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
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
3
Q
What does bilirubin form in the liver?
A
Bile
4
Q
What is the biliary tree?
A
A set of tubes connecting the liver to the 2nd part of the duodenum
5
Q
What is the gallbladders role?
A
Important in the storage and concentration of bile
6
Q
What is the role of bile?
A
Important for the normal absorption of fats from the small intestine
7
Q
To where does the pancreas release digestive enzymes?
A
The second part of the duodenum
8
Q
What are the three main functions of the liver?
A
Glycogen storage
Bile secretion
Other metabolic functions
9
Q
Where is the liver located and when does it change (quadrant, ribs?)
A
RUQ (right upper quadrant)
Protected by ribs 7-11
10
Q
What is the livers relationshop to the right hemi-diaphragm?
A
Inferior
11
Q
What is the livers relationship to the gallbladder?
A
Posterior Inferior
12
Q
What is the livers relationshop to the Hepatic flexure
A
Inferior
13
Q
What is the livers relationshop to the right kidney, right adrenal gland, IVC, abdominal aorta?
A
Posterior
14
Q
What is the livers relationshop to the stomach?
A
Posterior at mid/left side
15
Q
How many anatomical lobes does the liver hace and what are their names?
A
4
- right lobe
- left lobe
- caudate lobe
- quadrate lobe
16
Q
How many functional lobes does the liver have?
A
8 functional lobes
17
Q
Where foes the portal triad enter the liver?
A
The porta hepatis
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)
19
Q
what does the portal triad consist of?
A
Hepatic portal vein
Hepatic artery proper
Bile duct
20
Q
What is the coeliac trunk?
A
First of three midline branches of the aorta
21
Q
Is the coeliac trunk retroperitoneal or peritoneal?
A
Retroperitoneal
22
Q
Where does the coeliac trunk leave the aorta?
A
At the T12 vertebral level
23
Q
What does the coeliac trunk supply?
A
The organs of the foregut
24
Q
What are the trifurcations of the coeliac trunk?
A
- splenic artery
- left gastric artery
- common hepatic artery
25
What is the course of the splenic artery?
the superior border of the pancreas
26
Where is the spleen located?
Intraperitoneal orgen in the left hypochondrium
27
What is the spleens anatomical relationship to the;
1. diaphragm
2. stomach
3. splenic flexure
4. left kidney
1. diaphragm - posteriorly
2. stomach - anteriorly
3. splenic flexure - inferiorly
4. left kidney - medially
28
What is the major and minor blood supply to the stomach?
**_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
*
29
Where does the blood supply to the liver come from?
Right and left hepatic arteries ;
branches of the hepatic artery proper
30
What does the hepatic portal vein do?
Drains blood from foregut, midgut and hindgut to the liver for **first pass metabolism**
31
What forms the hepatic portal vein?
Splenic vein (drains foregut)
Superior mesenteric vein (midgut)
32
What foes the inferior mesenteric vein do?
Drains blood from the hindgut to the splenic vein
33
What does the IVC do?
Drains the cleaned blood from the hepatic veins to the right atrium
34
Where does the gallbladder lie?
Posterior aspect of liver (often firmly attached)
anterior to the duodenum
35
What is the function of the gallbladder?
Stores and concentrated bile in between meals
36
What does bile flow through as it leaves the gallbladder?
The cystic duct
37
What supplies the gallbladder with blood?
The cystic artery
*It is a branch of the right hepatic artery in 75% of people*
38
Where is the bifurcation of the right hepatic artery into the cystic artery?
In the triangle of calot
39
What can cause gallbladder pain?
Inflammation of gallbladder or cystic duct
Irritation from or impaction of a gallstone
40
Where do visceral afferents enter the spinal cord from the gallbladder?
T6-T9
41
Where will early gallbladder pain present?
The epigastric region
42
Where will later pain be present?
Where might it refer to?
What is this a result of?
Hypochondrium
Right shoulder
Anterior diaphragmatic irritation
43
What are the most common characteristics of asymptomatic oral cancer?
* A higher proportion are granular not smooth
* most are no more elevated than 1mm max
* No ulceration
* No bleeding
* not indurated
44
What are some aetiologies of mouth cancer?
* tobacco
* alcohol
* *tobacco & alcohol*
* Diet & nutrition
* HPV
* UVL
* Candida
* Syphilis/dental factors
45
What is the upper drinking limits per week for men and women?
14 units
46
47
What dietry deficits can predispose to oral cancer?
Low vitamin A
Low vitamin C
Low iron
48
What is leukoplakia and what vitamin can be used to treat it?
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
What is hairy leukoplakia a marker of?
AIDS
50
What are the high risk sites for oral cancer?
Soft (non keratinising sites)
* Ventral tongue
* Floor of mouth
* lateral tounge
51
What are the rare sites for Oral Cancer in the UK?
Dorsal tongue
hard palate
buccal mucosa (common in asia)
52
Can you name some potentially malignant lesions of oral cancer?
* erythoplakia
* erytholeukoplakia
* leukoplakia
* erosive lichen planus
* submucous fibrosis
* dyskeratosis congenita
* sideropenic dysphagia
53
What are some warning signs of oral cancer?
* 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
What are some orofacial manifestations of oral cancer?
* Drooping eye lid or facial palsy
* Fracture of mandible
* Double vision
* Blocker or bleeding from nose
* Facial Swelling
55
What four key questions should we ask when a suspicious lesion presents?
* **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
What are some of the uses of an endoscope?
* Diagnosis
* Theraputics
* emergency
* elective
* Screening
* Surveillance
57
What are some visual diagnosis that can be gained from an endoscope?
* oeseophagitis
* gastritis
* ulceration
* coeliac disease
* chron's disease
* ulcerative colitis
* sclerosing cholangitis
58
What are some vascular abnormalities seen with an endoscope?
* 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
What are some newer imaging techniques than endoscopy?
Narrow band imaging
Chromoendoscopy- using iodine
60
What are the steps for a microscopic diagnosis?
Biopsy and histology
brushing and cytology
rarely- aspirated and biopsies for microbiology
61
What is haematesis and melaena?
haematesis- vomitting fresh blood
maleana- dark faeces containing partially digested blood
62
What are the treatment options for life threatening variceal bleeding?
Life threatening medical emergency
* ABC resus
* Injection sclerotherapy (entholamine)
* Banding
* Histocryl glue
63
What are the treatment options for aterial bleeding?
Injection therapy
* *adrenaline*
* *tamponade*
* *vasocontriction*
Heater probe (coagulation)
Clips (ligate)
64
What are the treatment options for angiodyslaspia (small vessels)
Argon plasma coagulation
radio frequency ablation
65
What are the treatment options for strictures?
Dilatation
Stenting
*usually reserved for malignancy, removable stents can be used*
66
What are some of the common complications of metal self expanding stents?
* foreign body sensation
* reflux
* fever
* septicaemia
* fistula formation
67
What are two methods for dilatation?
Balloon
Bouginage (hard stent)
68
What are some options for tumour treatment via endoscope?
Polypectomy
Endoscopic mucosal removal
69
What are the steps for a polypectomy?
Raise polyp on a bed of saline/adrenaline
snare polyp
hot biospy
usually for colonic polyps
70
What are the steps for endoscopic mucosal resection?
Raise lesion on a bed of adrenaline/saline
Loop and convert into polyp
snare
71
How would you remove stones with an endoscope?
Sphincterotomy
*surgical division of any sphincter muscle*
Balloon and trawl
lithotripsy
*process of breaking stones into smaller fragments using shock waves*
72
How would you remove a foreign body with an endoscope?
Snare or basket
overtube
GA with endotracheal tube
73
How are endoscopes relevant to nutrition?
PEG insertion
PEJ
Naso-jejunal tube insertion
74
What is the process of PEG insertion?
* 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
What is the process for insertion of naso-jejunal tube?
* pass tube under direct vision
* pull out endoscope
* feed in nasal overtube
* draw NJ tube into overtube
* withdraw through nose
* fix in place
76
What are the benedits of screening asymptomatic individuals?
Prevention of colorectal cancer
detect polyps
early detection of cancer
77
What is the preparation for endoscopy?
Indication ( clear , justified)
Explanation to patient
Consent
Fasting
Bowel preparation
Monitor bleeding diathesis
Infection prophylaxis (endocarditis, shunt, immunosuppression)
78
What are some complications of endoscopy?
Respiratory arrest
aspiration
cardiac arrest
bleeding
perforation
infection (prions, viruses, bacterial endocarditis, immunosupression)
79
What is this?
Submucous fibrosis
80
What is this?
Melanoma
81
What is this?
Lichen Planus
82
What is this?
Floor of mouth keratosis
83
What is this?
Erytholeukoplakia
84
What is this?
Erosive L planus
85
What is this? What other changes are associated with this condition?
Dyskeratosis congenita
Nail changes
skin changes
86
What is this?
Barrett's Cancer
87
What are the physical, social and psychological impacts of oral health?
**_Physical_**
healthy diet
healthy dentition (pain free)
**_Social_**
Eating
Smiling
Kissing
**_Phsychological Health_**
self esteem
Communication
dental anxiety
88
What is are dental caries?
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.
## Footnote
**tooth-sugar-bacteria**
89
What is the DMF index?
Sum of...
* **D**ecayed
* **M**issing
* **F**illed
teeth or surfaces
90
What are DMFT, def and DMFS?
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
What are some of the associated illnesses of periodontal disease?
* atherosclerosis, stroke, MI
* adverse pregnancy outcome
* diabetes
* respiratory infections
* rheumatoid arthirits, osteoporosis
* obesity
92
