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Medicine > Alimentary System > Flashcards

Alimentary System Flashcards

1
Q

What type of condition is Coeliac disease

A

Autoimmune

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2
Q

What 2 antibodies mediate, and can be tested to diagnose coeliac disease

A

Anti-TTG
Anti-EMA

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3
Q

Where does coeliac disease mainly effect

A

Jejunum

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4
Q

What would be seen histologically in coeliac disease

A

Villi Atrophy
Crypt Hypertrophy

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5
Q

Coeliac disease presentation

A

Often asymptomatic
Failure to thrive
Diarrhoea
Fatigue
Mouth ulcers
Anaemia
Dermatitis Herpetiformis

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6
Q

What do we test all people for who have just had a new diagnosis of type 1 diabetes

A

Coeliac disease

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7
Q

Which 2 genes are linked to coeliac disease

A

HLA-DQ2
HLA-DQ8

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8
Q

What should people with coeliac disease not consume

A

Gliadin (In gluten)

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9
Q

Why is it important to also test total immunoglobulin A when testing for coeliac antibodies

A

Patients sometimes have an IgA deficiency so their Anti-TTG and Anti-EMA fall within the normal range

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10
Q

What do we do if a suspected coeliac patient has an IgA deficiency

A

Test IgG version
Endoscopy + Biopsy

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11
Q

How is coeliac disease diagnosed

A

WHILE STILL EATING GLUTEN:
-Total IgA
-Anti-TTG + Anti-EMA antibodies
-Endoscopy + biopsy

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12
Q

Which diseases are associate with coeliac disease

A

Type 1 diabetes
Thyroid disease
Autoimmune Hepitits
Primary biliary cirrhosis
Primary sclerosing cholangitis

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13
Q

Complications of untreated coeliac disease

A

Vitamin deficiency + anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T-cell-lymphoma
Non-Hodgkin Lymphoma
Small bowel adenocarcinoma

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14
Q

How is coeliac disease treated

A

Gluten free diet (completely cures disease)

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15
Q

What is refractory coeliac disease

A

Symptoms of coeliac disease continue even after adhering to a strictly gluten-free diet.

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16
Q

Which nerves maintain pelvic floor continence

A

C2,3,4 stops the bowel hitting the floor

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17
Q

How can you tell a colostomy apart from ileostomy

A

Ileostomy stoma: spouted appearance, right ileac fossa

Colostomy stoma: flush with skin, left ileac fossa

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18
Q

Signs and symptoms of bowel obstruction

A

Abdominal distension
Absolute constipation
Vomiting
Abdominal pain

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19
Q

What is dyspepsia

A

Group of symptoms:
-Pain/discomfort in abdomen
-Anorexia
-Nausea +/- vomiting
-Bloating
-Early satiety
-Heartburn

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20
Q

What drugs can cause dyspepsia

A

NSAIDs
Steroids
Biphosphonates
Ca channel antagonists
Nitrates
Theophyllines

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21
Q

What lifestyle aspects can cause dyspepsia

A

Alcohol
Diet
Smoking
Exercise
Weight loss

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22
Q

What investigations do we do for dyspepsia

A

Bloods:
-FBC
-Ferretin
-LFTs
-U&Es
-Calcium
-Glucose
-Coeliac serology

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23
Q

When do we refer for a endoscopy with dyspepsia

A

ALARMS

Anorexia
Loss of weight
Anaemia
Recent onset
Melaena/Heamatemesis or Mass
Swallowing problems

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24
Q

Treatment for H.Pylori infection

A

Triple therapy 7 days
-Clarithromycin
-Amoxicillin
-PPI

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25
Q

How is H.Pylori infection diagnosed non-invasively

A

Serology - IgG H.Pylori
13c/14c urea breath test
Stool antigen test (need to be off PPI for 2wks)

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26
Q

How is H.Pylori diagnosed invasively

A

Histology - biopsy
Culture of gastric biopsy
Rapid slide urea test (CLO)

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27
Q

Peptic ulcer symptoms

A

Epigastric pain
Nocturnal/hunger pain
Back pain
Nausea/vomiting
Weight loss/anorexia
Bleeding symptoms

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28
Q

Complications of peptic ulcers

A

Acute bleed
Chronic bleed
Perforation
Fibrotic stricture
Gastric outlet obstruction

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29
Q

Symptoms of gastric outlet obstruction

A

Vomit without bile
Early satiety
Dehydration + loss of HCL in vomit
Metabolic alkalosis

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30
Q

What can induce hepatitis

A

Viral
Alcohol
Drugs

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31
Q

How does each hepatitis spread

A

A&E - fecal oral
BCD - blood borne

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32
Q

What does HDV require to spread

A

Prior infection with HBV

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33
Q

Which variants of viral hepatitis usually resolve on there own

A

A&E

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34
Q

What is the pathology of alcoholic hepatits

A

Fatty change (steatohepatitis)

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35
Q

Treatment of end stage liver disease

A

Transplant

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36
Q

Complications of liver cirrhosis

A

Liver failure
Portal hypertension
Increased risk of hepatocellular carcinoma

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37
Q

Causes of common bile duct obstruction

A

Gallstones
Bile duct tumours
Benign stricture
External compression (tumours?)

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38
Q

Effects of common bile duct obstruction

A

Jaundice
No bile in duodenum
Ascending cholangitis
Secondary biliary cirrhosis

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39
Q

Liver cirrhosis causes

A

Alcohol
HBV,HCV
Autoimmune hepatitis
Primary biliary cholangitis
Metabolic disorders
-Primary haem chromatosis
-Wilson’s disease
Obesity

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40
Q

What are the 3 classifications of jaundice

A

Pre-hepatic
Hepatic
Post-hepatic

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41
Q

What molecule is increased in the body with jaundice

A

Bilirubin

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42
Q

Causes of pre-hepatic jaundice

A

Haemolysis

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43
Q

Hepatic causes of jaundice

A

Cholestasis
Intra-hepatic bile duct obstruction

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44
Q

Post-hepatic causes of jaundice

A

Cholelithiasis
Gallbladder disease
Extra-hepatic bile duct obstruction

45
Q

Risk factors of gall stones

A

Obesity
Diabetes

46
Q

What is the difference between cholecystitis and cholangitis

A

Cholecystitis-Gallbladder inflammation

Cholangitis - Inflammation of bile ducts

47
Q

What is cholestasis

A

Accumulation of bile within hepatocytes

48
Q

Causes of cholestasis

A

Hepatitis
Liver failure

49
Q

3 causes of intra-hepatic bile duct obstruction

A

Primary biliary cholangitis
Primary sclerosing cholangitis
Liver tumours

50
Q

Who does primary biliary cholangitis effect mainly

A

Females 9:1 Males

51
Q

What LFT is raised in primary biliary cholangitis

A

Alkaline phosphatase

52
Q

Who does primary sclerosing cholangitis mainly effect

A

Younger men

53
Q

Functions of hepatocytes

A

Metabolism
Detoxification
Immune cell activation
Protein synthesis

54
Q

Function of stellate cells

A

Store vitamin A in the liver

55
Q

Function of kupffer cells

A

Macrophages of the liver

56
Q

Functions of pit cells

A

NK cells of the liver

57
Q

What stimulates the release of Cholecystokinin

A

Fat/amino acids in duodenum

58
Q

What does CCK stimulate

A

Gastric emptying
Pancreatic enzyme secretion
Galbladder contraction
Sphincter of Oddi relaxation

59
Q

What stimulates the release of Secretin

A

Acid in duodenum

60
Q

What does secretin stimulate

A

Decreased gastric emptying/secretion
Increased duodenal HCO3 secretion
Increased pancreatic HCO3 secretion
Increased bile duct HCO3 secretion

61
Q

Symptoms of oesophageal disease

A

Heartburn (reflux)
Dysphagia
Odynophagia

62
Q

What investigations can we use on the oesophagus

A

Endoscopy
Contrast radiology (barium swallow)
pH-metry
Manometry (pressure waves)

63
Q

How does hypermotility of the oesophagus appear on a Barium swallow

A

Corkscrew appearance

64
Q

How is hypermotility of oesophagus treated

A

Smooth muscle relaxants

65
Q

What causes hypomotility of the oesophagus

A

Associated with connective tissue disease:
-Diabetes
-Neuropathy

66
Q

What is the cardinal feature of achalasia

A

Failure of LOS to relax - results in complete obstruction of the oesophagus

67
Q

Pharmacological treatment of achalasia

A

Nitrates
Calcium channel antagonist

68
Q

Endoscopic treatment of achalasia

A

Botulinum toxin
Pneumatic balloon dilatation

69
Q

Surgical treatment of achalasia

A

Myotomy

70
Q

3 types of oesophagectomy

A

Ivor Lewis
Trans-hiatal
Left thoraco-abdominal

71
Q

GORD symptoms

A

Heartburn
Cough
Water brash
Sleep disturbance

72
Q

Risk factors for GORD

A

Pregnancy
Obesity
Drug use
Smoking
Alcoholism
Hypomotility

73
Q

Treatment of GORD

A

Lifestyle measures
Drugs
Anti-reflux surgery

74
Q

What drugs are used in the treatment of GORD

A

Alginates
H2 Receptor antagonist
PPIs

75
Q

Who mainly gets eosinophilic oesophagitis

A

Males > Females
Children + young adults

76
Q

Presentation of eosinophilic oesophagitis

A

Dysphagia
Bolus obstruction

77
Q

Eosinophilic oesophagitis treatment

A

Topical/swallowed cortical steroids
Dietary elimination
Endoscopic dilatation

78
Q

What is the pathological change in Barret’s Oesophagus

A

Squamous epithelium -> columnar epithelium

79
Q

What are the 3 main categories of gastritis

A

ABC
Autoimmune
Bacterial
Chemical

80
Q

Specific signs/symptoms of autoimmune gastritis

A

Loss of intrinsic factor (leads to B12 deficiency)
Often seen with other autoimmune disease
Loss of specialised gastric epithelial cells

81
Q

What bacteria causes bacterial gastritis usually

A

Helicobacter Pylori

82
Q

What substances can cause chemical gastritis

A

Drugs - REMEMBER NSAIDs
Alcohol
Bile reflux

83
Q

What is the biggest risk factor for gastric cancer

A

Previos H.Pylori infection

84
Q

What causes peptic ulcers

A

Too much acid in the GIT

85
Q

Complications of peptic ulcer

A

Bleeding: -Acute haemorrhage
-Chronic, Anaemia
Perforation: -peritonitis
Fibrosis: -obstruction

86
Q

Where is vitamin B12 absorbed and how

A

Distal ileum after binding with intrinsic factor from the stomach

87
Q

How and where is iron absorbed, and distributed

A

In duodenum via enterocytes
Incorporated into FERRETIN for storage
Transported in blood by TRANSFERRIN

88
Q

Which nerves stimulate salivation

A

Cranial VII, IX
Facial nerve
Glossopharyngeal nerve

89
Q

What are the fat soluable vitamins

A

A, D, E, K

90
Q

What are the water soluable vitamins

A

B groups, C, folate

91
Q

What are the components of saliva

A

99% water
Mucins
Alpha - amylase
Electrolytes
Lysozymes

92
Q

Liver disease symptoms

A

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

93
Q

Compensated cirrhosis presentation

A

Only seen after screening
Abnormal LFTs

94
Q

Presentation of decompensated cirrhosis

A

Ascites
Hepatorenal syndrom
Variceal bleeding
Hepatic encephalopathy

95
Q

Ascites treatment

A

Diuretics
Large volume paracentisis
TIPS
Aquaretics
Liver transplant

96
Q

Hepatorenal syndrome treatment

A

Vasopressors:
-Terlipressin
-Octreotide
TIPSS
Liver transplant

97
Q

What are the effects of alcohol on the liver

A

Directly toxic
Steatosis (fatty liver)
Steatohepatitis (fatty lover + inflammation)

98
Q

Spontaneous bacterial peritonitis symptoms

A

Abdominal pain
Fever
Rigors

99
Q

Spontaneous bacterial peritonitis signs

A

Renal impairment
Sepsis
Tachycardia
Temperature

100
Q

Treatment for spontaneous bacterial bacterial peritonitis

A

IV Antibiotics
Ascitic fluid drainage
IV Albumin infusion (20% ALBA)

101
Q

Risks for fatty liver disease

A

Obesity
Diabetes
Hypercholesterolaemia

102
Q

Presentation of alcoholic hepatitis

A

Jaundice
Encephalopathy
Infection is common
Decompensated hepatic function

103
Q

How is alcoholic hepatitis diagnosed

A

Raised bilirubin
Raised GGT and Alkaline Phosphatase
Hx of alcohol
Exclude other causes

104
Q

Where is appendix pain felt

A

Right ileac region

105
Q

What are the 2 main idiopathic inflammatory bowel diseases

A

Crohn’s Disease
Ulcerative Colitis

106
Q

What area can ulcerative colitis be present

A

Limited to colon

107
Q

What area can Crohn’s Disease be present

A

Mouth to anus

108
Q

Who gets ulcerative colitis most commonly

A

M = F
Ages 20-30 and 70-80

109
Q
A

Medicine (13 decks)

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