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AMK > gastro amk > Flashcards

gastro amk Flashcards

1
Q

cholecystokinin released from what cells

A

I cells - contracts gall bladder in response to ingestion of fats, aa or proteins
delays gastric emptying for exocrine pancreas and induces satiety through vagal stimulation

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2
Q

K cells secrete what and L cells respectively

A

GIP - gastrin inhibitory peptide
L cells - GLP-1
these rise in response to glucose

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3
Q

ECL cells - enterchromaffin cells secrete what

A

found in stomach and secrete histamine increases acid secretion to help with digestion

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4
Q

D cells release

A

somatostatin - found din pancreas , stomach and intestine

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5
Q

caecal carcinoma removal via hemicolectomy - what vessel could you damage and what does this originate from

A

epigastric artery - external iliac

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6
Q

maltose broken down by maltase

A

glucose and glucose

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7
Q

sucrose

A

glucose and fructose

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8
Q

lactose

A

glucose and galactose

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9
Q

GIP is released from where

A

duodenum

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10
Q

GLP-1 is released from where

A

distal ileum

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11
Q

order of vessels medial to lateral tongue

A

ANV

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12
Q

over what INR is vit K needed

A

1.4

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13
Q

Histology
signet ring cells may be seen in gastric cancer. They contain a large vacuole of mucin which displaces the nucleus to one side. Higher numbers of signet ring cells are associated with a worse prognosis

Associations
H. pylori infection
blood group A: gAstric cAncer
gastric adenomatous polyps
pernicious anaemia
smoking
diet: salty, spicy, nitrates
may be negatively associated with duodenal ulcer
A

gastric cancer

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14
Q

where is the chemoreceptor trigger zone located?

A

The chemoreceptor trigger zone is located in the area postrema which is on the floor of the 4th ventricle in the medulla and, importantly, outside the blood brain barrier.

The nucleus of tractus solitarius in the medulla is the location of autonomic centres involved in mediating the vomiting reflex and receives input from the chemoreceptor trigger zone.

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15
Q

what do parietal cells secrete

A

secrete HCl, Ca, Na, Mg and intrinsic factor

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16
Q

chief cells secrete

A

secrete pepsinogen

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17
Q

blood supply to a Meckels diverticulum?

A

vitelline artery

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18
Q

what is the whipples procedure

A

carcinoma of pancreatic head
A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas

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19
Q

Which one of the following vessels is mainly responsible for the blood supply to the bile duct?

A

hepatic artery

he bile duct has an axial blood supply which is derived from the hepatic artery and from retroduodenal branches of the gastroduodenal artery. Unlike the liver there is no contribution by the portal vein to the blood supply of the bile duct. Damage to the hepatic artery during a difficult cholecystectomy is a recognised cause of bile duct strictures.

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20
Q

what cells line the gallbladder

A

columnar epithieulm

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21
Q

medial of the gall bladder is the quadrate lobe what is lateral

A

right lobe of the liver

22
Q

arterial supply to gall bladder

A

Cystic artery (branch of Right hepatic artery)

mainaly responsible is hepatic

23
Q

sentinel node of the gall bladder

A

Lund’s node is the sentinel lymph node of the gall bladder

24
Q

pneumonic for acute pancreatic

A

Popular mnemonic is GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

pancreatitis is 7 times more common in patients taking mesalazine than sulfasalazine

25
Q

epiploic boundaries

A

Anteriorly (in the free edge of the lesser omentum): Bile duct to the right, portal vein behind and hepatic artery to the left.
PosteriorlyInferior vena cava
Inferiorly1st part of the duodenum
SuperiorlyCaudate process of the liver

26
Q

most commonly affected site in ischaemic colitis

2nd area

A

The splenic flexure is a watershed area for arterial supply from the superior and inferior mesenteric artery, and is the location most susceptible to ischaemic colitis.

Sigmoid colon- second most common site for ischaemic colitis- also a watershed area, referred to as ‘Sudek’s point’.

27
Q

descending colon supplied by what

A

supplied by the left colic branch of the inferior mesenteric artery

28
Q

hepatic flexure supplied by what

A

supplied by the right colic branch of the superior mesenteric artery.

29
Q

rectum arterial supply

A

receives arterial blood from the inferior mesenteric artery (more proximal areas) and the middle rectal artery (from internal iliac artery) and inferior rectal artery (from the internal pudendal artery).

30
Q

gene associated with gastric cancer

A

STK11

31
Q

The region enclosed by Hesselbach’s triangle represents the location where a direct inguinal hernia would appear. Direct hernias are due to defects or weaknesses in the posterior abdominal wall, whilst indirect hernias protrude through the inguinal canal.

what are the boundaries of hesselbachs triangle

A

Superolaterally Epigastric vessels
Medially Lateral edge of rectus muscle
Inferiorly Inguinal ligament

32
Q

what epithelium in the intestines

A

Simple columnar epithelium lines the intestines.

33
Q

what happens in barrets oesophagus

A

In Barrett’s oesophagus the native stratified squamous epithelium is replaced by columnar epithelium

there is an increased risk of oesophageal adenocarcinoma

34
Q

peptic ulcer disease due to bleeding of what arteyr

A

gastroduodenal artery

35
Q

symptoms of peptic ulcer disease

A

he most common presenting symptom is haematemesis. Other features include:
melaena
hypotension, tachycardia

36
Q

first line treatment for peptic ulcer disease

A

ABC approach as with any upper gastrointestinal haemorrhage
IV proton pump inhibitor
the first-line treatment is endoscopic intervention
if this fails (approximately 10% of patients) then either:
urgent interventional angiography with transarterial embolization or
surgery

37
Q

is the pancreas retroperitoneal

A

yes

The pancreatic head sits in the curvature of the duodenum. Its tail lies close to the hilum of the spleen, a site of potential injury during splenectomy.

38
Q

in patients with an annular pancreas where is the most likely site of obstruction

A

When the pancreas fails to rotate normally it can compress the duodenum with development of obstruction. Usually occurring as a result of associated duodenal malformation. The second part of the duodenum is the commonest site.

39
Q

where is the porta hepatitis

A

Postero inferior surface, it joins nearly at right angles with the left sagittal fossa, and separates the caudate lobe behind from the quadrate lobe in front

transmits
Common hepatic duct
Hepatic artery
Portal vein
Sympathetic and parasympathetic nerve fibres
Lymphatic drainage of the liver (and nodes)

The portal vein is the most posterior structure at the porta hepatis.
except hepatic veins

40
Q

A 34-year-old female has an emergency caesarean section delivery for failure of induction of labour and a macrosomic baby - the baby is delivered safely and the patient is transferred to the post-natal ward. Prior to discharge, the patient develops a fever of 39ºC, tachycardia of 106 bpm, and reports abdominal pain. She has a CT scan which is reported to show a fluid accumulation in the retroperitoneal space.

What is the most likely cause for these CT findings?

A

The ureters are retroperintoneal organs and damage can cause fluid accumulation in the retroperitoneal space

41
Q

2 most common causes of pancreatitis - acute

A

gallstones and alcohol

42
Q

In liver failure all clotting factors are low, except for

A

8
This is because factor VIII is synthesised in endothelial cells throughout the body, unlike the other clotting factors which are synthesised purely in hepatic endothelial cells.
Furthermore, whilst activated factor VIII is usually rapidly cleared from the blood stream, good hepatic function is required for this to occur, further leading to increases in circulating factor VIII.

43
Q

5 Fs for risk factors for gallstones

A

Fat (Body mass index greater than 30 kg/m2)
Female
Fertile
Fair (caucasian)
Forty (age greater than or equal to 40 years)

44
Q

What is the most common cause of mesenteric infarction

A

acute embolism affecting SMA - SPLENIC FLEXURE

45
Q

origination of abdomianl aorta

A

T12

46
Q

Clostridium difficile is a Gram positive rod often encountered in hospital practice. It produces an exotoxin which causes intestinal damage leading to a syndrome called

A

pseudomembranous colitis

psi risk factor

47
Q

symptoms fo C.diff infection

A

diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe toxic megacolon may develop

48
Q

first line for C.diff

A

first-line therapy is oral vancomycin for 10 days

49
Q

A 28-year-old man is shot in the abdomen and haemorrhages. Which one of the following substances will produce vasoconstriction in response to this process?

A

angiotensin II

50
Q

what is sepsis

A

defined as an infection that triggers a particular Systemic Inflammatory Response Syndrome (SIRS)

51
Q

5 types of shock

A 
Septic
Haemorrhagic
Neurogenic
Cardiogenic
Anaphylactic
52
Q

Which one of the following is not well absorbed following a gastrectomy

A

vitB12 and iron and OP

AMK (12 decks)

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