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Year 2 > B15 Passmed Questions > Flashcards

B15 Passmed Questions Flashcards

1
Q

What are the intraperitoneal organs?

A

Stomach
1st part of duodenum, Jejunum, Ileum
Transverse colon
Sigmoid colon
Liver
Spleen
Tail of pancreas

Lined with Serosa.

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2
Q

What are the retroperitoneal organs?

A

2nd, 3rd, 4th part of duodenum
Ascending colon, Descending colon
Pancreas excluding tail
Oesophagus
Kidneys and ureter
Aorta, Inferior vena Cava

Lined with adventitia.

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3
Q

What is the role of VIP?

A

Vasoactive intestinal peptide is responsible for relaxation of smooth muscle of the intestine. In response to gastric acid by stimulating D cells for somatostatin release from the stomach and duodenum. Somatostatin causes reduced insulin and glucagon secretion, reduces pancreatic enzyme secretion and PROMOTES mucous production in the stomach.

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4
Q

What is Secretin?

A

Produced by S cells in the duodenum. It responds to gastric acid entry by stimulating bicarbonate production from the pancreas. It has a tropic effect on pancreatic acinar cells that produce digestive enzymes.

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5
Q

What is Zollinger-Ellison syndrome?

A

Gastrin secreting tumour in the pancreas which leads to trophy and hyperplasia of the parietal cells that causes gastric and peptic ulcers. This can present as heartburn and central chest pain, worse when lying down.

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6
Q

How to test for Zollinger-Ellison syndrome?

A

Secretin administration, in order to monitor gastric acid levels.
—> Secretin is responsible for the production of pancreatic bicarbonate secretions to reduce gastric acid levels.

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7
Q

What are the effects of CCK?

A

Produced from i cells in the duodenum for fat and protein digestion via to:
—> Increase pancreatic secretion of lipase, protease and bicarbonate
—> Relaxation of Sphincter of Oddi
—> Aid in fat digestion via contraction of gall bladder
—> Reduce gastric emptying

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8
Q

What are oxyntic cells?

A

Parietal cells of the stomach which produces HCL- and intrinsic factor.

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9
Q

Role of the submucosal nerve plexus?

A

Blood flow to mucosa and increased secretion and mucosal folds.

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10
Q

What is the blood supply to the head of the pancreas?

A

Pancreaticoduodenal artery, which arises from the gastroduodenal artery.

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11
Q

What is the epiploic foramen?

A

AKA foramen of Winslow which is located between the greater and lesser omentum of the stomach

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12
Q

What is a direct inguinal hernia?

A

Protrusion of the bowel through Hesselbach’s triangle due to a weakness in the floor of the inguinal canal. It passes through the transversalis fascia to the superficial inguinal ring, medial to the inferior epigastric artery.

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13
Q

What is an indirect inguinal hernia?

A

Protrusion of the bowel through the deep inguinal ring to the superficial inguinal ring, lateral to the inferior epigastric artery. It is the most common type of hernia which occurs due to a birth defect.

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14
Q

What does the inguinal canal contain?

A

Round ligament.

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15
Q

What are the boundaries of Hesselbach’s triangle?

A

The boundaries are
Medially: Rectus abdominal
Laterally: Inferior epigastric vessels
Inferiorly: Inguinal ligament

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16
Q

What are the boundaries of the inguinal canal?

A
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17
Q

What does the inguinal canal contain in males?

A

Spermatic cord and ilioinguinal nerve.

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18
Q

What does the inguinal canal contain in females?

A

Round ligament of uterus and ilioinguinal nerve.

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19
Q

What level does the inferior mesenteric artery arise?

A

L3 to supply the distal transverse colon to the rectum up to the pectinate line. It gives off the left colic artery at its origin in L3 and the sigmoid branches.

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20
Q

What does shortness of breath and frequent travel increase the risk of?

A

Pulmonary embolism, which can be treated with a filter in the IVC. IVC is located posteriorly to the peritoneum.

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21
Q

Where does the inferior epigastric artery originate?

A

External iliac artery.

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22
Q

What is the most likely site for a complete large bowel obstruction?

A

Caecum.

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23
Q

What are the contents of the femoral canal?

A

NAVEL from lateral to medial:
Nerve
Artery
Vein
Empty space
Lymphatics

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24
Q

What is the femoral sheath?

A

CCOntains the femoral artery, femoral vein and femoral lymphatics, located in the femoral triangle.

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25
Q

What are the boundaries of the femoral canal?

A

LATERALLY: Sartorius
MEDIALLY: Adductor longus
SUPERIORLY: Inguinal ligament
ROOF: Fascia lata and long Saphenous vein
FLOOR: Adductor Longus, pectineus and iliopsoas

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26
Q

What is the arcuate line?

A

Point where the inferior epigastric vessels enter the rectus sheath

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27
Q

What is the trasnverse mesocolon?

A

Mesentery which is a reflection of the parietal peritoneum to connect the colon to the posterior abdominal wall. The transverse mesocolon contains the middle colic artery to supply the transverse colon.

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28
Q

What is mesentery?

A

Double fold of peritoneal tissue that suspends the intestines from the posterior abdominal wall.

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29
Q

What demarcates the transition between te sigmoid colon and the rectum?

A

Disappearance of the taenia Coli. The anal canal is supplied by the inferior rectal artery.

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30
Q

Which structures are posterior to the colon?

A

Ureter and gonadal vessels.

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31
Q

What is the location of the quadrate lobe?

A

Anatomically located in the right lobe.
Functionally located in the left lobe, and receives blood supply from the left hepatic artery.

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32
Q

What is the blood supply to the caudate lobe?

A

Left and right hepatic artery.

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33
Q

What is the blood supply to the rectum?

A

Superior rectal artery, a terminal continuation of the inferior mesenteric artery.

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34
Q

What is the ligamentum venousum?

A

Located in the porta hepatis, attached to the left branch of the portal vein. It is a remnant of the ductus venousus.

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35
Q

What supports the duodenojejunal flexure?

A

Ligament of Treitz, which is found between the ileum and caecum.

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36
Q

What is a side effect of sulphasalazine?

A

Sulphasalazine is prescribed for IBD and megalbolastic anaemia is a major side effect.

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37
Q

What is the role of gastrin?

A

Increases gastric motility
Parietal cells for gastric acid and intrinsic factor secretion
Pepsinogen from chief cells

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38
Q

What is the innervation of the external urethral sphincter?

A

Pudendal nerve, from S2,S3 and S4 nerve roots.

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39
Q

What is the outermost layer of the oesophagus?

A

Adventitia

40
Q

What is the location of the appendix?

A

Retrocoecal.

41
Q

What is the blood supply to the upper third of the oesophagus?

A

Inferior thyroid artery

42
Q

What is the blood supply to the upper third of the oesophagus?

A

Inferior thyroid artery.

43
Q

What is the blood supply to the middle third of the oesophagus?

A

Aortic branches.

44
Q

What is the blood supply to the lowest portion of the oesophagus?

A

Left gastric artery.

45
Q

What is the blood supply to the caecum?

A

Ileo-colic artery.

46
Q

Which bowel condition causes an increase in goblet cells?

A

Crohn’s disease.

47
Q

How is a variceal bleed treated?

A

Medication
Connection of the hepatic vein to the portal vein

48
Q

How is a variceal bleed treated?

A

Medication
Connection of the hepatic vein to the portal vein

49
Q

What is an ideal indicator for liver cirrhosis?

A

Prothrombin time, which measures the extrinsic pathway for coagulation factors 3, VII, V and X.
Liver enzymes are a poor indicator in late stage liver cirrhosis due to a significant loss of functioning liver cells which will be only slightly elevated, and liver enzymes are a better indication for inflammation

Prothrombin raises very quickly with acute liver failure compared to albumin.

50
Q

What is the most common cause of liver failure in the UK?

A

Paracetamol overdose- presents with altered mental status, jaundice and hepatic dysfunction.

51
Q

What are the complication of Crohn’s disease at the anus?

A

Perianal disease, characterised by fistula, abscess/pus discharge and skin tags in the perianal region.

Causes non-caesating granuloma in the intestines.

52
Q

What is used to prevent oesophageal bleeding?

A

Propanolol due to vasoconstriction via B-agonist activity.

53
Q

What are the features of the colon in ulcerative colitis?

A

Psuedopolyps, continuous superficial inflammation and mucosal frailability.
Crypt atrophy.

54
Q

What is the cause of pernicious anaemia?

A

Autoimmune destruction to gastroparietal cells.

55
Q

How does diverticular disease preset?

A

Lower quadrant tenderness, abdominal pain, vomiting and painless haematochemezia (passage of fresh blood). It is caused by increased pressure inside the colon that causes outward projections between the taenia coli of the colon which become inflamed and are at risk of bowel obstruction, fistula, bowel perforation and abscess formation.

It rarely occurs in the rectum because the rectum lack taenia. Low grade fever is present in elderly.

Largest risk factor is a low fibre diet.

56
Q

What are the features of ulcerative colitis?

A

It always starts in the rectum, with superficial inflammation that never exceeds past the ileocaecal valve. Peak incidence in 15-25 year olds and 55-65 years old, with bloody diarrhoea and goblet cell depletion. There is pseudopolyp formation and causes colon to narrow and shorten.

It is associated with primary sclerosing cholangitis.

Tenderness in the lower left quadrant.

57
Q

What are the extracolonic mainfestations of IBD?

A

Arthritis
Clubbing
Erythema nodusum
Pyoderma gangrenosum

58
Q

What is a carcinoid tumour?

A

Neuroendoccrine tuour which is typically located in the appendix and releases serotonin into the circulation. It becomes carcinoid syndrome when this serotonin-producing tumour metastasises to the liver.

59
Q

What are the symptoms of carcinoid syndrome?

A

Vasodilation, itching, Increased GI motility and greater bronchoconstriction and right valvular stenosis.
The serotonin-secreting carcinoid tumour in the liver may produce ACTH and can lead to Cushing’s syndrome.

60
Q

What is the presentation of ischaemic colitis?

A

Widespread INTENSE abdominal pain that is acute, and abdominal distention, nausea and vomiting. It is caused by ischaemia to the large colon typically in the splenic flexure and the rectosigmoid junction, where there is a change in blood supply from superior -> inferior mesenteric artery and inferior mesenteric artery -> colic artery.

61
Q

What are the risk factors for gastric cancer?

A

Pernicious anaemia
Blood Group A
Japanese and Chinese ethnicity
Salty diet of smoked meats
Abdominal pain

62
Q

How does gastric cancer present?

A

Epigastric pain with weight loss, vomiting
Dysphagia
Dyspepsia (heartburn) typically post-prandial

63
Q

What is the risk factors for C-difficile infection?

A

Proton pump inhibitors
Antibiotics: clarithromycin, clindamycin, cephalosporin, co-amoxiclav

64
Q

What is the presentation of C.dificle infection?

A

Diarrhoea
Abdominal pain
Raised WCC and risk of toxic megacolon

65
Q

What does foecal calprotectin test for?

A

Inflammation of the intestines used to diagnose IBD.

66
Q

What is the FIT test?

A

Faecal immunochemical test for prescence of blood in the stool, from the lower intestines.

67
Q

What is the most commmon causes of ascites?

A

Liver disease due to
Alcohol
Acute liver failure
Liver metastases such as carcinoid syndrome

68
Q

What are the cardiac causes of ascites?

A

Right sided heart failure which leads to oedema
Constrictive pericarditis which reduces the heart’s pumping function and causes oedema
Tuberculosis infection causing pericarditis, tuberculous pericarditis

69
Q

What is biliary colic?

A

Pain in the abdomen due to obstruction by stones in the common bile duct or cystic duct.

70
Q

Which enzyme is an indicator for acute pancreatitis?

A

Lipase

71
Q

How is pancreatitis imaged?

A

Ultrasound imaging
CT scan
MRCP

—>ERCP will aggravate

72
Q

What are the stigmata of chronic liver disease?

A

Palmar erythema
Spider naevia
Jaundiced sclera

73
Q

What does the AMpulla of Vater demarcate?

A

Change from foregut to midgut
Blood supply from coeliac trunk to superior mesenteric artery

74
Q

Which part of the pancreas is not retroperitoneal?

A

Tail of the pancreas

75
Q

What is the blood supply to the gall bladder?

A

Cystic artery, a branch of the right hepatic artery.

76
Q

What happens during hypovolemic shock?

A

Decreased blood pressure and cardiac output
Increased heart rate
Increased vascular resistance through vasoconstriction

77
Q

What happens during cardiogenic shock?

A

Decreased cardiac output
Decreased BP
Increased HR
Increased systemic vascular resistance

78
Q

What happens during septic shock?

A

Reduced vascular resistance
Increased heart rate
Normal/decreased cardiac output
Decreased blood pressure

79
Q

What does helicobacter pylori produce to aid survival in the stomach?

A

Urease

80
Q

What are the causes of hepatomegaly?

A

Right sided heart failure/ Cor pulmonale
Malignancy
Cirrhosis of the liver

81
Q

What is the blood supply to the tail of the pancreas?

A

Branches of the splenic artery.

82
Q

What is Meckel’s diverticulum?

A

Outpouch on the lower part of the small intestine due to a remnant of the umbilical cord.

83
Q

What is diverticulosis?

A

Asymptomatic prescence of diverticula in the colon

84
Q

What is diverticular disease?

A

Non-inflamed diverticula present with symptoms such as colicky abdominal pain and rectal bleeding.

85
Q

What are the risk factors for gallstones?

A

Fat
Fertile
Fair/Caucasian
Forty
Female

86
Q

What is a risk factor for hepatocellular carcinoma?

A

Chronic hepatitis B
Chronic hepatitis C
Aflatoxin from mouldy nuts like peanut butter
Liver cirrhosis due to alcohol or obesity
Oral contraceptive
Diabetes mellitus

87
Q

What does alpha-feta protein test for?

A

Hepatocellular carcinoma.

88
Q

Which layers of the are colon affected in Crohn’s disease?

A

All layers from the mucosa to the serosa.

89
Q

What are the features of pancreatic cancer?

A

Painless obstructive jaundice
Weight loss
Steatorrhoea due to insufficiency of lipase enzyme

A major feature is KRAS mutation.

90
Q

Difference between small bowel vs large bowel obstruction?

A

Small bowel obstruction would show vomiting before constipation

Large bowel obstruction would show constipation before vomiting. Bleeding from rectum would indicate colon cancer.

91
Q

How is Clostridium difficile infection treated?

A

Vancomyin

92
Q

What is the most common site of duodenal ulcers?

A

Posterior wall, which is at risk of gastroduodenal artery bleeding.

93
Q

What is the pharmacological treatment of Crohn’s disease?

A

Glucocorticoids such as prednisolone
5-ASA drugs like mesasalazine are second line treatment

94
Q

How should treatment of Coeliac’s for vitamin deficiencies be approached?

A

B12 deficiency must be treated BEFORE folate to prevent worsening subacute combined degeneration of the spinal cord.

95
Q

What are the intraluminal causes of gut malabsorption?

A

Zollinger-Ellison syndrome
Pancreatic insufficiency
Bile acid malabsorption
Small intestine bacterial overgrowth

96
Q

What are the structural causes of gut malabsorption?

A

Crohn’s disease
Diverticular disease
Blind loop syndrome

97
Q

What is the common cause of acute pancreatitis?

A

Gallstones and alcohol.

Year 2 (247 decks)

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