7. The Gut Flashcards
What is steatorrhea?
What is absorbed only from the terminal ileum?
What is enterohepatic circulation?
How much does poo weigh?
Pale floating (due to air) stools caused by malabsorption of fat in the small intestine and thus greater fat content in stool. In eg. Crohn’s Disease
B12 and bile acids. B12 stored in liver
Ciculation of biliary acids from liver to bile, followed by entry into the small intestine, absorption by the enterocyte and transport back to the liver.
Roughly 250-300g
What problems can affect the oesophagus?
What are the signs/symptoms of GORD?
What is Barrett’s oesophagus, and what is it caused by?
Who does it affect most, and how is it managed?
Reflux - oseophagitis, hiatus hernia, lack of propulsion, cancer
Heartburn, positional (bend down/lie down), sore throat, nausea, chest pain, acid/water brash, chronic cough. Normally: “I have a burning pain in my chest”
Distal oesophageal epithelium undergoes metaplasia from squamous to columnar + goblet cells. Caused by long-standing reflux. 30-40% are pre-malignant carcinoma.
Middle aged males. Regular biopsies.
What would you do if a 45yo male presented with a 2m history of food getting stuck in his gullet - he now has difficulty swallowing liquids. Weight loss
What is normal gullet pH?
What is achalasia?
What would oseophageal manometry look like for
a) a normal pt
b) a pt with achalasia
c) systemic sclerosis
d) diffuse spasm?
Endoscopy and biopsies, dilate with dilator
4
Failure of osophageal SM in LOS to relax, which can cause a sphincter to remain closed and fail to open.
a) normal peristalsis with wave progression
b) synchronous low amplitude waves, elevated LOS pressure with poor sphincter relaxation
c) Low amplitude waves and LOS pressure
d) High amplitude waves, occasional peristaltic progression
What are oesophageal varices?
List some things the stomach produces.
What conditions can affect the stomach?
What 2 drugs work on the P cells in the stomach?
Very dilated submucosal veins in the lower 1/3 of the oesophagus. Often consequence of portal hypertension due to cirrhosis and liver damage. If pop, lots of bleeding (pic).
Acid, IF, gastrin, pepsinogen
Gastritis, gastric ulcer, pernicious anemia, cancer
Histamine antagonist works on H2 receptors, and PPI works on H+/K+ ATPase
What is H. pylori?
Two 66yo male patients, one with a 10 month history of epigastric pain worse after meals, and one with a 2 month history. Which case would be benign/metastatic?
List some features of the small intestine.
Bacteria - type 1 carcinogen, risk of gastric carcinoma 3-6x, most peptic ulcers
10m = benign, 2m = metatastic (b/c pt changed in 2 months)
Villi - increase SA, absorption of CHO, proteins, fats, vitamins, defence against antigens (GALT, Peyer’s patches and scattered lymphoid cells)
If a patient presents with diarrhoea/steatorrhoea, abdominal pain/discomfort, weight loss and nutritional deficiencies, what could be causing his problems?
Distinguish between Crohn’s disease and Ulcerative colitis.
What is Giardia intestinalis?
Coeliac disease, Crohn’s disease, Infection/infestation
CD: mouth -> anus especially the terminal ileum. Transmural = goes through whole wall so get more fissures, fistulas and blockages.
UC: colon, can affect terminal ileum too but more superficial = bleed more and present with bleeding diarrhoea.
Flagellated parasite with 2 big suckers to stick to mucosa.
What woud you do to diagnose Coeliac disease, and how would you treat it?
What conditions affect the colon and rectum?
What is diverticular disease?
Serology (EMA, tTG), duodenal biopsy for villus atrophy. Treat via gluten free diet. (Pic: jejunal mucosa showing sub-total villus atrophy)
Diverticular disease, IBD, cancer, rectum - haemorrhoids (bright red blood when wipe)
Diverticulum = outpouching of a structure. If in colon: little outpockets of colonic mucosa/submucosa through weaknesses of muscle layers in colon wall. Typically symptomless, unless they become inflamed (diverticulitis) or bleed.
Where is the most common distribution of colorectal cancer?
What can you see in this colonoscopy?
Descending colon.
Colon carcinoma.
