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JG Year 1 > 101 Diarrhoea > Flashcards

101 Diarrhoea Flashcards

1
Q

At which level is the bifurcation of the abdominal aorta?

A

L IV

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2
Q

At which level does the common iliac veins drain into the vena cava?

A

LV

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3
Q

At which level does the IMA branch off the abdo aorta?

A

L III

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4
Q

Between which 2 structures is the epiploic foramen found?

A

Between the greater and the lesser sac

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5
Q

Why is there initally generalised abdominal pain followed by more acute localised pain to the right iliac fossa in appendicitis?

A

Visceral peritoneum= sensitive to stretch –> generalised pain referred from here.

More localised pain from the inflammed appendix irritating the parietal peritoneum

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6
Q

Which ligament is found in the dj junction?

What is its purpous?

A

Ligament of Treitz - skeletal muscle which contracts to widen the angle of the dj felxure and allow m’ment of intestinal contents

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7
Q

Which nerves supply the lateral 2/3rds of the diaphragm?

A

T VII to T XII

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8
Q

Where does the root of the mesentary extend from?

A

L side of L2 –> R SI joint

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9
Q

How do you differentiate the mesentary of the jejenum from the ileum?

A

Vasa recta –> ileum =shorter

Arterial arcades –> ileum more numerous

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10
Q

Name the 6 possible positions of the appendix

A
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11
Q

Which organ does the transverse mesocolon attach to superiorly?

A

Pancreas

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12
Q

Which ligament suspends the splenic flexure?

A

Phrenicocolic ligament

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13
Q

In females, what are the anatomical relations to the sigmoid colon?

A

Posterior surface of the uterus ad upper part of the vagina

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14
Q

The pull of which muscle makes the anorectal angle?

A

Puborectalis portion of levator ani

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15
Q

Name the broad longitudinal bands which run along the large colon?

A

Taenia coli

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16
Q

Name the circular folds of the small colon

A

Plicae circulares

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17
Q

Where in the GIT has thick stratified squamous non keratinising epithelium?

A

Oral cavity

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18
Q

Where is Meissner’s complex found?

A

In the submucosa

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19
Q

Which ANS plexus is found between the layers of circular and longitudinal muscle?

A

Auerbach

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20
Q

Describe the muscularis externa in each third of the oesophagus

A

Top = striated muscle

Middle = mixture of striated and smooth

Bottom = SM

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21
Q

Name the 4 layers of GIT

A

Mucosa,

Submucosa,

Muscularis propria (inner circular, outer longitudinal)

Serosa

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22
Q

What’s the difference between the epithelium of the oesophagus at the cardio-oesophageal junction?

A

Stratified squamous epithelium proximal to the junction then changes to simple columnar –> goblet cells here secreting mucous to counteract the damage gastric acid inflicts on the epithelium

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23
Q

Where is the function of parietal cells and where are they found?

A

Secrete HCl and peptide for B12 antibodies (stimulated by gastrin and ACh) - found in the mucosa of the stomach (mainly the body) within the gastic pits

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24
Q

Which cells secrete rennin, pepsinogen and gastric lipase - where are they found?

A

Chief cells - in the base of the gastric glands

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25
Q

What do the enterochromafifn-like cells found and what do they secrete?

A

In the neck of the gastric pits - secrete histamine. Stimulated by gastrin which is released by G cells (stimulated by vagus)

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26
Q

Where in the stomach will no chief cells be present?

A

Pylorus

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27
Q

What are Brunners glands?

A

Tubuloacinar glands which penetrate the muscularis mucosa of the duodenum. They secrete mucous to alkanalise the acidic chyme from the stomach.

28
Q

What is the pH of the duodenum?

A

pH 9

29
Q

What is the role of cholecystokinin and secretin in the duodenum?

A

To stimulate the pancreas to secrete digestive enzymes and to stimulate contraction of the gallbladder

30
Q

Name the 3 types of cells in the crypts of Lieberkhun

A
  1. Paneth cells - contain granules of antimicrobial compounds
  2. Endocrine
  3. Stem cells
31
Q

How much fluid is taken into the GIT through diet?

A

1500ml

32
Q

How much fluid is secreted into the lumen of the jejenum?

A

7000ml

33
Q

How much fluid is absorbed by the colon?

A

1400ml

34
Q

How much fluid is needed to form a stool in the rectum?

A

100ml

35
Q

How is H2O moved across the intestinal mucosa?

A

It moves passively through the work of electrochemical gradients provided by active transport of electrolytes

36
Q

Where is vitamin B12 absorbed? What is the consequence of a pathology here?

A

Distal ileum - if problem here then pernicious anaemia can develop. Need vit B12 to produce erythrocytes

37
Q

Where are M cells found and what is their function?

A

Immune cells of Payer’s patches. Facilites transcytosis of bacterial pathogens and presents to immune cells

38
Q

Why is apoptosis important in the mucosa of the small and large bowel?

A

Important to maintain the cellular balance in the crypts. Apoptosis happens close the the stem cells in the small intestine but further away in the large intestine- therefore higher risk of developin Ca as more abnormal cells escape programmed cell death

39
Q

What is the unstirred layer of the GIT? What is its contents?

A

It functions to separate the lumen from the sub-epithelial space

Contains:

mucous –> binds bacteria

IgA –> binds bacterial antigen

CO3- –> neutralises luminal acids

40
Q

Name the 4 transport mechanisms across the apical membrane of epithelial cells in the GIT mucosa

A
  1. Paracellular passive
  2. Trancellular active
  3. Transcellular passive
  4. Water transport (always passive)
41
Q

Which part of the GIT is dysfunctional if high volume diarrhoea is seen?

A

Small intestine - it’s unable to absorbe a large amount of fluid

42
Q

Which part of the GIT is dysfunctional if low volume diarrhoea is seen?

A

Large colon

43
Q

What are the 3 roles of the intestinal flora?

A
  1. Assist in fermentation of faecal material
  2. Suppress overgrowth of pathogenic organisms
  3. Degrades intestinal mucins
44
Q

What is dysentry?

A

Diarrhoea in small vols with blood. mucous and abdo pain

45
Q

What is osmotic diarrhoea?

What is the ion gap?

A

Presence of an osmotically active substance in the gut lumen.

Ion gap >100mOsm/kg

46
Q

What is secretory diarrhoea?

What is the osmotic gap?

A

Presence of e.g. bacterial toxin –> ion gap <100mOsm/kg i.e. no osmotically active substance in gut lumen

47
Q

What is inflammatory diarrhoea?

Name 4 diseases where this is a symptom

A

Happens when the GIT is damages –> disordered stucture and function.

Increased secretion and malabsorption

Problem with digestion so larger molecules are found lower down the GIT

Coeliac, IBS, Crohns, Food intolerance

48
Q

Name 4 symptoms of inflammatory bowel disease

A

Pain

Infection

Bloody mucoid stools (diarrhoea)

W/L

49
Q

How is E. Coli 0157 transmitted?

A

Throught ingestion of <10 organisms after contaminated uncooked meat (sometimes diary and vegetables).

Can also be transmitted through contaminated faeces

50
Q

What is HUS and which bacteria can cause it?

A

(Haemolytic-uraemic syndrome) haemolytic anaemia and renal failure - E. coli 0157

51
Q

What is TTP? Which group are most likely to develop this after an E.coli infection of the GIT?

A

Thrombotic thrombocytopaemic purpura

OAPs

52
Q

How is campylobacter transmitted?

A

Through uncooked poultry - lives in the GIT of birds and mammals

53
Q

What is the contents of ORS?

A

H2O

Glucose

NaCl

54
Q

What is the MOA of ORS?

A

Glucose and Na taken into enterocytes by Na driven glucose transporter - this draws water into the cells via osmotic gradient.

55
Q

What is the dose of ORS?

A

1 sachet in 200ml initially and 200 ml following every loose stool

56
Q

When would loperamide be an appropriate treatment for diarrhoea?

A

For travellers diarrhoea –> never in people where there is potential damage to the GIT - perforation is a risk here

57
Q

What drug class is loperamide and what is its MOA?

A

Opioid receptor agonist.

Decreases motility of the bowel by decreaseding longitudinal muscle activity and increasing tone of anal sphincter –> increases absorption.

SE : can act systemically causing drowsiness (morphine and codeine act on the same receptors)

58
Q

What is the immediate Tx of shock?

What are the risks here?

A
  • ABCs
  • Give O2
  • IV / intraosseus line
  • IV infusion of 20ml/kg NaCl 0.9% or Hartmanns
  • Monitor and repeat if signs persist

Overhydration is a risk –> tachycardia, crackles in lung field, resp distress, hepatomegaly, oedema

59
Q

Hypernatraemic dehydration is another risk of Tx for shock.

  1. What is it?
  2. What are the symptoms?
  3. What is the Tx?
A
  1. When Na >150mmol/L
  • Jittery movements
  • Increased muscle tone
  • Hyper-reflexia
  • Convulsions
  • Drowsiness/coma
    1. Need to reduce the serum Na slowly and measure frequently. i.e. give 0.45% NaCl over a short time or 0.9% NaCl over a long time
60
Q

Following the initial Tx of shock, how much fluid should be given IV to treat dehydration?

A

100ml/kg/day

61
Q

Name 4 RF for dehydration in children

A
  1. <1 year old
  2. Low birth weight
  3. Fluid not tolerated/offered
  4. Cessation of breast feeling during illness
  5. >5 stools in 24hrs
62
Q

What is the advice given about the nutritional management of acute diarrhoea in children?

A

During rehydration therapy - continue breastfeeding but don’t give solids. After rehydration therapy, re-introduce solid foods and avoid fruit juices

63
Q

What is SAM and what are the signs?

A

Severe acute malnutrition

  • Muscle wasting and decreased sub cut fat
  • Angular stomatitis
  • Smooth tongue
  • Conjunctival/palmae pallor
  • Skin hypo/hyperpigmentation
64
Q

What are the risks of fluid management in SAM?

A

IV fluids could cause HF and death

Total [Na] is highg and there’s decreased cardiac reserve. Also leaky endothelium`

65
Q

Name 5 signs of dehydration (8 listed)

A
  • Appears unwell/deteriorating
  • Altered responsiveness
  • Decreased urine output
  • Sunken eyes
  • Dry mucous membranes
  • Tachycardia
  • Tachypnoea
    • Decreased skin turgor
66
Q

Name 4 signs of shock (6 listed)

A
  • Decreased AVPU
  • Pale/mottles skin
  • Cold extremities
  • Weak peripheral pulses
  • Prolonged CRT
  • Hypotension

i.e. all hypoperfusion

JG Year 1 (27 decks)

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