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Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is the definition of jaundice?

A

Yellowing of the sclera (white of eyes) and skin caused by an increase in blood levels of bilirubin

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2
Q

What is bilirubin? Where does its synthesis occur?

A

The normal by-product of the break down of red blood cells, in the spleen

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3
Q

What does bilirubin form in the liver?

A

Bile

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4
Q

What is the biliary tree?

A

A set of tubes connecting the liver to the 2nd part of the duodenum

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5
Q

What is the gallbladders role?

A

Important in the storage and concentration of bile

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6
Q

What is the role of bile?

A

Important for the normal absorption of fats from the small intestine

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7
Q

To where does the pancreas release digestive enzymes?

A

The second part of the duodenum

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8
Q

What are the three main functions of the liver?

A

Glycogen storage

Bile secretion

Other metabolic functions

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9
Q

Where is the liver located and when does it change (quadrant, ribs?)

A

RUQ (right upper quadrant)

Protected by ribs 7-11

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10
Q

What is the livers relationshop to the right hemi-diaphragm?

A

Inferior

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11
Q

What is the livers relationship to the gallbladder?

A

Posterior Inferior

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12
Q

What is the livers relationshop to the Hepatic flexure

A

Inferior

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13
Q

What is the livers relationshop to the right kidney, right adrenal gland, IVC, abdominal aorta?

A

Posterior

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14
Q

What is the livers relationshop to the stomach?

A

Posterior at mid/left side

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15
Q

How many anatomical lobes does the liver hace and what are their names?

A

4

  1. right lobe
  2. left lobe
  3. caudate lobe
  4. quadrate lobe
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16
Q

How many functional lobes does the liver have?

A

8 functional lobes

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17
Q

Where foes the portal triad enter the liver?

A

The porta hepatis

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18
Q

What does each functional lobe of the liver have?

A
  • branch of hepatic artery
  • branch of hepatic portal vein
  • bile drainage (to bile duct)
  • Venous drainage (to IVC)
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19
Q

what does the portal triad consist of?

A

Hepatic portal vein

Hepatic artery proper

Bile duct

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20
Q

What is the coeliac trunk?

A

First of three midline branches of the aorta

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21
Q

Is the coeliac trunk retroperitoneal or peritoneal?

A

Retroperitoneal

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22
Q

Where does the coeliac trunk leave the aorta?

A

At the T12 vertebral level

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23
Q

What does the coeliac trunk supply?

A

The organs of the foregut

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24
Q

What are the trifurcations of the coeliac trunk?

A
  • splenic artery
  • left gastric artery
  • common hepatic artery
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25
Q

What is the course of the splenic artery?

A

the superior border of the pancreas

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26
Q

Where is the spleen located?

A

Intraperitoneal orgen in the left hypochondrium

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27
Q

What is the spleens anatomical relationship to the;

  1. diaphragm
  2. stomach
  3. splenic flexure
  4. left kidney
A
  1. diaphragm - posteriorly
  2. stomach - anteriorly
  3. splenic flexure - inferiorly
  4. left kidney - medially
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28
Q

What is the major and minor blood supply to the stomach?

A

Major

  • right and left gastric arteries
    • ​along junction of lesser curvature and lesser ommentum
    • anastamose together
  • right and left gastro-omental arteries
    • along junction of greater curvature and greater ommentum
    • anastomose together

Major

  • posterior gastric arteries and short gastric arteries
    *
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29
Q

Where does the blood supply to the liver come from?

A

Right and left hepatic arteries ;

branches of the hepatic artery proper

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30
Q

What does the hepatic portal vein do?

A

Drains blood from foregut, midgut and hindgut to the liver for first pass metabolism

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31
Q

What forms the hepatic portal vein?

A

Splenic vein (drains foregut)

Superior mesenteric vein (midgut)

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32
Q

What foes the inferior mesenteric vein do?

A

Drains blood from the hindgut to the splenic vein

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33
Q

What does the IVC do?

A

Drains the cleaned blood from the hepatic veins to the right atrium

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34
Q

Where does the gallbladder lie?

A

Posterior aspect of liver (often firmly attached)

anterior to the duodenum

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35
Q

What is the function of the gallbladder?

A

Stores and concentrated bile in between meals

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36
Q

What does bile flow through as it leaves the gallbladder?

A

The cystic duct

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37
Q

What supplies the gallbladder with blood?

A

The cystic artery

It is a branch of the right hepatic artery in 75% of people

38
Q

Where is the bifurcation of the right hepatic artery into the cystic artery?

A

In the triangle of calot

39
Q

What can cause gallbladder pain?

A

Inflammation of gallbladder or cystic duct

Irritation from or impaction of a gallstone

40
Q

Where do visceral afferents enter the spinal cord from the gallbladder?

A

T6-T9

41
Q

Where will early gallbladder pain present?

A

The epigastric region

42
Q

Where will later pain be present?

Where might it refer to?

What is this a result of?

A

Hypochondrium

Right shoulder

Anterior diaphragmatic irritation

43
Q

What are the most common characteristics of asymptomatic oral cancer?

A
  • A higher proportion are granular not smooth
  • most are no more elevated than 1mm max
  • No ulceration
  • No bleeding
  • not indurated
44
Q

What are some aetiologies of mouth cancer?

A
  • tobacco
  • alcohol
  • tobacco & alcohol
  • Diet & nutrition
  • HPV
  • UVL
  • Candida
  • Syphilis/dental factors
45
Q

What is the upper drinking limits per week for men and women?

A

14 units

46
Q
A
47
Q

What dietry deficits can predispose to oral cancer?

A

Low vitamin A

Low vitamin C

Low iron

48
Q

What is leukoplakia and what vitamin can be used to treat it?

A

A thickened white patch on mucous membrane that cannot be rubbed off. It is not a specific disease. Ocassionaly it can become malignant.

Vitamin A

49
Q

What is hairy leukoplakia a marker of?

A

AIDS

50
Q

What are the high risk sites for oral cancer?

A

Soft (non keratinising sites)

  • Ventral tongue
  • Floor of mouth
  • lateral tounge
51
Q

What are the rare sites for Oral Cancer in the UK?

A

Dorsal tongue

hard palate

buccal mucosa (common in asia)

52
Q

Can you name some potentially malignant lesions of oral cancer?

A
  • erythoplakia
  • erytholeukoplakia
  • leukoplakia
  • erosive lichen planus
  • submucous fibrosis
  • dyskeratosis congenita
  • sideropenic dysphagia
53
Q

What are some warning signs of oral cancer?

A
  • red/white/red & white lesion
  • ulcer (exclude trauma, drug, systemic etc.)
  • Numb feeling in lip and face
  • Unexplained pain in mouth or neck
  • Change in voice
  • dysphagia
54
Q

What are some orofacial manifestations of oral cancer?

A
  • Drooping eye lid or facial palsy
  • Fracture of mandible
  • Double vision
  • Blocker or bleeding from nose
  • Facial Swelling
55
Q

What four key questions should we ask when a suspicious lesion presents?

A
  • how long has lesion been present?
  • is it painful? pain is usually a late manifestation of pral cancer but would be expected in benign ulcer
  • Does patient smoke? or drink?…. how much?
  • What colour is the lesion?
56
Q

What are some of the uses of an endoscope?

A
  • Diagnosis
  • Theraputics
    • emergency
    • elective
  • Screening
  • Surveillance
57
Q

What are some visual diagnosis that can be gained from an endoscope?

A
  • oeseophagitis
  • gastritis
  • ulceration
  • coeliac disease
  • chron’s disease
  • ulcerative colitis
  • sclerosing cholangitis
58
Q

What are some vascular abnormalities seen with an endoscope?

A
  • varices
    • ​distended, lengthened and tortuous veins
  • etatic blood vessels (GAVE, dieulafoy)
    • dieulafoy- may cause spontaneuous haemorrhage
  • Angiodysplasia
    • due to degeneration of previously healthy blood vessels
59
Q

What are some newer imaging techniques than endoscopy?

A

Narrow band imaging

Chromoendoscopy- using iodine

60
Q

What are the steps for a microscopic diagnosis?

A

Biopsy and histology

brushing and cytology

rarely- aspirated and biopsies for microbiology

61
Q

What is haematesis and melaena?

A

haematesis- vomitting fresh blood

maleana- dark faeces containing partially digested blood

62
Q

What are the treatment options for life threatening variceal bleeding?

A

Life threatening medical emergency

  • ABC resus
  • Injection sclerotherapy (entholamine)
  • Banding
  • Histocryl glue
63
Q

What are the treatment options for aterial bleeding?

A

Injection therapy

  • adrenaline
  • tamponade
  • vasocontriction

​Heater probe (coagulation)

Clips (ligate)

64
Q

What are the treatment options for angiodyslaspia (small vessels)

A

Argon plasma coagulation

radio frequency ablation

65
Q

What are the treatment options for strictures?

A

Dilatation

Stenting

usually reserved for malignancy, removable stents can be used

66
Q

What are some of the common complications of metal self expanding stents?

A
  • foreign body sensation
  • reflux
  • fever
  • septicaemia
  • fistula formation
67
Q

What are two methods for dilatation?

A

Balloon

Bouginage (hard stent)

68
Q

What are some options for tumour treatment via endoscope?

A

Polypectomy

Endoscopic mucosal removal

69
Q

What are the steps for a polypectomy?

A

Raise polyp on a bed of saline/adrenaline

snare polyp

hot biospy

usually for colonic polyps

70
Q

What are the steps for endoscopic mucosal resection?

A

Raise lesion on a bed of adrenaline/saline

Loop and convert into polyp

snare

71
Q

How would you remove stones with an endoscope?

A

Sphincterotomy

surgical division of any sphincter muscle

Balloon and trawl

lithotripsy

process of breaking stones into smaller fragments using shock waves

72
Q

How would you remove a foreign body with an endoscope?

A

Snare or basket

overtube

GA with endotracheal tube

73
Q

How are endoscopes relevant to nutrition?

A

PEG insertion

PEJ

Naso-jejunal tube insertion

74
Q

What is the process of PEG insertion?

A
  • gastroscopy
  • ​Identify insertion site
  • transabdominal passage of wire
  • pull wire out of mouth
  • tie peg tube to wire and pull into position
  • fix in place and set up connectors
75
Q

What is the process for insertion of naso-jejunal tube?

A
  • pass tube under direct vision
  • pull out endoscope
  • feed in nasal overtube
  • draw NJ tube into overtube
  • withdraw through nose
  • fix in place
76
Q

What are the benedits of screening asymptomatic individuals?

A

Prevention of colorectal cancer

detect polyps

early detection of cancer

77
Q

What is the preparation for endoscopy?

A

Indication ( clear , justified)

Explanation to patient

Consent

Fasting

Bowel preparation

Monitor bleeding diathesis

Infection prophylaxis (endocarditis, shunt, immunosuppression)

78
Q

What are some complications of endoscopy?

A

Respiratory arrest

aspiration

cardiac arrest

bleeding

perforation

infection (prions, viruses, bacterial endocarditis, immunosupression)

79
Q

What is this?

A

Submucous fibrosis

80
Q

What is this?

A

Melanoma

81
Q

What is this?

A

Lichen Planus

82
Q

What is this?

A

Floor of mouth keratosis

83
Q

What is this?

A

Erytholeukoplakia

84
Q

What is this?

A

Erosive L planus

85
Q

What is this? What other changes are associated with this condition?

A

Dyskeratosis congenita

Nail changes

skin changes

86
Q

What is this?

A

Barrett’s Cancer

87
Q

What are the physical, social and psychological impacts of oral health?

A

Physical

healthy diet

healthy dentition (pain free)

Social

Eating

Smiling

Kissing

Phsychological Health

self esteem

Communication

dental anxiety

88
Q

What is are dental caries?

A

Dental caries is a dynamic process involving the exchange of calcium and phosphate ions between tooth structure and saliva, in the pressence of acids produced by the fermentation of carbohydrated by oral micro-organisms.

tooth-sugar-bacteria

89
Q

What is the DMF index?

A

Sum of…

  • Decayed
  • Missing
  • Filled

teeth or surfaces

90
Q

What are DMFT, def and DMFS?

A

DMFT- a count of all decayed or missing or filled teeth

def- a count of all primary teeth that are decayed, etracted due to caries or filled

DMFS- a count of all decayed or missing or filled tooth surfaces

91
Q

What are some of the associated illnesses of periodontal disease?

A
  • atherosclerosis, stroke, MI
  • adverse pregnancy outcome
  • diabetes
  • respiratory infections
  • rheumatoid arthirits, osteoporosis
  • obesity
92
Q
A

Medicine (9 decks)

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