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Year 2 > Case 11 > Flashcards

Case 11 Flashcards

1
Q

Arterial supply of caecum

A

Superior mesenteric artery
Branches into ileocolic artery
Branches into right and left caecal arteries

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2
Q

Pain course in Appendicitis

A

Initially, vague pain in periumbilical region due to stretching of visceral peritoneum.

Then severe pain in right lower quadrant due to irritation of parietal peritoneum

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3
Q

Phrenicolic ligament

A

Attaches transverse colon to diaphragm

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4
Q

Omental appendices

A

Small pouches of peritoneum on the surface of the colon, filled with fat

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5
Q

Teniae Coli

A

3 strips of muscle on surface of the bowel wall.
Contract to shorten the bowel

(Mesocolic, free, omental)

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6
Q

Haustra

A

Sacculations in bowel wall caused by contraction of teniae coli

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7
Q

Components of solids found in rectum

A

Cellulose/Epithelial cells
Bacteria
Salts
Stercobilin

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8
Q

Gaseous components found in rectum

A

Indol and Skatol

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9
Q

Production of gases found in rectum

A

Indol and Skatol produced by breakdown of amines by bacteria

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10
Q

Pouch of Douglas is also known as

A

Rectouterine pouch

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11
Q

Anorectal ring

A

Fusion of internal and external anal sphincters, and puborectalis muscle

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12
Q

Epithelium lining anal canal and rectum

A

Columnar

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13
Q

Epithelium lining anal canal below pectinate line

A

Non keratinised stratified squamous

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14
Q

Vascular supply above pectinate line in anal canal

A

Superior rectal artery and vein

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15
Q

Vascular supply below pectinate line in anal canal

A

Inferior rectal artery and vein

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16
Q

Nerve supply above pectinate line in anal canal

Sensitive to…

A

Hypogastric plexus

Sensitive to stretch

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17
Q

Nerve supply below pectinate line in anal canal

Sensitive to…

A

Inferior anal nerves

Sensitive to pain, temperature, touch and pressure

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18
Q

Non pathological haemorrhoids

A

Vascular cushions found within anal canal.

Help to maintain faecal continence

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19
Q

Type of muscle in Internal Anal Sphincter

A

Smooth (involuntary, controlled by autonomic NS)

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20
Q

Type of muscle in External Anal Sphincter

A

Skeletal

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21
Q

Nerve supply to External Anal Sphincter

A

Pudendal Nerve

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22
Q

Process of Defaecation

A

Contraction of external anal sphincter and puborectalis muscle
Increases anorectal angle and compresses anal canal

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23
Q

Main site of sodium reabsorption in the GI tract

A

Jejunum

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24
Q

Main site of potassium reabsorption in the GI tract

A

Jejunum (and ileum)

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25
Q

How is potassium reabsorbed into the jejunum?

A

Solvent drag i.e. by the flow of water, not through specific ion channels

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26
Q

Site of potassium secretion into GI tract

A

Colon

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27
Q

Regulator of potassium secretion into GI tract

A

Aldosterone

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28
Q

Main site of calcium reabsorption in the GI tract

A

Duodenum

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29
Q

How is calcium reabsorbed into the GI tract?

A

TRPV channels (Transient Receptor Potential Vallinoid)

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30
Q

Hormone regulator of calcium uptake in the GI tract

A

Calcitrol

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31
Q

Intracellular buffer required for calcium uptake in the GI tract

A

Calbindin

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32
Q

Transferrin

A

Glyco-protein found in blood which binds to iron and tranports it

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33
Q

High ferritin suggests

A

Iron storage problem - haemochromatosis, or chronic disease process

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34
Q

Low ferritin suggests

A

Iron deficiency causing anaemia

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35
Q

Low transferrin causes

A

anaemia

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36
Q

Ferritin

A

Intracellular protein which stores iron

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37
Q

Role of Enteric (NANC) neurons in regulation of secretion/absorption in the GI tract

A

Release VIP - Chloride ion secretion

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38
Q

Role of Enterochromaffin cells in regulation of secretion/absorption in the GI tract

A

Release serotonin - Chloride ion secretion

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39
Q

Role of D cells in regulation of absorption/secretion in the GI tract

A

Release somatostatin - chloride and sodium ion absorption

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40
Q

Actions of Somatostatin

A

Inhibits G cells (inhibits secretion of gastrin)

Stimulates sodium and chloride ion absorption

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41
Q

Role of enteric neurons in regulation of absorption/secretion

A

Release encephalins - chloride and sodium ion absorption

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42
Q

NANC neurons

A

Non adrenergic, non cholinergic neurons

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43
Q

Role of luminal bacteria on regulation of secretion/absorption in the GI tract

A

Release enterotoxins (e.g. cholera toxin) - chloride ion reabsorption

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44
Q

Role of mast cells in regulation of secretion/absorption in the GI tract

A

Release histamine - chloride ion absorption

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45
Q

Effect of aldosterone on secretion/absorption in the GI tract

A

Sodium ion and water reabsorption in the GI tract

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46
Q

Verner Morrison Syndrome

A

Increased VIP
Increased Cl- secretion into GI tract
Draws water into lumen
Watery diarrhoea

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47
Q

Why do SSRIs (e.g. Prozac) cause diarrhoea?

A

Increased availability of serotonin
Increased Cl- secretion into GI tract
Draws water into lumen

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48
Q

Excitatory neurotransmitters in enteric nervous system

A

ACh and Substance P

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49
Q

Inhibitory neurotransmitters in enteric nervous system

A

VIP and Nitric Oxide

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50
Q

Intestinal wall contractions after a meal (Postprandial)

A

Shortening/Lengthening of individual villi
Segmentation mixing via circular smooth muscle
Pendular mixing via longitudinal smooth muscle
Peristaltic waves (transports contents approx 5cm)

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51
Q

Migrating Motility Complexes

A

Once/hour during fasting, contents is moved over a long distance (0.5m) due to MOTILIN released by M cells
Flushing of the intestines

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52
Q

Peristaltic Reflex

A

Stretch receptors in submucosal plexus activated due to bolus in lumen.
Relaxation of intestinal wall ahead of bolus.
Contraction of intestinal behind bolus

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53
Q

SIP syncytium

A

Smooth Muscle cells
Interstitial cells of cajal
PDGFR-alpa+

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54
Q

Interstitial cells of Cajal

A

Show pacemaker activity due to cyclic release of Ca2+ from stores

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55
Q

Motilin released from… in response to…

A

Released from M cells in the duodenum in response to fat and acid

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56
Q

Neurotensin released from… in response to…

A

N cells in ileum in response to fat

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57
Q

Effect of Neurotensin on intestinal epithelial cells

A

Decreases motility

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58
Q

Effect of motilin

A

Stimulates gastric emptying

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59
Q

Enteroglucan released from… in response to …

A

L cells in the distal ileum in response to glucose and fat

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60
Q

Effect of enteroglucan

A

Decreases motility

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61
Q

Effect of VIP on intestinal smooth muscle cells

A

Relaxation

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62
Q

Effect of encephalins on intestinal motility

A

Stimulates Peristaltic reflex

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63
Q

Hirschsprung’s disease

A

Aganglionic congenital megacolon

Part of GI tract have no ganglion cells so cannot function - MEGACOLON
Muscle remains contracted.
Distention of area of colon proximal to affedted area

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64
Q

Why is Cl- exchanged for HCO3- in colon?

A

Bicarbonate neutralises acidity produced by bacterial symbiotic flora

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65
Q

Factors affecting mass movement in the colon

A

Parasympathetic intrinsic reflex pathways (vagal neurons)
Gastrin
CCK

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66
Q

Immune function of Greater Omentum

A

Forms adhesions near an inflamed organ (e.g. appendix), enclosing it off to protect other organs

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67
Q

Epiploic foramen

A

Connects greater and lesser sacs of peritoneum

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68
Q

Clinical presentation of Pneumoperitoneum

A

Abnormal presence of gas in peritoneum.
Affected diaphragm (C3,4,5)
Therefore, referred pain in tip of shoulder

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69
Q

Vertebral level of coeliac trunk

A

T12

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70
Q

Left gastric artery supplies

A

Oesophagus and lesser curvature

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71
Q

Splenic artery supplies

A

Spleen and part of pancreas

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72
Q

Common hepatic artery supplies

A

Proximal duodenum
Liver
Gallbladder

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73
Q

Vertebral level of Superior Mesenteric Artery

A

L1

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74
Q

Inferior Pancreaticoduodenal artery supplies

A

Duodenum and Pancreas

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75
Q

Right colic artery supplies

A

Ascending colon

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76
Q

Middle colic artery supplies

A

Proximal 2/3 of transverse colon

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77
Q

Vertebral level of Inferior Mesenteric Artery

A

L3

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78
Q

Left colic artery supplies

A

Distal 1/3 of transverse colon

Descending colon

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79
Q

Ligament of Treitz

A

Attaches duodenojejunal flexure posterior to abdominal wall

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80
Q

Surface anatomy: Where are the small intestines located?

A

Epigastric and umbilical region

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81
Q

Surface anatomy: Where is the ileocaecal junction located?

A

Right Iliac Fossa

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82
Q

Jejunum has a …. diameter than ileum

A

Greater

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83
Q

Ileum has a …. wall than jejunum

A

Thinner

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84
Q

Plicae circularis

A

Circular folds/large valvular flaps
Project into the lumen of the small intestine
(more in jejunum than ileum)
Continue across entire circumference of bowel

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85
Q

Jejunum has (long/short) vasa recta and (few/many) arcades

A

Long

Few

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86
Q

Ileum has (long/short) vasa recta and (few/many) arcades

A

Short

Many

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87
Q

Symptoms of intussusception

A

Pain
Distension
Constipation
Absent bowel sounds

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88
Q

Meckel’s Diverticulum

A

Congenital
Slight bulge in small intestine
Remnant of yolk sac

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89
Q

Normal diameter of caecum

A

9cm

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90
Q

McBurney’s Place

A

Appendicular orifice used in surgical excision of appendix

1/3 of the distance from Right ASIS to the umbilicus

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91
Q

Normal diameter of colon

A

6cm

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92
Q

What are diverticula?

A

Mucosa extruding through weakened muscular wall of colon

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93
Q

Cause of diverticulitis

A

Faeces obstructing neck of diverticula causing accumulation of bacteria

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94
Q

Diverticulitis normally affects

A

Sigmoid colon

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95
Q

Symptoms of diverticulitis

A 
Pain/Tenderness/Guarding in Left Iliac Fossa
Palpable mass
Fever
Constipation 
Tachycardia
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96
Q

Complications of diverticulitis

A

Bowel perforation
Abscess formation
Fistulae into adjacent organs
Generalised peritonitis

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97
Q

Lymphatic drainage of rectum/anal canal above pectinate line

A

Internal iliac nodes

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98
Q

Lymphatic drainage of anal canal below pectinate line

A

Superficial inguinal canal

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99
Q

Why are internal haemorrhoids painless?

A

Supplied by Hypogastric plexus which only responds to stretch

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100
Q

Why are external haemorrhoids acutely painful?

A

Supplied by inferior anal nerves

Respond to pain, temperature, touch and pressure

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101
Q

Indirect inguinal hernia

A

Lateral to inferior epigastric vessels

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102
Q

Direct inguinal hernia

A

Medial to inferior epigastric vessels

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103
Q

Young boy with inguinal hernia descending into the scrotum

A

Indirect

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104
Q

Elderly man with inguinal hernia, palpable in abdominal wall above pubic tubercle

A

Direct

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105
Q

Nerves involved in sympathetic innervation of GI tract

A

Splancnhnic Nerves

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106
Q

Spinal level of foregut

A

T5-T9

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107
Q

Spinal level of midgut

A

T10-T12

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108
Q

Spinal level of hindgut

A

L1/2

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109
Q

Splanchnic nerve supplying foregut

A

Greater

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110
Q

Splanchnic nerve supplying midgut

A

Lesser

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111
Q

Splanchnic nerve supplying hindgut

A

Lumbar

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112
Q

Area of referred pain from foregut

A

Epigastric region (below nipples, above umbilicus)

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113
Q

Area of referred pain from midgut

A

Umbilical region

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114
Q

Area of referred pain from hindgut

A

Left and right flanks

Lateral and anterior thighs

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115
Q

Adenomas are

A

neopastic polyps

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116
Q

Polyps are

A

Precursors for carcinoma

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117
Q

Adenomas in the intestine arise from

A

Glandular epithelium

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118
Q

Ulcerative colitis

A

Diffuse mucosal inflammation, limited to the colon

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119
Q

Symptoms of Ulcerative colitis

A

RECTAL BLEEDING
Diarrhoea
Urgency
Abdominal pain

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120
Q

UC almost always affects

A

Rectum (Proctitis)

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121
Q

Crohn’s Disease

A

Patchy, transmural inflammation affecting any part of the GI tract (Mouth to anus)

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122
Q

Crohn’s Disease commonly affects…

A

Large bowel and terminal ileum

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123
Q

Toxic megacolon is an acute complication of…

A

Ulcerative colitis

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124
Q

How does Ulcerative colitis cause toxic megacolon?

A

Ulcerating inflammatory processes dissect into the wall of the colon

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125
Q

What is seen on a radiograph of toxic megacolon?

A

Early - accumulation of gas over a segment of the colon. Scalloped edge due to oedema and spasm.

Late - dilatation (maximal in transverse colon), abnormal haustra and thumb-printing

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126
Q

Thumb-printing

A

Caused by inflammation e.g. UC, Crohn’s Disease, Pseudomembranous colitis, ischaemic colitis

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127
Q

Contraindicated procedures in Toxic Megacolon

A

Barium enema

Colonoscopy

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128
Q

Early sign on radiograph of bowel perforation

A

Subserosal dissection of luminal gas into bowel wall

i.e. gas from the bowel invades the bowel wall

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129
Q

Inflammation in Crohn’s disease usually occurs where?

A

Ileocaecal region (75-80%)

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130
Q

Symptoms of inflammation in Crohn’s disease

A 
Right lower quadrant pain
Tenderness
Low grade fever
Anorexia and weight loss 
Diarrhoea
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131
Q

How does an obstruction occur in Crohn’s disease? (4)

A

Fibromuscular proliferation and deposition of collagen in bowel wall (narrowing of lumen)

Inflammatory infiltration
Fibrosis (above)
Spasm
Oedema

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132
Q

Symptoms of obstruction in Crohn’s disease

A 
Post-prandial cramps 
Distention
Borborgymi (noisy bowel sounds)
Vomiting (due to high grade obstruction)
Weight loss
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133
Q

Symptoms of enteroenteric fistulisation

A

Usually asymptomatic

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134
Q

Symptoms of Enterovesical fistulisation

A

UTIs

Pneumoturia (air in urine)

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135
Q

Symptoms of retroperitoneal fistulisation

A

Psoas abscess signs

e.g. pain in back, hip or knee and a limp

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136
Q

Symptoms of enterocutaneous fistulisation

A

Drainage via a scar on the skin

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137
Q

Symptoms of perianal fistulisation

A

Pain, drainage

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138
Q

Symptoms of rectovaginal fistulisation

A

Drainage of faeces/air through vagina

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139
Q

Treatment of perianal fistulae

A

Seton - stitch to hold open fistula, allowing its contents to drain out rather than becoming infected.

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140
Q

‘String-sign’

A

String-like appearance of a contrast filled bowel due to severe narrowing of lumen

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141
Q

Why would ‘string-sign’ be seen in inflammation in Crohn’s Disease?

A

Narrowing of lumen due to transmural thickening and irritative spasm

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142
Q

Red flags for IBD

A 
Anaemia
Weight loss 
Fever 
Perianal disease
Occult blood/Faecal WBCs
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143
Q

Effect on IBD risk of smoking

A

Decreases risk of UC

Increases risk of CD

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144
Q

Effect on IBD of appendicectomy

A

Protects against UC

No effect on CD

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145
Q

MOA of mesalazine

A

5-ASA is the active moiety
Diminishes inflammation of bowel by blocking COX
Reduces prostaglandin production

146
Q

5 Aminosalicylic Acid drugs

A

Mesalazine
Balsalazine
Olsalazine

147
Q

What is the problem with sulfalazine treatment?

A

When cleaved it forms 5ASA and sulphapyridine

Sulphapyridine is clinically toxic when circulating

148
Q

Indication for mesalazine

A

Mild to moderate Ulcerative colitis (active and in maintaining remission)
Crohn’s Disease

149
Q

Indication for prednisolone

A

Severe active UC or CD

150
Q

MOA of prednisolone

A

Glucocorticoid analogue
Binds to steroid receptor acting as a transcription regulator.
Increased anti inflammatory proteins
Decreased inflammatory immune factors

151
Q

Route of administration of prednisolone

A

Oral

152
Q

Route of administration of hydrocortisone

A

IV

153
Q

ADRs of prednisolone

A

Cushing’s
Weight gain
Immunosuppression

154
Q

Contraindications of prednisolone

A

Cushing’s
Immunosuppressed
Active infection

155
Q

MOA of Budesonide

A

Glucocorticoid analogue
Binds to steroid receptor acting as a transcription regulator.
Increased anti inflammatory proteins
Decreased inflammatory immune factors

156
Q

Why is budesonide used in ulcerative colitis?

A

Corticosteroid - reduces inflammation

Controlled ileal release (a common site of inflammation in UC)

157
Q

Immunosuppressant used in UC

A

Cyclosporin

158
Q

Immunosuppressant used in CD

A

Methotrexate

159
Q

MOA of Azathioprine

A

Immunosuppressant
Active metabolite interferes with nucleic acid synthesis in WBCs (especially T cells)
Reduces production of inflammatory mediators by WBCs

160
Q

Antibiotics used for Crohn’s disease

A

Metronidazole

Ciprofloxacin

161
Q

MOA of Metronidazole

A

Antibiotic

Inhibits nucleic acid synthesis in

162
Q

MOA of ciprofloxacin

A

Antibiotic

Inhibitor of topoisomerase II/DNA gyrase

163
Q

MOA of Infliximab

A

Anti-TNF drug

Competitive inhibitor of TNF alpha receptor

164
Q

Benefits of Kock pouch over Brooke Ileostomy

A

Faecal continence maintained

No external appliance

165
Q

Ileal-pouch Anal Anastomoses

A

Formation of a new rectum surgically
Will always have watery stools
Faecal continence maintained

166
Q

Drug therapy for mild/moderate active disease in UC

A

Mesalazine

167
Q

Drug therapy for severe active disease in UC

A

Corticosteroids

Anti-TNF therapy

168
Q

Drug therapy in maintaining remission in UC

A

Mesalazine

Azothioprine (Immunosuppressant)

169
Q

Drug therapy in moderate active disease in CD

A

Budesonide (Corticosteroid)
Dietary therapy
Antibiotics

170
Q

Drug therapy in severe active disease in CD

A

Corticosteroids

Anti TNF drugs

171
Q

Drug therapy in maintaining remission in CD

A

Azathioprine (Immunosuppressant)

Anti TNF drugs

172
Q

Brunner’s Glands

A

Submucosal glands which secrete alkaline mucus-like fluid into duodenal lumen

173
Q

Peyer’s Patches

A

Aggregates of lymphocytes in wall of jejunum/ileum

174
Q

Coeliac Disease

A

Inflammation of upper small bowel mucosa which improves when gluten is withdrawn from the diet

175
Q

Clinical features of Coeliac Disease

A 
Steatorrhoea/Diarrhoea
Abdominal Pain
Ulcers/Algular stomatitis 
Flatulence
Weight loss
176
Q

Why do coeliac patients get steatorrhoea?

A

Duodenal cells cannot signal for CCK release
No contraction of gallbladder
Reduces fat digestion and absorption

177
Q

Why do coeliac patients get flatulence?

A

Fermentation of undigested food by gut flora

178
Q

Why are coeliac patients at risk of osteomalacia?

A

Low calcium absorption

179
Q

Findings in colonoscopy of coeliac patient

A

Erythematous, inflamed, scalloped lining of upper GI tract

180
Q

Site of absorption of B12

A

Terminal ileum

181
Q

Pseudopolyp

A

Piece of mucosa, where the surrounding mucosa has eroded from around it.

182
Q

Bacteria commonly associated with gastroenteritis in the UK

A

Campylobacter Jejuni

Salmonella

183
Q

Indication of C.Diff infection on colonoscopy

A

Yellow plaques

184
Q

Treatment of C. Diff

A

Metronidazole

185
Q

Erythema Nodosum

A

Red lumps on skin of shins (and sometimes thighs and forearms)
Associated with IBD

186
Q

Apthous Stomatitis

A

Non contagious, benign mouth ulcers

Associated with IBD

187
Q

Episcleritis

A

Inflammation of episclera - between sclera and conjunctiva

Associated with IBD

188
Q

Anterior Uveitis

A

Inflammation of iris and ciliary body

Associated with IBD

189
Q

Pyoderma Gangrenosum

A

Painful ulcers, usually on legs

Associated with IBD

190
Q

Central arthropathy in IBD associated with which genotype

A

HLA B27

191
Q

Central arthropathy seen in IBD

A

Ankylosing spondylitis

Sacroiliitis

192
Q

Features of liver disease associated with IBD

A

Primary sclerosing cholangitis
Steatosis - fatty liver
Chronic hepatitis
Cirrhosis

193
Q

Extraintestinal manifestations in IBD which are unrelated to disease activity:

A

Central arthropathy

Liver disease

194
Q

Transmission of Clostridium Difficile

A

.Person to Person

Faeco oral

195
Q

Who is at high risk of contracting clostridium difficile?

A

Elderly
Hospitalised
On antibiotics (destory gut flora)

196
Q

Clinical manifestation of Clostridium difficile infection

A

Colitis - diarrhoea, abdo pain, anorexia
Increased WCC
Reduced renal function
Fever

197
Q

Management of Clostridium difficile

A

Nutrition and fluid balance
Metronidazole
Infection control

FMT - faecal microbiological transplantation

198
Q

Transmissionof Campylobacter

A

Ingestion of contaminated food (usually chicken)

199
Q

Management of campylobacter

A

Self-limiting, does not normally require Abx

Erythromycin may shorten duration of symptoms

200
Q

Clinical manifestation of campylobacter infection

A

Small bowel - Diarrhoea, N+V, Fever, Cramping

201
Q

Transmission of salmonella

A

Ingestion of poorly cooked/contaminated food (chicken + eggs)

202
Q

Clinical manifestation of salmonella

A 
Diarrhoea 
N+V
Headache 
Cramps 
Fever
203
Q

Incubation period for campylobacter

A

1-7 days

204
Q

Symptoms of campylobacter last

A

2-7 days

205
Q

Incubation period for salmonella

A

8-48 hours

206
Q

Symptoms of salmonella last

A

48-96 hours

207
Q

Why is salmonella infection a public health issue?

A

Takes 9 weeks for an infected individual to become culture negative.
potential to infect others during that time

208
Q

Non GI manifestations of salmonella

A

Osteolmyelitis (bone infection)
Focal infections e.g. of prosthetic joints
Meningitis

209
Q

Management of salmonella infection

A

Normally no antibiotics

In severe cases:
Quinolones
Macrolides
Cephalosporins

210
Q

MOA of fluoroquinolones

A

Topoisomerase II inhibitor

211
Q

MOA of macrolides

A

Protein synthesis inhibitor - prevents translocation

212
Q

MOA of cephalosporins

A

Inhibit cell wall synthesis (Beta lactams)

213
Q

Transmission of E. Coli

A

Ingestion of contaminated food

214
Q

Management of E. Coli

A

Supportive
Isolation
Ciprofloxacin if severe

215
Q

MOA of ciprofloxacin

A

Fluoroquinolone

DNA gyrase inhibitor

216
Q

Transmission of cholera

A

Faecally contaminated food/water

217
Q

Clinical manifestation of cholera

A

Watery diarrhoea

218
Q

Management of cholera

A

aggressive rehydration (Rehydration solution, Oral rehydration salts)

219
Q

Transmission of Shigella

A

Faeco-oral

220
Q

Management of Shigella

A

Rehydration

Ciprofloxacin if severe

221
Q

Clinical manifestation of Shigella Dysenteriae

A

Diarrhoea - small amount containing blood and mucus
Abdominal cramps
Fever

222
Q

Incubation period for shigella

A

12 hours to 6 days

223
Q

Symptoms of shigella last

A

3-7 days

224
Q

Clinical manifestation of norovirus

A

Small bowel affected
Fever
Vomiting
Diarrhoea

225
Q

Incubation period for norovirus

A

24-48 hours

226
Q

Antibiotic treatment for C.Diff

A

Metronidazole or vancomycin

Causative Abx should be continued if possible

227
Q

Antibiotic treatment for Campylobacter

A

Azithromycin

228
Q

Antibiotic treatment for Salmonella

A

Ciprofloxacin

229
Q

Antibiotic treatment for E.Coli (VTEC)

A

Avoid - Increases risk of Haemolytic Uraemic Syndrome by release of toxin from bacteria
HUS can lead to renal damage or death

230
Q

Antibiotic treatment for Giardia (Lamblia)

A

Metronidazole

231
Q

Transmission of Giardia(Lamblia)

A

Contaminated water

232
Q

Symptoms of Giardia (Lamblia)

A

Diarrhoea - bulk, offensive smelling, pale
Abdo bloating
Anorexia
Nausea

233
Q

Transmission of Cytospordium

A

Contaminated water

234
Q

Cytospordium particularly affectes…

A

Immunocompromised - associated with AIDS and low CD4

235
Q

Clinical manifestation of Cytospordium

A

Small intestine

Diarrhoea, abdo cramps, weight loss

236
Q

Clinical manifestation of Cytospordium in px with AIDS

A

Small intestine
Diarrhoea, abdo cramps, weight loss

PLUS Cholangitis and cholecystitis

237
Q

Management of cytospordium

A

None with immunocompetent

Immunocompromised patients - HAART

238
Q

Management of Entamoeba Histolytica

A

Metronidazole

Luminal amoebacide

239
Q

Treatment of cyclospora

A

Usually self limiting

Can be given cotrimoxazole

240
Q

CCDA agar plate used for

A

Campylobacter

241
Q

SMAC agar plate used for

A

E.Coli

242
Q

XLD agar plate used for

A

Salmonella

Shigella

243
Q

TCBS agar plate used for

A

Vibrio Cholera

244
Q

Lynch syndrome increases risk of

A

Cancers (inc. colorectal)

245
Q

Gene mutations causing adenomatous colorectal polyps

A

APC

MYH-AP

246
Q

Gene mutations in Lynch syndrome

A

MSH-2, MLH-1

247
Q

Inheritance pattern of FAP

A

Autosomal dominant

248
Q

Gene mutation in FAP

A

APC

249
Q

Inheritance pattern of MYH-Associated Polyposis

A

Autosomal recessive

250
Q

Regions of bowel most commonly affected by colorectal cancer

A

21% sigmoid colon

38% rectum

251
Q

‘Signet ring’ cells

A

Where mucin produced by adenocarcinoma displaces cell nucleus to side of cell.
Poor prognosis

252
Q

Symptoms of colorectal cancer

A 
Change in bowel habit
Tenesmus
Rectal bleeding 
palpable mass 
Symptoms of anaemia (due to GI bleeding)
253
Q

Location of APC gene

A

5q21

254
Q

Role of APC gene

A

Tumour suppressor

255
Q

K-ras

A

Protein which regulates cell division.
Mutated in 30-50% of colorectal cancers
Allows adenoma to become adenocarcinoma

256
Q

SMAD2 and SMAD4

A

Intracellular proteins which mediate TGF-beta - Therefore regulating transcription, apoptosis and differentiation.
May be lost in colorectal cancer

257
Q

Role of p53 in formation of cancer from adenoma

A

Coordinates response to DNA damage, oxidative stres and aberrant proliferative signals

258
Q

Dukes’ classification of colorectal cancer - A

A

Tumor confined to mucosa

259
Q

Dukes’ classification of colorectal cancer - B1

A

Tumor growth into muscularis propria

260
Q

Dukes’ classification of colorectal cancer - B2

A

Tumor growth into muscularis propria and serosa (full thickeness)

261
Q

Dukes’ classification of colorectal cancer - C1

A

Tumor spread to 1-4 lymph nodes

262
Q

Dukes’ classification of colorectal cancer - C2

A

Tumor spread to >4 lymph nodes

263
Q

Dukes’ classification of colorectal cancer - D

A

Distant metastases (liver, lung, bone)

264
Q

Premalignant lesions for colorectal cancer in Lynch Syndrome patients

A

MMR (mismatch repair) deficient crypts

265
Q

PD-1 inhibitors/blockade

A

Activate immune system to attack tumors.

Used in tumours with mismatch repair deficiency

266
Q

Management of Lynch Syndrome

A

Aspirin (600mg/day)
Vaccines - Micoryx and Monocyte derived dendritic cells
PD-1 blockade

267
Q

5-FU Response

A

S phase arrest
p53 accumulation
Upregulation of p53 target genes
Apoptosis

268
Q

Small bowel is positioned…

A

centrally

269
Q

Diameter of small bowel

A

3cm

270
Q

Ileus

A

Bowel stops peristalsis

Causes abnormal bowel dilatation despite no mechanical blockage

271
Q

Intususception

A

One part of bowel invaginates into another part of bowel

272
Q

Volvulus

A

Loop of intestine twists around itself and the mesentary

Closed loop obstruction in large bowel.

273
Q

Pneumatosis Intestinalis

A

Intramural gas in bowel wall due to gaseous cysts

will eventually perforate

274
Q

What does pneumatosis intestinalis look like on AXR?

A

Gas tracks in intestinal wall (black line outlining lumen)

275
Q

Rigler’s Sign

A

Triangle-shaped pockets of gas in peritoneal cavity

Suggestive of bowel perforation

276
Q

Why is an erect CXR useful in detecting perforation?

A

Gas rises up above liver - black line over liver, under diaphragm

277
Q

Falciform sign

A

Occurs in bowel perforation when gas rises up either side of the falciform ligament
Can be seen on a supine abdominal X Ray

278
Q

Football sign on a AXR suggests

A

Bowel perforation - gas rises up in a circular fashion

279
Q

Barium follow through in Crohn’s patient shows:

A

Rose thorn ulcers (spikes on outer surface)
Stricturing
Thumb printing

280
Q

When is oral contrast indicated in imaging of the bowel?

A

Suspected Acute inflammation

281
Q

When is Portal Venous IV contrast indicated in imaging of the bowel?

A 
Suspected:
Obstruction
Perforation
Ischaemic bowel 
Acute inflammation 
Acute GI bleed
282
Q

After IV contrast is administered, non enhancing bowel suggests…

A

Ischaemia - since contrast was not able to reach that area

283
Q

What is the significance of carrying out CT scan of the patient prone and supine?

A

Normal bowel contents will move when the patient changes from supine to prone.
A polyp or other lesion will not.

284
Q

Indication for Colonoscopy

A

Colonic symptoms
Suspected cancer/colitis
Ideally <40yrs

285
Q

Indication for minimum prep CT

A

Colonc symptoms

>80yrs

286
Q

Indication for CT Pneumocolon (Virtual colonoscopy)

A

40-80yrs (outside age for colonoscopy)
Suspected extracolonic cancer
Failed colonoscopy

287
Q

T1 MRI

A

Fat = white
Water = black
Good for anatomy

288
Q

T2 MRI

A

Fat = black
Water = white
Good for pathology

289
Q

When is a chest X Ray indicated in abdominal pathology?

A

Perforation suspected - pneumoperitoneum

290
Q

Vertebral level of kidneys

A

T12-L3

291
Q

Benefits of ingestion of plant sterols and stanols

A

Reduce total blood cholesterol

292
Q

Marasmus

A

Undernourishment causing weight to be significantly lower than expected (variable loss of muscle and fat)
Metabolism is normal
Seen in anorexia nervosa

293
Q

Cause of Kwashiokor

A

Deficiency in dietary protein

294
Q

Mechanism for kwashiorkor

A

Reduces intracellular glutathione/GSH
Peroxidation of cell membranes
Membranes become leaky
Fluid moves from blood into interstitium due to high osmotic pressure

295
Q

Sources of vitamin A

A

Dairy
Fish
Meat (liver)

296
Q

Function of vitamin A

A

Colour vision

Antioxidant

297
Q

Deficiency of vitamin A

A

Keratosis (permanent goosebumps)
Xeropthalmia (dry, inflamed conjunctive)
Poor night vision

298
Q

Sources of vitamin D

A

Eggs
Liver
Fish oil

299
Q

Role of sunlight in vitamin D pathway

A

Converts 7-dehydrocholesterol into vitamin D

300
Q

Function of vitamin D

A

Increases absorption of calcium in the GI tract

301
Q

Deficiency of vitamin D

A

Rickets/Osteomalacia

302
Q

Parathyroid hormone is released when…

A

Plasma calcium falls

303
Q

Function of PTH

A

To increase plasma calcium by:

Increased absorption from GI tract
Increased reabsorption in kidney tubules
Increased release from bone

304
Q

Source of vitamin E

A

Spinach
Almonds
Sunflower seeds

305
Q

Function of vitamin E

A

Antioxidant - protects against atherosclerosis

reduces risk of stroke and MI

306
Q

Vitamin E deficiency

A

Haemolytic anaemias

307
Q

Sources of vitamin K

A

Green leafy vegetables

Liver

308
Q

Function of vitamin K

A

Clotting factor synthesis (Prothrombin, VII, IX, X)

309
Q

Vitamin K deficiency

A

Bruising/Bleeding

310
Q

Sources of vitamin B1 (thiamine)

A 
Lean meat
Fish
Eggs
Legumes 
Green vegetables
311
Q

Vitamin B1 is also known as ..

A

Thiamine

312
Q

Function of vitamin B1/Thiamine

A

Involved in carbohydrate metabolism - a coenzyme in the link reaction

313
Q

Deficiency of vitamin B1/Thiamine

A

Beri beri

314
Q

Wet Beri beri

A 
Affects cardiovascular system:
Tachycardia
Dyspnoea 
Oedema 
Raised JVP

Due to thiamine deficiency

315
Q

Dry Beri beri

A 
Affects peripheral nervous system:
Loss of reflexes
Loss of muscle function
Tingling or loss of sensation 
Confusion
316
Q

Sources of vitamin B2/Riboflavin

A 
Milk
Liver
Kidneys
Heart 
Meat
Green vegetables
317
Q

Function of vitamin B2/Riboflavin

A

Component of FAD - involved in hydrogen transfer in oxidative phosphorylation

318
Q

Deficiency of vitamin B2/riboflavin

A

Dermatitis
Angular Chelitis
Glossitis
Hypersensitivity to light

319
Q

Sources of vitamin B3/niacin

A

Most foods (rare deficiency)

320
Q

Function of vitamin B3/niacin

A

Component of NAD - involved in hydrogen transfer in oxidative phosphorylation

321
Q

Deficiency of vitamin B3/niacin

A

Pellagra - diarrhoea, dermatitis, dementia, death

322
Q

Deficiency of vitamin B5/Pantothenic acid

A

Neuropathy

Abdominal pain

323
Q

Deficiency of B6

A 
Irritability 
Convulsions 
Anaemia 
Vomiting 
Skin lesions
324
Q

Who is at risk of B7 (Biotin) deficiency?

A 
Alcoholics
Px on antacids 
Px with partial gastrectomy 
Pregnant women
lactating womn
325
Q

Sources of vitamin B9 (Folic acid)

A

Liver
Green vegetables
(Also synthesised by intestinal bacteria)

326
Q

Function of vitamin B9/Folate

A

Haematopoiesis
Nucleic acid synthesis
Development of neural tube

327
Q

Deficiency of B9/Folate

A

Anaemia

GI disturbance and diarrhoea

328
Q

Folic Acid (Vitamin B9) supplementation is recommended for….

A

Women trying to conceive

Women during their first 12 weeks of pregnancy

329
Q

Vitamin B12 (Cobalamin) deficiency

A

Pernicious anaemia
Loss of muscle power
Spinal nerve demyelination

330
Q

Function of Vitamin B12/Cobalamin

A

Red blood cell production
Amino acid metabolism
CNS function

331
Q

Function of vitamin C

A

Collagen synthesis
Redox reactions
Antioxidant

332
Q

Deficiency of vitamin C

A

Scurvy - increased risk of infection, poor wound healing, anaemia

333
Q

Vitamin C is also known as…

A

Ascorbic acid

334
Q

Function of iron

A

Haemoglobin synthesis

Electron transport

335
Q

Iron deficency

A

Spooning of nails
Whitening of sclera
Anaemia

336
Q

Zinc deficiency

A

Delayed puberty and small stature
Dermatitis
Alopecia
Poor wound healing

337
Q

Magnesium deficiency

A

Muscle weakness

Neuromuscular dysfuncion

338
Q

Function of phosphorus

A

Bone mineralisation

339
Q

Phosphorus deficiency

A

Rickets and osteomalacia

340
Q

Iodine deficiency

A

Enlarged thyroid gland

341
Q

Copper deficiency

A

Impaired mental development
Failure to keratinise hair
Skeletal and vascular problems

342
Q

MOA of Mebeverine

A

Muscarinic ACh receptor antagonist
Prevents Calcium entry into cells
Therefore, antispasmodic

343
Q

ADRs of Mebeverine

A

Constipation
Indigestion
Dry mouth
Dry skin

344
Q

Contraindications of mebeverine

A

Paralytic ileus

345
Q

MOA of loperamide

A

Mu-opioid receptor agonist
Reduces myenteric plexus activity
Reduces peristalsis

346
Q

ADRs of Loperamide

A

Dizziness
Headache
Flatulence
Nausea

347
Q

Contraindications of loperamide

A

Ulcerative colitis

Bacterial Colitis

348
Q

MOA of Cinchocaine

A

Blocks voltage gated sodium channels in nociceptive fibres
Prevents action potential propagation along axon to CNS

i.e. local anaesthetic

349
Q

ADRs of cinchocaine

A

Bradyarrhythmias
CNS effects
Hypotension

350
Q

Route of administration of antihaemorrhoidals

A

Topical application as a gel

Rectal suppository

351
Q

Local anaesthetic for haemorrhoids is combined with…

A 
Anti inflammatory (NSAID or steroid)
Peripheral vasoconstrictor (e.g. phenylephrine)
352
Q

Site of absorption of ethanol

A

Stomach

353
Q

Site of absorption of calcium ions

A

Duodenum
Jejunum
Proximal ileum

354
Q

Site of absorption of iron ions

A

Duodenum
Jejunum
Proximal ileum

355
Q

Site of absorption of glucose (and other sugars)

A

Duodenum
Jejunum
Proximal ileum

356
Q

Site of absorption of fatty acids

A

Duodenum
Jejunum
Proximal ileum

357
Q

Site of absorption of vitamins

A

Duodenum
Jejunum
Proximal ileum

358
Q

Site of absorption of Vitamin C

A

Proximal ileum

359
Q

Site of absorption of Vitamin B12

A

Distal ileum

360
Q

Site of absorption of Bile salts

A

Distal ileum

361
Q

Cholesterol

A

Small bowel

362
Q

Site of absorption of monovalent ions and water

A

Small and large bowel

Year 2 (17 decks)

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