GASTROINTESTINAL Flashcards
infant
dark green emesis
fussiness
abdominal distention
midgut volvulous
(midgut malrotation)
can cause ischaemia to SMA - proximal bowel
IMA - lower gut
duojejunal flexure, jejunal loops lie on RIGHT side
ladd bands
in Hurschsprung disease which area of colon lacks innervation
distal colon (rectum)
NCC migrate caudally
NCC develop in foregut mesenchyme
reach proximal colon 8 weeks
reach rectum 12th week
rectum always affected
fibrous connection between umbilicus and ileum
incomplete obliteration of vitilline duct
umbilicus and ileum (not bladder)
conditions resulting from this:
persistent vittiline duct
meckels diverticulum
vitelline sinus
vitelline duct cyst
patent urachus
failure of allantois to obliterate
fibrous band between umbilicus and bladder (not ileum) - urine
anomaly - urachal cyst
gene affected in Lynch Syndrome (HNPCC)
MSH2, HLH1
hereditary non polyposis colorectal cancer
**AD
mismatch repair
microsatellite instability
always involves proximal colon
321 rule : 3 family members, 2 generations, 1 relative <50yo
nausea
bloating
occassional vomiting post meals
T2DM
delayed gastric emptying
diabetic gastroparesis
cause of diabetic gastroparesis
nerve damage from chronic hyperglycaemia
glycosylation of axon proteins
sortibol osmotic damage to neuron
barium swallow to rule out mechaniclal bowel obstruction
adult
atherosclerosis
abdominal pain after eating
weight loss
PAD
CAD
diminished pedal pulses
celiac or mesentierc ischaemia
reduced blood flow to small intestine
acute or chronic
acute = embolic or thrombotic arterial obstruction
chronic = atherosclerotic stenosis (SMA common)
common asssoc findings:
atherosclerotic sequalae - PAD, CAD, pedal pulses
diverticulosis is caused by
increased luminal pressure
herniatino of mucosa and submucosa through muscularis propria
abnormal colonic motility
high dietary intake red meat
low fiber
obesity / low physical acivity
are risk factors of
diverticulosis
glucagon acts on hepatocytes via
cAMP
activates protein kinase
(Gs)
activation of gycogen phosphoryalse
what rash is associated with glucagonoma
necrolytic migratory erythema
often mouth and distal exremities
what process is occuring in the liver with a glucagonoma
partial oxidation of fatty acids
glucoagon acts on hepatocytes
glycogen stores exhauseted
relies on fat breakdown - beta oxidation
progressive dysphagia solid -> liquid
enlarged paratracheal lymphadenopathy
chest pain
wheezing, hoarseness
weight loss, cachectic
oesophageal cancer
SCC or adenocarcinoma
adenocarcinoma (lower 2/3) - assoc with GERD, obesity, barret oeseophagus
SCC (upper 2/3) - assoc with smoking, drinking, hot liquids, strictures
risk factors of SCC of oesophagus
smoking
drinking
hot liquids
strictures
affects upper 2/3
risk factors of andeocarcioma oesophagus
GERD
Barrett oesophagus
obesity
affects lower 1/3
what is X
increased mucosal surface area
feathered appearance
larger caliber
thicker muscular walls
longer vasa rectae
fewer arcades
jejunum
Y = ileum
cause
perforation
retroperitoneal duodenum
2-4th segment retroperitoneal
m/c duodenal ulcer perforation
acute abdo pain
peritonitis
fever
free air on RADS
perforation
(duodenal ulcer)
injury caused by anterior vs posterior wall duodenal ulcers
anterior = perforation
posterior = haemorrhage (gastroduodenal artery)
m/c cause of petic ulcer disease - duodenal
H pylori
also zollinger-ellison disease
m/c cause of petic ulcer disease - gastric
NSAIDS
LN for gastric spread:
Primary: Celiac lymph nodes
Distant spread:
Virchow’s node
Sister Mary Joseph nodule
Irish node
location of node
Primary drainage: (gastric, hepatic, splenic)
Distant spread:
(left supraclavicular)
(periumbilical)
(left axillary)
abdo pain 1hr after eating
weight loss
HTN
ectatic aorta
pairs of arteries affected?
SMA
IMA
mesenteric circulation: SMA, IMA, celiac
increased BF after eating
occluson -> collaterals kick in
>2 arteries affected = symptoms
splenic flexure common site (watershed area) ischaemia
name the cells at B
gastric biopsy - Zollinger Ellsion Syndrome
parietal cells
large size
central nucleus
intensely acidophilic cytoplasm (pink)
middle region of gastric gland
A - gastric mucous cell
D - vascular endothelial cell - lining capillary
E - perivascular fibroblast - dark oblong mucleus
name the cells at C
**cheif cell
**
basophilic cytoplasm
numerous cytoplasmic vesicles
granular appearance
produce pepsin
A - gastric mucous cell
D - vascular endothelial cell - lining capillary
E - perivascular fibroblast - dark oblong mucleus
veins part of the portal vein system
portal vein
L gastric vein
splenic vein
superior mesenteric vein
risk oesophageal varices
L gastric drains into inferior oesophageal vein
haematamesis occurs with rupture of varices
system at risk with:
cirrhosis
schistosomiasis
portal venous thrombosis
veins part of the ‘hepatic venous sytem’
not part of portal system
hepatic vein
IVC
drain blood from liver to IVC
can be affected in right heart failure
can cause cardiac cirrhosis
TIPS procedure (portal-hepatic stent) can reliveve portal pressure –> but cause hepatic encephalopathy - ammonia accumulation (liver not working)
