29/04 Flashcards
liver cirrhosis glucose
hypoglycaemia- encalopathy
Nodules in the palm of the hands.
alcoholic liver disease symptoms
anti 1 antitrypsin deficiency
type of emphysema
panacinar
liver cirrhosis histology
excess collagen and extracellular matrix deposition in periportal and pericentral zones making regenerative nodules
varicose veins investiagtions
duplex US
mesenteric ischaemia, what part affects mostly
splenic flexure
Interstitial Cells of Cajal (ICCs)–
pacemaker cells located between circular and longitudinal smooth muscle. Determines Max frequency, direction + velocity of rhythmic contractions.
Enteric Nervous system
parasympathetic and sympathetic
autonomic
Sympathetic
increase sphincter tone. Decreases motility, secretion and blood flow
affarent
signals to CNS/pons+medulla
CN 9,10
efferent
signals away from CNS
CN12, 9, 10, 11
to pharynx and laynx
parotid
innervated by the glossopharyngeal nerve
Formation of saliva
Primary secretion by acinar cells then secondary modification by duct cells
cephalic stage of gastric secretion
before food reaches stomach
Muscuranic receptor antagonists (e.g. pirenzipine)
block competitively M3
H2 histamine receptor antagonists (e.g. ranitidine
block competitively (reversible).
Proton-pump inhibitors (e.g. omeprazole
inhibit active H+/K+ dependent ATPase (proton pump). Must be present in plasma at an effective concentration whilst proton pumps are active
NSAIDs (e.g. aspirin
block irreversibly cyclo-oxygenase
reduce prostaglandin formation so may trigger gastric ulceration and bleeding
BMI
Weight (kg) / Square of height (m)
adiposity signals (hormones)
Leptin (from fat cells), reduced levels mimics starvation causing unrestrained appetite.
-Insulin (pancreatic cells), high levels inhibit food intake and decrease body weight. (Deletion of insulin receptors = obesity)
Drug Treatment of Obesity
-Orlistat – inhibits pancreatic lipase so decreases triglyceride absorption. (Causes cramping and diarrhoea).
-Contrave (Mysimba) – combination of dopamine re-uptake inhibitor + opioid antagonist
Liraglutide (Saxenda) – Glucagon like peptide 1 receptor agonist (GLP-1 a satiety peptide) injected.
Bariatric Surgery – gastric bypass surgery – weight loss + reduces mortality. Induces resolution of type II diabetes.
Carbs
starch, cellulose, glycogen, dissacharides
lipids
triacylglycerols, phospholipids, cholesterol, free fatty acids, lipid vitamins
luminal digestion
by pancreatic enzymes secreted into the duodenum
Absorption
where absorbable products are transferred across both apical (brush border) and basolateral membranes of enterocytes
CARB DIGESTION
polysaccharides (45-60%) starch and glycogen, - oligossacharides (30-40%) sucrose and lactose, - monosaccharides (5-10%) Glucose and fructose
all converted to monosaccharides for absorption
PROTEIN DIGESTION
digested to oligopeptides and amino acids
Peptides are hydrolysed (by peptidases) to amino acids which cross basolateral membrane by Na+ independent transporters.
In Duodenum – pancreatic lipase + bile salts (HCO3- in pancreatic juice neutralises stomach acid).
[Bile salts – emulsify large lipid droplets to small so greater surface area for lipase to act. Colipase allows access of lipase to hydrophobic core of small droplets. Failure to secret bile salts causes Steatorrhea, and secondary vitamin deficiency.]
Plasma protein secretion
- Albumin
- Alpha Globulins – transport lipoproteins, lipids, hormones and bilirubin (eg ceruloplasmin transports copper). Retinol binding protein transports vitamin A.
- Beta Globulins – transferrin (transports Fe3+, stored bound to ferritin), Fibrinogen (inactive form of fibrin, clotting of blood
GGT
gamma-glutamyl transferase (GGT) blood test measures the activity of GGT in your blood. GGT may leak into your bloodstream if your liver or bile duct is damaged, so having high levels of GGT in your blood may indicate liver disease or damage to your liver’s bile ducts
Achalasia
symptoms
signs
treatment
unknown aetiology which causes failure of the lower oesophageal sphincter to relax.
associated with underlying oesophageal cancer
Dysphagia – gradual onset (months to years)
Regurgitation of undigested food
Aspiration
Retrosternal chest pain / heartburn – often does not respond to PPI
Weight loss – often mild
dilated oesophagus, containing residual materia
‘bird’s beak appearance’ in barium swallow
Botulinum toxin injections (botox)
Medical therapy can be tried (calcium channel blockers / nitrites) in patients who fail botox therapy or are not suitable surgical candidates
Surgery: Options include oesophageal dilatation and surgical cleavage of the muscle, called ‘Heller’s Myotomy’.
Bacillus cereus
Gram-positive rods that produce 2 toxins, an emetic pre-formed enterotoxin that is absorbed into the blood-stream from the stomach, and a diarrhoea-causing enterotoxin that acts on receptors in the small intestine and large bowel.
Symptoms start 30 minutes to 6 hours after eating contaminated food (due to the pre-formed toxin), and profuse vomiting is a common feature. Fever is usually absent.
Rice is a common source, as it provides the carbohydrate for the bacteria to produce the toxins.
These are heat stable, so when the rice is reheated they remain active
types of ascities
exudate- malignancy/infection
transudate- increased pressure from portal hypertension
causes of oesophageal varicies
portal hypertension
from liver cirrhosis, hep, liver disease, budd chiari
leads to enlarged spleen but GB isn’t affected!! because the hepatic vein doesn’t supply the gall bladder
icterus
jaundice
painless jaundice, old age and weight loss
which cancer?
pancreatic more likely than cholangiocarcinoma
which IBD has transmural/ mucosal involvement
t- crohns
m- UC
crypt abscess with which IBD
UC
