disease develop _______________.
What are four causes of obstructive appendicitis?
2. Enlarged lymphoid follicles
Patients with liver or biliary tract disease develop deficiency of _________________, _________________, and _________________.
Deficiency of fat soluble vitamins (A, D, E, K), hypocalcemia and hypomagnesemia
What are the signs and symptoms of appendicitis?
Pain in RLQ (especially rebound tenderness)
What sign or symptom is indicative of appendix perforation?
Fever > 38.3
Symptoms of diverticulitis are similar to _________________ if ________________________.
Symptoms similar to appendicitis if right colon involved
What is indicative of a peri-appendiceal abscess?
Mass in RLQ
Will treat with antibiotics and then once that resolves take the appendix out
Considered full stomach
What is Diverticulosis?
Herniations of mucosa and submucosa
Surgical treatment of diverticulosis and diverticulitis involves _____________________.
Surgical treatment involves resection of diseased colon
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