anesthesia effects on GI system
opioids reduce GI motlity how
high density of peripheral mu receptors in the myenteric and submucosal plexuses
leading to delayed gastric emptying and slower transit through the intestines
when should N2O be avoided
length abdominal surgeries
bowel is already distended
colonic ileus with massive dilation of the colon without mechanical obstruction
upper GI therapeutic procedure of choice
*endoscopic ulcer litigation, ligation of bleeding varices
mechanical balloon tamponade
hallmark signs of pancreatis
increased serum amylase and lipase
other adverse effects of opioids on the GI system
nausea, anorexia, delayed digestion, abdominal pain, excessive straining during BM, incomplete evacuation
pre-existing gas in the bowel
duration of N2O administration
concentration of N2O adminstered
what can cause an adynamic ileus
loss of peristalis = distention of colon
orthostatic hypotension indicates a HCT < __%
25%
30%
symptoms and complications of acute pancreatitis
Epigastric pain that radiates to the back, N/V, abdominal distention, steatorrhea, ileus, fever, tachycardia, and hypotension
complications: shocks, ARDS, renal failure, necrotic pancreatic abscess
sugammadex effects on GI motility
no effect
T/F volatile anesthetics increase the spontaenous, electrical, contractile, and propulsive activity in the stomach, small intestine, and colon
false, depress
*volatile agents + SNS hyperactivity = can inhibit GI function and motility
causes and treatment of adynamic ileus
electrolyte disorders, immobility, excessive narcotics, anticholinergics
Treatment: restore electrolyte balance, hydrate, mobilize, NG suction, enemas
neostigmine (2-2.5 mg over 5 min) immediate results in 80-90%
melena indicates
bleed above the cecum
how is autodigestion normally prevented
proteases packaging in precursor form
protease inhibitors
low intra-pancreatic calcium, which decreases trypsin activity
neostigmine effect on bowel peristalsis
increases PSNS and increases the frequency and intensity of contractions
inhbition of GI activity is directly proportional to
amount of NE secreted from SNS stimulation
high anxiety= high inhibition
if an adynamic ileus is left unntreated what can occur
ischemia or perforation
causes of lower GI bleed
diverticulosis, tumors, colitis
generally occurs in the elderly
common causes of acute pancreatitis
gallstones and alcohol abuse
Gallstones obstruct the ampulla of Vater and prevent pancreatic excretion (pancreatic HTN)
also seen in immunodeficiency symptoms, hyperparathyroidism, and hypercalcemia
T/F the cholinergic activity is partially offset by concurrent administration of glycopyrrolate or atropine
true!
recovery of the GI tract postop
followed by stomach 24 ours
then colpon 30-40 hours postop
an adynamic ileus is though to be caused by a
neural - input imbalance of excessive SNS stim and inadequate PSNS input to colon
A colonoscopy preformed if the patient can tolerate prep
persistent bleeding warrants angiography and embolic therapy
treatment of acute pancreatitis
aggressive IVF, NPO to reset pancreas, enteral feedings (over TPN), opioids
ERCP
-remove stone, stent placement, sphincterotomy, hemostasis