Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Phys > 4. Peptic Ulceration, Neuroendocrine Tumours and Crohns Disease > Flashcards

4. Peptic Ulceration, Neuroendocrine Tumours and Crohns Disease Flashcards

1
Q

diarrhoea

A

passage of 3 or more bowel motions
increased fluidity of stool
water insoluble faecal solids to hold water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

gut fluid load

A

upper tract: 10L

small intestine: 6L to jejunum
2.5L to ileum

1.5L to colon
1.4L absorbed
0.1L out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

small intestines function
and parts

A

absorption of nutrients
duodenum most proximal portion
jejunum middle portion
ileum most distal portion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

mechanisms of diarrhoea (types)

A

secretory diarrhoea - over secretion of water and electrolytes
caused by bacterial toxins
no healthy cells to absorb nutrients so there is a leakage of fluid

inflammatory diarrhoea - cellular damage of mucosa causes hypersecretion

osmotic diarrhoea - osmotically active solutes
lactose intolerance
lactulose intake

motility - increased motility eg IBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

secretory diarrhoea

A

many infections
cholera toxin increases levels of cyclic AMP
cyclic AMP increases chloride secretion
and increases water secretion
so leads to dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

inflammatory diarrhoea

A

cellular damage of intestinal mucosa
decreased water and Na absorption
blood and mucus

ulcerative colitis - affects colon only
Crohn’s disease - small intestine, colon, perineum and occasionally stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

acute/chronic

A

acute 2 weeks history
chronic 4 or more weeks of diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bristol stool chart

A

type 1-7
hard- watery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

colicky pain

A

colicky pain is usually a sharp, localized gastrointestinal or urinary pain that can arise abruptly, and tends to come and go in spasmlike waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

risk factors for diarrhoea

A

Viruses. …
Bacteria and parasites. …
Medications and antibiotics
Lactose intolerance. …
Fructose. …
Artificial sweeteners. …
Surgery. …
Other digestive disorders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

investigations for diarrhoea

A

faecal calprotectin
normal <50ug/mg
marker for inflammatory bowel disease

C-reactive protein
normal 5mg/L
inflammatory marker in blood
marker for autoimmune diseases

Hb (haemoglobin)
anaemia symptom for IBD

full blood count

iron, vitamin B12, folic acid

screening for certain viral infections

colonoscopy/gastroscopy/capsule endoscopy

CT/MRI small bowel imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

examination for diarrhoea

A

pallor
skin lesions
abdomen soft/tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

changes to mucosa

A

mucosa of terminal ileum
ulcerations -> leaking contents -> diarrhoea

inflamed caecal mucosa - mucosa eroded and patchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

management of diarrhoea

A

induction of remission
reduce inflammation
oral rehydration solution (glucose&sodium&water)

maintenance of remission
long term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Crohn’s disease

A

chronic inflammatory condition affecting any part of the gut

age 15-40 y/o
15% have relatives with crohn’s or ulcerative colitis
more common in smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

clinical features of Crohn’s disease

A

diarrhoea, abdominal pain, weight loss

malaise lethargy, anaemia

mouth aphthous ulcers (more frequent and persistent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

types of Crohn’s disease

A

small bowel crohn’s disease 50%
colonic crohns disease 20%
perianal crohns disease 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

perianal fistula
(crohns)

A

An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the opening of the bottom (anus). It’s usually caused by an infection near the anus, which results in a collection of pus (abscess) in the nearby tissue. When the pus drains away, it can leave a small channel behind.
Fistulas can cause a lot of discomfort, and if left untreated, may cause serious complications. Some fistulas can cause a bacteria infection, which may result in sepsis, a dangerous condition that can lead to low blood pressure, organ damage or even death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SKIN: erythema nodosum
(crohns)

A

Erythema nodosum is swollen fat under the skin causing bumps and patches that look red or darker than surrounding skin. It usually goes away by itself, but it can be a sign of something serious

an inflammatory disorder affecting subcutaneous fat. It presents as tender red nodules on the anterior shins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pyoderma gangrenosum
(crohns)

A

Pyoderma gangrenosum is a rare skin condition that causes painful ulcers

daily doses of corticosteroids. These drugs may be applied to the skin, injected into the wound or taken by mouth (prednisone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

iritis
conjunctivitis
(crohns)

A

Iritis is swelling and irritation (inflammation) in the colored ring around your eye’s pupil (iris).

Conjunctivitis is a condition that occurs when the conjunctiva (a thin layer of cells covering the front of your eyes) becomes inflamed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

joint complications (crohns)

A

arthralgia - describes joint stiffness

sacroiliitis - painful condition that affects one or both sacroiliac joints. These joints sit where the lower spine and pelvis meet. Sacroiliitis can cause pain and stiffness in the buttocks or lower back, and the pain might go down one or both legs.

arthritis - common condition that causes pain and inflammation in a joint.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

management of crohn’s disease

A

assessment of severity/extent
steroids
nutrition/exclusive enteral feeding (you receive all of your calories through formula and you do not eat regular food. liquid diet)
drugs (infliximab)
surgery (resection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

drugs for crohns disease

A

targets a single pro-inflammatory cytokine TNF

produced by macrophages and intiates a cascade of inflammation

infliximab was the first drug used in inflammatory bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
epigastric pain
pain or discomfort right below your ribs in the area of your upper abdomen. It can have many causes, including acid reflux, gallstones, or indigestion.
26
anadin
painkiller taking it for too long can cause peptic ulcers
27
rectal examination
doctor uses finger to check for problems in rectum checks for melaena digested blood in stool due to gastrointestinal bleeding
28
management for peptic ulcers
fluid resuscitation stop non steroidal medications eg. anadin proton pump inhibitors (omeprazole) upper GI endoscopy (from mouth)
29
peptic ulcers
sore on the lining of your stomach, small intestine or esophagus result of inflammation can cause indigestion, abdominal pain, vomiting...
30
non steroidal medications
systemic and local effects reduced mucosal prostaglandins affect mucosal blood flow reduced mucosal integrity
31
stomach epithelium
epithelium has 2 gland types oxyntic gland = parietal cells body and fundus (80% of stomach) pyloric gland = G cell antrum (20% of stomach)
32
the stomach secretes...
acid water electrolytes glycoproteins mucin intrinsic factor enzymes
33
gastric acid
necessary for protein digestion absorption of Ca+, iron, vitamin B12, thyroxin prevention of bacterial overgrowth and enteric infections reduction or elimination of food allergenicity gastric acid in excess results in ulceration
34
control of acid secretion
balance of neural, hormonal and paracrine pathways activated directly by stimuli from brain reflex activation by stimuli in stomach and intestines (distension, protein/lipid/acid)
35
hormone and paracrine mechanism of acid secretion control
hormone released into blood reaches targets via bloodstream ie. gastrin paracrine released into tissue reaches targets by diffusion ie. histamine and somatostatin
36
stimulation of acid secretion cephalic phase
smelling or thinking about food as stimuli Gastric juice is secreted
37
stimulation of acid secretion gastric phase
food has just arrived beginning of gastric phase stomach stretched Acid continues to be secreted in response to distension pH is lowered gastrin release
38
stimulation of acid secretion gastric phase
food has just arrived mediated by vagus nerve stomach stretched Acid continues to be secreted in response to distension pH is lowered gastrin releases
39
stimulation of acid secretion intestinal phase
somatostatin inhibition (gastrin and histamine) decreases vagus stimulation inhibits gastrin release
40
gastric lipase
initiates digestion of fats hydrolyses 20% of tyiglycerides resistant to acid secreted by fundic chief cells detectable by 10 weeks of gestation
41
pepsinogen
secreted by gastric chief cells proenzyme converted to pepsin by gastric acid necessary for protein digestion stimulated by cephalic vagal input
42
pepsin
digestive enzyme mucolytic ulcerogenic inactive at ph>4
43
intrinsic factor
secreted by parietal cells binds to vitamin B12 intrinsic factor-vitamin B12 complex: binds to cubilin repector in ileal mucosa absorbed by endocytosis
44
causes of peptic ulcers
H.pylori infection use of NSAIDS non-steroidal-anti-inflammatory-drugs Crohns disease
45
H. pylori
colonises gastric epithelium of 50% of worlds population causes gastritis, peptic ulcers, mucosa-associated-lymphoid tissue lymphoma MALT, gastric cancer
46
H. pylori acute and chronic infection
acute: causes hypochlorhydria chronic: hypochlorhydria or hyperchlorhydria (stomach acid)
47
how H. pylori produces mucosal damage
organisms synthesise urease, which produces ammonia, that damages the gastric mucosa colonises epithelial cells and decreases the production of mucus so stomach mucosa is exposed to its own secretions gastric acids causes the formation of ulcers
48
how NSAIDs cause peptic ulcers
Inhibition of COX-1 in the gastrointestinal tract leads to a reduction of prostaglandin secretion and its cytoprotective effects in gastric mucosa. This therefore increases the susceptibility to mucosal injury.
49
Gastrinomas and Zollinger-Ellison syndrome
gastrinomas are rare tumours autonomous production of gastrin, leads to overproduction of gastric acid Zollinger-Ellison syndrome is a rare condition in which one or more gastrinomas grow in the pancreas or in the upper part of the small intestine.
50
neuroendocrine cells
peptide hormone-producing cells that share a neural-endocrine phenotype
51
neuroendocrine neoplasms/tumours
rare tumours that develop in neuroendocrine system/ in neuroendocrine cells
52
D cells (location and products)
GI tract Somatostatin
53
Enterochromaffin (location and products)
GI tract Serotonin, substance P
54
Enterochromaffin-like (location and products)
GI tract Histamine
55
G cells (location and products)
Stomach& duodenum Gastrin
56
VIP cells (location and products)
GI tract VIP
57
A cells (location and products)
Pancreas Glucagon
58
B cells (location and products)
Pancreas Insulin
59
Chromaffin (location and products)
Adrenals Catecholamines
60
C cells (location and products)
Thyroid Calcitonin
61
Histopathological assessment of NEN
cell morphology immunohistochemistry Ki67
62
Immunohistochemistry of NEN
general markers (chromogranin, synaptophysin, cytokeratin) peptide hormones (serotonin) receptors
63
Ki67
assesses tumour grading marker of proliferation and shows how many cells are in cycle if Ki67 > 20% : neuroendocrine carcinoma (poorly differentiated) Ki67 > 20% : neuroendocrine tumours of G3 grade (well diff) Ki67 3-20% : neuroendocrine tumours of G2 grade (well diff) Ki67 < 2% : neuroendocrine tumours of G grade (well diff)
64
Carcinoid syndrome
Carcinoid syndrome is the collection of symptoms some people with a neuroendocrine tumour may have. It is more common when the tumour has spread to the liver and releases hormones such as serotonin into the bloodstream.
65
Carcinoid syndrome symptoms
flushing diarrhoea abdominal pain carcinoid heart disease telangiectasias bronchospasm pellagra
66
Carcinoid crisis & symptoms
a rare but serious condition called a carcinoid crisis, which involves severe flushing, breathlessness and a changes in your blood pressure. severe symptoms of carcinoid syndrome (bronchospasm and flushing) and hypotension
67
flushing due to carcinoid syndrome
dry and intermittent provoked by alcohol, exercise, food containing tyramines (blue cheese and choc) involves face and upper trunk (above nipple)
68
diagnosing flushing due to other causes (not carcinoid syndrome)
+diarrhoea - medullary thyroid carcinoma, pancreatic VIPoma wet flushing - menopause constant - alcoholism, polycythemia, mitral valve disease +headaches - phaeocromocytoma or mastocytosis +rash features - rosacea, mastocytosis
69
initial diagnostic approach
biopsy of lesions (compatibility w neuroendocrine neoplasm) history and clinical examination biochemical tests “biomarkers” imaging studies to localise primary and metastatic lesions histology - gold standard

Clin Phys (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions