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P2 - Gastrointestinal system > Extra lab questions > Flashcards

Extra lab questions Flashcards

1
Q

What is the 24 h intragastric pH profile?

A

Approximately 3 waves of increase intragastric pH; corresponding to main meals of the day, ranges from 3 to 1 pH of 1 during the night

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2
Q

What are the factors that affects the intragastric pH profile?

A

How often one eats Type of food Amount of fluids Drugs

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3
Q

Name the methods to diagnose Helicobacter pylori infection

A

Breath test - most accurate Stool antigen Blood test - antibody Histological biopsy

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4
Q

Explain the breath test for diagnosing H pylori infection

A

Testing for urease activity Bacteria synthesise CO2 from the urea and thus the %CO2 determines the urease activity

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5
Q
  1. Describe the mechanism by which Helicobacter pylori infection predisposes to duodenal ulcer disease
A

a. (NH2)2CO2 + H20 —> CO2 + 2 NH3 b. Ammonia makes mucous cloud around the lumen of the epithelium c. This sends message that the pH is too high and increased secretion of acid is stimulated d. Some evidence that bacteria causes also inflammation

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6
Q

What are the protective mechanisms of the oesophagus?

A
  • Intrinsic sphincter - Extrinsic sphincter - Intra-abdominal oesophagus - Angle of His/Flap valve - Secondary peristalsis
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7
Q

What are the results of failure of protective mechanisms of the oesophagus?

A

Impaired defences ○ Hiatus hernia ○ Transient lower oesophageal relaxations ○ Low sphincter pressure ○ Impaired oesophageal clearance Increased offences ○ Increased intra-abdominal pressure ○ Reduced gastric emptying

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8
Q

What are the characteristics of the greater omentum?

A

Covers the bowel Under ventral abdominal wall Blocks possible openings Helps to stop infection Attached to tranverse colon

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9
Q

What are the spaces between liver and diaphragm and what divides them?

A

Left and right subphrenic spaces divided by fold of peritoneum called Falciform ligament

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10
Q

What is ligamentum teres?

A

Round ligament at the bottom of Falciform lig; remnant of the umbilical vein which became fibrous core

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11
Q

What is the infra-colic compartment?

A

Space behind greater omentum below transverse colon

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12
Q

What is lesser omentum?

A

Covers the stomach and other organs, has the omental bursa

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13
Q

What is epiploic foramen?

A

Also omental foramen, passage between the greater and lesser sacs

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14
Q

What are the 2 types of hiatus hernia?

A

Sliding type Rolling type - stomach slips in

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15
Q

What are the tests used to assess pancreatic function?

A

Test for reducing sugars - tests for the extent of digestion of carbohydrates as only the last carbon in the chain has reducing powers

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16
Q

Which cells store the normal and abnormal fat in steatosis of the liver?

A

Normal - parasinusoidal cells Abnormal - Hepatcytes

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17
Q

How are drugs removed by the liver?

A

Lipid soluble drugs are converted to water soluble by the liver, these are excreted in urine Phase I and phase II metabolisms

18
Q

Describe phase I metabolism for removal of drugs by the liver

A

Dependent on cytochrome P450 enzyme system; produces more polar metabolites by oxidation, reduction and hydrolysis

19
Q

Describe phase II metabolism for removal of drugs by the liver

A

Converts parent drug into a more polar form by combining it with glycine, glutamine, sulphate or glucuronic acid; or by adding an acetyl or a methyl group

20
Q

What is therapeutic range?

A

Concentration that causes the desired effect vs the concentration that causes toxic effects; usually associated with blood concentration

21
Q

Describe the changes to fluid volume in diarrhoea associated with NaCl and water loos

A

Dehydration -> decreased glomerular filtration rate and tubular luminal flow rate -> increased tubular reabsorption -> rise in serum urea -> significant reduction in extracellular fluid volume

22
Q

What factors control the composition of the gut bacterial flora?

A

Physiochemical - pH, nutrients Host-bacteria interactions - secretions, immune system Microbe-microbe interactions - Bacteriophages, toxic metabolites

23
Q

What is the range of potentially harmful metabolic activity of the colonic flora

A

Hydrolysis, aromatization, reduction, synthesis, degraduation

24
Q

What are the potential harmful products of the colonic flora?

A

Carcinogens and toxins, azo dyes, phenols and paracresols, H2S, hydroxy fatty acids, secondary bile acids

25
Q

What is the role of fibre in maintaining balance of the potential harmful effects of colonic motility

A

Increased insoluble fibre - speed transit through colon and reduces exposure time to the toxins and carcinogens

26
Q

What is the role of protein in maintaining balance of the potential harmful effects of colonic motility

A

Decreased protein in the colon and increased production of bacterial cells will reduce production of ammonia, phenols and paracresols and H2S

27
Q

Summarise the absorption and secretion of the small intestine

A
28
Q

Summarise absorption and secretion of the colon

A
29
Q

What are the pathogenic mechanisms of enteric bacteria?

A

Neurotoxin, Cytotoxin and secretory enterotoxin

30
Q

Give examples of bacteria that belong to neurotoxin group

A

Clostridium botulinum

Staphylococcus aureus - enterotoxin B

Bacillus cereus - emetic toxin

31
Q

Give examples of bacteria that belong to secretory enterotoxin group

A

Vibrio cholera and E. coli, LT - cAMP

Salmonella

Shigella dysenteriae

Clostridium pefringes - A

32
Q

Give examples of bacteria that belong to cytotoxin group

A

Clostridium difficile - A and B

A. coli - EHEC - groups 26, 157

Helicobacter pylori

Campylobacter jejuni

33
Q

What are the 3 types of enteric infection?

A

Non-inflammatory (enterotoxin, or adherence/superficial invasion)

Inflammatory (cytotoxin, invasion)

Penetrative

34
Q

What are the features of non-inflammatory infection and example organism

A

Proximal small bowel

Watery diarrhoea

No faecal leukocytes

Examples: Vibrio cholerae, E. colia, gardia lamblia, rotavirus

35
Q

What are the features of inflammatory enteric infection and example organism

A

Colon

Dysentery

Faecal polymorphonuclear leukocytes

Examples: Shigella, E. coli (EHEC), Clostridium difficile

36
Q

What are the features of penetrating enteric infection

A

Distal small bowel

Fever

Fecal mononuclear Leukocytes

Examples: Salmonella typhi, Yersinia

37
Q

Draw diagram of a stomach

A
38
Q

Draw diagram showing the blood supply to the stomach

A
39
Q

Draw diagram of the pancreas, spleen and the important blood vessels in the area

A
40
Q

Draw a diagram of the gallbladder and associated ducts

A

P2 - Gastrointestinal system (5 decks)

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