10. GI // stomach // pancreas Flashcards
The majority function of the pancreas is in what?
Exocrine function
What special enzyme is a trypsin inhibitor found in the pancreas?
what cells is it found in?
SPINK-1
acinar + ductal cells
PRSS1 is what type of inheritance?
SPINK1 is what type of inheritance?
PRSS1 ==> Autosomal Dominant
SPINK1 ==> Autosomal Recessive
Amylase in blood is a sign of what?
Acute pancreatitis
What type of plug occurs in chronic pancreatitis?
Protein plugs
What order is destroyed first in chronic pancreatitis?
Exocrine => Endocrine
what is formed in chronic pancreatitis?
Fibrous tissue
most common type of pancreatic cancer
pancreatic ductal carcinoma
PanIN (pancreatic intraepithelial neoplasia) epi
Most common neoplastic precursor to invasive pancreatic cancer
what relatives are affected in a familial pancreatic cancer?
2x 1st degree relatives
Pancreatic carcinoma generally affects what part of the pancreas?
Head of pancreas
What syndrome is associated with pancreatic carcinoma?
Trousseau’s syndrome
What is a desmoplastic response?
intense non-neoplastic host reaction
What cells are responsible in desmoplastic response (30
Fibroblasts // Lymphocytes // ECM
Pancreatic neuroendocrine tumours originate from what cells?
islet cells
What disease has an increased risk of pancreatic neuroendocrine tumour?
MEN-1 pituitary adenoma
What is the most common type of neuroendocrine tumour?
Insulinoma
What happens to blood sugars in insulinoma?
Hypoglycaemia
Majority of acute pancreatitis are caused by what?
Gallstones
Peri-umbilical haemorrhage is associated with what sign?
Cullen’s sign
calculi are associated with what?
Chronic pancreatitis + excess alcohol
What is the most common form of oesophagitis?
Reflux oesophagitis
What is defective in reflux oesophagitis?
lower oesophageal sphincter
What type of metaplasia is present in Barrett’s oesophagus?
Glandular metaplasia
H pylori infects what part of the stomach to cause problems
Antrum
Most common type of gastric cancer?
Adenocarcinoma
In Coeliac disease, what component is there a reaction to?
Gliadin
What do epithelial cells express in Coeliac disease which activates CD8 (Intraepithelial lymphocytes)
IL-15
What is the diagnosis test used in Coeliac disease?
What does this AB bind to?
IgA
Tissue Transglutaminase (TTG)
Diverticulosis typically affects what part of the colon?
Sigmoid colon
Most common symptom presenting in ulcerative collitis?
Rectal bleeding
what is the most common area affected in Crohn’s disease?
Ileocolic region
What is the most common type of polyp?
Hyperplastic polyp
In Peutz-Jeghers syndrome, what chromosome is affected
What type of inheritance is it?
STK11 Ch.19
Autosomal dominant
DUKES stage is used in what diagnosis criteria
Adenocarcinoma of Colon
Von Meyenberg complex is a proliferation of what type of cells?
What are formed/
Bile duct cells ====> White nodules form
cholangiocarcinoma is what?
Malignant tumour of bile duct cells
What is the main cause of cholangiocarcinoma (parasite)
Liver fluke => Clonorchis sinesis
tumours of the liver are typically secondary and derive from what 4 areas/
lung
breast
colon
pancreas
Pancreatic NENs can metastasise to bone (T/f)
t
what is the normal epithelium lining of the oesophagus
stratified squamous layer
formation of multiple colorectal polyps
FAP
Familial Adenomatous Polyposis
What happens to intravascular fluids in physical trauma?
Intravascular fluid loss
What happens to extravascular fluids in physical trauma?
Extravascular volume increase
Shock post trauma occurs how many hours post onset
2-4
Catabolic state post trauma occurs when?
What happens to glycolysis // lipolysis / proteolysis?
24-48hr
Increase
What are 2 key components responsible for activating the catabolic state // anabolic state
IL-1 // TNF-A
How does adrenaline affect glycolysis
adrenaline = Increase Glycolysis => increase glucose
Glutamine + Omega -3FA does what?
Reduce inflammatory cytokine IL-1 // TNF-a
Why do patients die of pneumonia post trauma
Structural weakness => poor cough + retention of secretions
What is produced as a biproduct of anaerobic metabolism that leads to hypoxia
Pyruvate ==> Lactate
Protein // calorie undernutrition (starvation) is a type of what malnutrition?
Primary malnutrition
appetite // absorption and utilisation inadequate are all type of what malnutrition
Secondary malnutrition
What happens to phosphates during refeeding syndrome
hypophosphataemia => low phosphates after a starved state
meconium ileus can occurs in babies with what type of disease
CFTR => CF
Creon delayed release capsules can be given to patients with what?
What does it contain (3)
CF
Lipases // proteases // amylases
Thiamine is a ….. for transketolase // PDH //a-KGDH
Co-factor
Wernicke-Korsakoff is what type of def?
B1 def
RBC are broken down where?
what does it release
Spleen
Bilirubin
Where does conjugation of bilirubin occur?
What is it conjugated with?
Liver
Glycine // taurine
What can bacteria do in the intestine to the bilirubin thats conjugated?
What is it absorbed as
Unconjugate it => Reabsorbed back into system
Absorbed as urobilinoigen
Jaundice is first seen where?
Sclera
Pre-hepatic causes of jaundice (2) that lead to too much bilirubin (unconjugated)
**included 1 syndrome
Haemolytic anaemia // Gilbert’s syndrome
Bile duct obstruction is a form of what type of jaundice?
Post hepatic obstructive jaundice
High ALK phosphatase would be indicative of what type of jaundice
Obstructive
High ALT // AST would be indicative of what type of jaundice
Damage to hepatocytes
What are the 3 stages of cirrhosis
Portal fibrosis –> Bridging fibrosis -> Cirrhosis
Which type of viral hepatitis does not cause chronic hepatitis
Hep A
Haemochromatosis is a failure of what?
What does it lead to
Failure of iron absorption
Excess iron stored in wrong places
What 2 genes are responsible for haemochromatosis?
HFE + C282Y
Wilsons disease =>
What transporter is affected
Copper deposited in wrong areas due to too little copper transporter
Caeruloplasmin
Kayser-Fleischer rings are found in the eyes in what disease
Wilson’s disease
What happens to urine // liver copper levels in Wilson’s disease
High Copper => Urine + liver
Low Copper => Serum
Penicillamine is a treatment for what disease
Wilson’s => Copper
PiZZ is the most common type of what?
Alpha 1 anti-trypsin deficiency
Alpha 1 anti-trypsin is a type of what
Anti-protease
Primary Biliary cholangitis (PBC) BT results (2)
Anti-mitochondrial AB + Raised ALP
PBC => Inc. ALP
Primary sclerosing Cholangitis (PSC) BT results (1)
What disease is it associated with
High ALK
ulcerative colitis
PSC => Inc. ALK
The ELF score is used in what?
Fibrosis marker
2 inherited disorders of conjugation that would lead to increased unconjugated bilirubin
Gilberts // Crigler-Najjar
2 inherited disorders of unconjugation that would lead to increased conjugated bilirubin
Dubin-Johnson // Rotor
AST // ALT elevated + normal ALP
Hepatitis
AST // ALT normal + High ALP
Obstructive Jaundice
In chronic pancreatitis, what is there loss of (2)
Islet cells + acinar tissue
Is ALT used in bilary tract damage?
No
Only used for damage to hepatocytes => hepatitis
where does UC affect?
What about crohn’s
UC => Large bowel only
Crohn’s => Mouth -> anus
presence of granulomas that are non-caseating epithelioid cell aggregates with Langhans’ giant cells.
Crohn’s
Crypt abscesses and goblet cell depletion are common in ->
Ulcerative collitis
p-ANCA negative
Crohn’s
p-ANCA positive
UC
what happens to albumin levels in trauma
reduced => Hypoalbuminaemia
