Gastrointestinal Flashcards
How to WBC find their way to the gut tissue?
a4b7 hunts down MADCAM in gut
What are the two main causes of cirrhosis?
Hepatitis infection and alcohol abuse.
What could cause pain in the left iliac fossa?
Colon issues, IBD, Inguinal hernias, Kidney stones
How often do the small and large bowels have episodes of peristalsis?
Small Int - every 3 mins
Large Int - every 15-30 minutes.
A key history question for gall stones?
Does the pain get worse after eating
Which liver enzymes come from where?
GGT and ALP from biliary tree
AST and ALT from hepatocytes
How do squamous cell carcinomas impact bone?
Paraneoplastic syndrome due to PTHrP - parathyroid hormone related protein
What does high transferrin typically indicate?
Body is searching for iron - iron deficiency.
Explain dysphagia in terms of liquids and solids.
If have difficulty with solids only = obstruction like cancer.
If have difficulty with both liquids and solids = neuro or muscular issue like spasms.
Mnemonic for absorption of key blood factors?
Dude Is Just Feeling Ill Bro
Duodenum - iron
Jujenum - Folate
Ileum - B12
Where does most water get reabsorbed in the gut?
Small intestine
Where are carbs digested?
Starts in mouth with amylase, more amylase in duodenum, brush border begins at jujunum which releases all the small sugar enzymes like maltase - absorbed here for portal system.
Where are proteins absorbed in the small intestine?
All 3 levels (all of small int)
How and where do fats gets digested and absorbed?
Start in mouth with chewing and a small amount of lipases, gastric lipases in stomach, in duodenum get bile salts to emulsify fats and get pancreatic lipases - fats mostly absorbed in the ileum.
What symptom will poor bile reabsorption result in?
Diarrhoea - bile salts irritate the intestines, if they make it to the colon they will cause increased motility. The bile salts will drag water with them.
Why can maldigestion cause bloating?
If absorption is bad, too many nutrients will reach bacteria in the colon, they will make gasses out of them due to fermentation.
Which protein carries conjugated bilirubin?
Albumin
How can bilirubin exit as urine?
It can either be made into urobilinogen in the gut OR if bile is building up it can enter the blood from the liver and enter the kidney - that’s no good.
What happens if bilirubin from the liver is blocked due to a post-hepatic cause?
Bilirubin will go backwards and into the blood
What could cause pre-hepatic jaundice?
All caused by unconjugated bilirubin - leads to CNS issues.
Could be due to:
-haemolysis
-crap liver
- albumin competition
- low albumin
Will urine bilirubin be elevated in a pre-hepatic cause?
NO - just builds up.
Bilirubin in the urine is always conjugated, so must be hepatic or post-hepatic cause.
What type of bilirubin issue (hepatic, pre or post) would cause regular brown stools with urine full of bilirubin?
Hepatic only.
Bilirubin can still get to gut, so not a post-hepatic.
Bilirubin present in urine so can’t be pre-hepatic.
List the functions of a liver.
- blood glucose
- stores vitamins
- makes bile
-makes complement
-makes albumin - makes coagulation factors
- detoxification
Describe the transmission of each type of Hepatitis
Ass and Eating - A and E are fecal-oral
The rest are body fluids. C is Chronic, B is acute or chronic, D is dependant on B.
What does steatorrhea indicate?
fatty stools are likely due to poor absorption or not enough bile to allow for absorption.
How would post-hepatic issues present on history?
urine - low urobilinogen or urobilin (may be pale)
poo - pale due to no stercobilinogen
also would have steatorrhea and vitamin deficiency (ADEK)
Is unconjugated or conjugated bilirubin a bigger risk?
Unconjugated - affects CNS
What pathology can GORD lead to?
It causes basal cell hyperplasia which becomes Barrett’s Esophagus - squamous to columnar metaplasia. SALMON MUCOSA.
What autoimmune conditions often clump with coeliac?
T1D and Thyroid diseases.
What are the 3 coeliac histo findings?
- Villous atrophy
- Crypt hyperplasia
- Intra-epithelial lymphocytes
What are the 2 antibodies screened for in coeliac?
Tissue transglutaminase IgA and deaminated gliadin IgG.
Compare Crohn’s to UC.
Chrons - ass to mouth, skip lesions, cobblestone appearance, transmural, cause fistulae, steatorrhea.
UC - Just colon and rectum, polyps, just the submucosa, typically associated with blood.
Complications of IBD?
Chrons - fistulas, cancer, vitamin deficiency
UC - vitamin deficiency, cancer, toxic megacolon
How does the cephalic phase impact stomach acid?
Cephalic phase, thinking about eating, will cause Ach release to increase acid and will also inhibit somatostatin which itself inhibits acid production.
What chemicals does the duodenum produce to aid in digestion?
CCK - stimulates pancreas to release lipases
Secretin - for pancreatic bicarbonate
Somatostatin - inhibit acid
What are the gut divisions? What arteries supply them?
Foregut - mouth to duodenal papilla. Coeliac trunk.
Midgut - duodenal papilla to 2/3 of transverse colon. Superior Mesenteric.
Hindgut - the rest. Inferior mesenteric.
Which IBD can cause granulomas?
Chrons
Fowl smelling stools typically means what parasite for MD1?
Giardia
Which hepatitis is incurable?
Chronic HBV
Why can liver failure cause esophageal varices?
Due to portosystemic anastamoses - blood will divert past the portal system if it is under huge pressure, which can lead to blood buildup and even rupture in key areas like the lower esophagus.
Name 3 causes of hematemesis.
- Burst varice (liver damage)
- Peptic ulcer
- Cancer
What are the 5 sites of portosystemic anastamoses?
Lower esophagus (gastroesophageal junction), umbilicus, anal canal, retroperitoneal, bare area of liver.
“varices of the Gut, Butt and Caput”
What causes leuchonychia?
Low albumin
Which liver enzymes are alcohol related?
GGT and AST - Giant Gin and Tonic, A Shot Thanks