gastro amk Flashcards
cholecystokinin released from what cells
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
K cells secrete what and L cells respectively
GIP - gastrin inhibitory peptide
L cells - GLP-1
these rise in response to glucose
ECL cells - enterchromaffin cells secrete what
found in stomach and secrete histamine increases acid secretion to help with digestion
D cells release
somatostatin - found din pancreas , stomach and intestine
caecal carcinoma removal via hemicolectomy - what vessel could you damage and what does this originate from
epigastric artery - external iliac
maltose broken down by maltase
glucose and glucose
sucrose
glucose and fructose
lactose
glucose and galactose
GIP is released from where
duodenum
GLP-1 is released from where
distal ileum
order of vessels medial to lateral tongue
ANV
over what INR is vit K needed
1.4
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
gastric cancer
where is the chemoreceptor trigger zone located?
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.
what do parietal cells secrete
secrete HCl, Ca, Na, Mg and intrinsic factor
chief cells secrete
secrete pepsinogen
blood supply to a Meckels diverticulum?
vitelline artery
what is the whipples procedure
carcinoma of pancreatic head
A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas
Which one of the following vessels is mainly responsible for the blood supply to the bile duct?
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.
what cells line the gallbladder
columnar epithieulm
medial of the gall bladder is the quadrate lobe what is lateral
right lobe of the liver
arterial supply to gall bladder
Cystic artery (branch of Right hepatic artery)
mainaly responsible is hepatic
sentinel node of the gall bladder
Lund’s node is the sentinel lymph node of the gall bladder
pneumonic for acute pancreatic
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
epiploic boundaries
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
most commonly affected site in ischaemic colitis
2nd area
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’.
descending colon supplied by what
supplied by the left colic branch of the inferior mesenteric artery
hepatic flexure supplied by what
supplied by the right colic branch of the superior mesenteric artery.
rectum arterial supply
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).
gene associated with gastric cancer
STK11
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
Superolaterally Epigastric vessels
Medially Lateral edge of rectus muscle
Inferiorly Inguinal ligament
what epithelium in the intestines
Simple columnar epithelium lines the intestines.
what happens in barrets oesophagus
In Barrett’s oesophagus the native stratified squamous epithelium is replaced by columnar epithelium
there is an increased risk of oesophageal adenocarcinoma
peptic ulcer disease due to bleeding of what arteyr
gastroduodenal artery
symptoms of peptic ulcer disease
he most common presenting symptom is haematemesis. Other features include:
melaena
hypotension, tachycardia
first line treatment for peptic ulcer disease
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
is the pancreas retroperitoneal
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.
in patients with an annular pancreas where is the most likely site of obstruction
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.
where is the porta hepatitis
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
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?
The ureters are retroperintoneal organs and damage can cause fluid accumulation in the retroperitoneal space
2 most common causes of pancreatitis - acute
gallstones and alcohol
In liver failure all clotting factors are low, except for
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.
5 Fs for risk factors for gallstones
Fat (Body mass index greater than 30 kg/m2)
Female
Fertile
Fair (caucasian)
Forty (age greater than or equal to 40 years)
What is the most common cause of mesenteric infarction
acute embolism affecting SMA - SPLENIC FLEXURE
origination of abdomianl aorta
T12
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
pseudomembranous colitis
psi risk factor
symptoms fo C.diff infection
diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe toxic megacolon may develop
first line for C.diff
first-line therapy is oral vancomycin for 10 days
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?
angiotensin II
what is sepsis
defined as an infection that triggers a particular Systemic Inflammatory Response Syndrome (SIRS)
5 types of shock
Septic Haemorrhagic Neurogenic Cardiogenic Anaphylactic
Which one of the following is not well absorbed following a gastrectomy
vitB12 and iron and OP
