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Step 1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

When does the midgut start to develop?

A

week 6

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2
Q

what happens to the midgut in week 6-10?

A

herniates through umbilical ring

returns to abdo in week 10

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3
Q

what does the gut rotate around?

A

superior mesenteric artery

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4
Q

gastroschisis

A

abdo contents extends through folds, not covered by peritoneum

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5
Q

omaphalocele

A

herniation of abdo contents into umbilical cord sealed by peritoneum

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6
Q

failure of rostral fold closure

A

sternal defects

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7
Q

failure of lateral fold closure

A

omphalocele, gastrochisis

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8
Q

failure of caudal fold closure

A

bladder extrophy

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9
Q

polyhydraminos in utero can cause

A

esophageal atresia and distal tracheoesophageal fistula

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10
Q

baby with cyanosis, excessive drooling and choking on first feed

A

tracheaoosophageal fistula

cyanosis secondary to laryngospasm

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11
Q

gassless abdomen

A

esophageal atresia

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12
Q

bilous vomiting and abdominal distension within first 1-2 days
due to

A

intestinal atresia

disruption of mesenteric vessels

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13
Q

duodenal atreasia associated with

A

Down’s syndrome

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14
Q

most common cause of infantile gastric outlet obstruction

A

hypertrophic pyloric stenosis

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15
Q

olive mass in epigastric region, nonbilous vomiting

A

hypertrophic pyloric stenosis

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16
Q

hypertrophic pyloric stenosis associated with exposure to

A

macrolides

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17
Q

what does hypertrophic pyloric stenosis result in?

A

hypokalaemia hypochloremic metabolic alkalosis

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18
Q

duodenal narrowing, nonbilous vomiting, pancreas abnormal

A

annular pancreas

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19
Q

pancreas divisum due to a problem at how many weeks?

A

failure of dorsal and ventral to fuse at 8 weeks

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20
Q

pancreas divisum symptoms

A

none

abdo pain/ pancreatitis

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21
Q

how is the spleen embryology odd?

A

arises in stomach mesentery (mesodermal)

supplied by the foregut

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22
Q

Retroperitoneal

A

SAD PUCKER

Suprarenal, aorta (and IVC), pancreas, uterus, colon (vertical), kidneys, esophagus, rectum

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23
Q

connects liver to anterior abdo wall

derived from

A

falciform ligament

ventral mesentery

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24
Q

what is contained in the hepatoduodenal ligament?

A

proper hepatic artery, portal vein, common bile duct

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25
Q

pringle maneuver

A

hepatoduodenal ligament compressed using omental foramen

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26
Q

what does the omental foramen do?

A

connects the greater and lesser sacs

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27
Q

where does the gastrohepatic ligament connect?

A

liver and lesser curve of stomach

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28
Q

what is contained in the gastrohepatic ligament?

A

the gastric arteries

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29
Q

what do you have to cut through to gain access to the lesser sac?

A

gastrohepatic ligament

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30
Q

gastrocolic ligament connects

A

greater curvature and transverse colon

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31
Q

gastroepiploic arteries

A

contained in the gastrocolic ligament

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32
Q

what is surrounds the short gastric arteries?

what does it also contail?

A

gastrosplenic

gastroepiploic vessels

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33
Q

what seperates the greater and lesser sacs on the lift?

A

gastrosplenic ligament

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34
Q

splenorenal ligament

A

spleen to posterior abdominal wall

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35
Q

what nerves are found in the submucosa?

A

meissner’s plexus

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36
Q

what nerves are found in the muscularis externa?

A

myenteric nerve plexus - Auerbach’s

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37
Q

where is the serosa?

A

when the gut is intraperitoneal

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38
Q

where is the adventitia?

A

when the gut is retroperitoneal

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39
Q

what is the difference between an erosion and an ulcer?

A

an erosion is on the mucosa only, an ulcer can extend to the other layers

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40
Q

electric activity of stomach, duodenum, ileum

A

3 waves/ minute, 12, 8-9

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41
Q

brunner glands
found in
use

A

duodenum

secrete HCO3-

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42
Q

where are crypts of leiberkuhn?

A

all through intestines

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43
Q

where are plicae circulares found?

A

jejunum and ileum

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44
Q

where are peyer’s patches found?

A

ileum

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45
Q

where are there most goblet cells in the SI?

A

Ileum

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46
Q

What comes off the aorta at T12?

A

celiac trunk

middle suprarenal

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47
Q

what comes off the aorta at L1/2?

A

superior mesenteric
first lumbar, renal
gonadal
second lumbar

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48
Q

what comes off the aorta at L3?

A

inferior mesenteric

third lumbar

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49
Q

intermittent intestinal obstruction symptoms

called

A

superior mesenteric artery sundrome

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50
Q

how does superior mesenteric artery syndrome work?

what is it associated with?

A

transverse duodenum compressed between SMA and aorta

associated with low mesenteric fat

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51
Q

what is the parasympathetic innervation to the

foregut, midgut, hindgut

A

vagus, vagus, pelvic

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52
Q

what does esophageal varices shunt between?

A

left gastric and azygous

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53
Q

what do caput medusea shunt between?

A

paraumbilical and small epigastric veins of anterior abdominal wall

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54
Q

what do anorectal varices shunt between?

A

superior rectal and middle and inferior rectal

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55
Q

How do you treat portal htn?

A

transjugular intrahepatic portosystemic shunt (TIPS)

bypasses liver

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56
Q

where does the anus gets its blood supply?

A

above pectinate - superior rectal ( IMA)

below - inferior rectal (internal pudendal)

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57
Q

cancer seen above and below pectinate line

A 
above = adenocarcinoma
below = squamous cell carcinoma
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58
Q

which haemorrhoids are painful?

A

external (somatic innervation not visceral)

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59
Q

lymph drainage of anus

A

above - internal iliac lymph nodes

below - superficial inguinal nodes

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60
Q

Kupffer cells

A

specialised mpgs found in the liver sinusoids

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61
Q

hepatic stelate cells

A

space of Disse
store vitamin A
produce extracellular atrix

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62
Q

hepatocytes - apical and basolateral ends

A

a - bile canaliculi

b - sinusoids

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63
Q

zones of the liver, and what they are affected by

A

I - periportal zone - viral hepatitis, ingested toxins
II - intermediate zone - yellow fever
III - pericentral vein (centrilobular) - ischaemia, P-450 - metabolic toxins

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64
Q

where is alcoholic hepatitis?

A

zone III

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65
Q

ampulla of vater

A

common bile duct and pancreatic duct

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66
Q

femoral canal

A

NAVLymphatics

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67
Q

femoral sheath

A

contains femoral vein, artery and deep inguinal lymph nodes

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68
Q

What are the boarders of the femoral triangle?

A

satorius, adductor longus, inguinal ligament?

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69
Q

What sits in the femoral ring?

what happens here?

A

femoral nerve

femoral hernias

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70
Q

indirect hernia

in infants

A

deep inguinal ring
ends up in scrotum
when vaginalis doesn’t close

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71
Q

hernia incarceration

A

cannot reduce

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72
Q

hourglass stomach

A

sliding hiatal hernia

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73
Q

where does a direct hernia sit?

A

mediall to the inferior epigastric vessels

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74
Q

where does a direct hernia protrude?
end up?
covered by

A

inguinal triangle
superficial inguinal ring
external spermatic fascia

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75
Q

what is the inguinal triangle made up of?

A

inferior epigastric vessels, lateral border of rectus abdominus, inguinal ligament

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76
Q

Where is gastrin found?

A

G cells in antrum and duodenum

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77
Q

what does gastrin do?

A

increases H+
grows gastric mucosa
increases gastric motility

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78
Q

what stimulates gastrin?

inhibits

A

stomach distension, amino acids, alkalinazation, peptides, vagal stimulation, GRP
pH of less than 1.5

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79
Q

When is gastrin pathologically increased?

A

Chronic PPI use, atrophic gastritis, xollinger-ellison syndrome

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80
Q

where is somatostatin found?

A

D cells in pancreatic islets and GI mucosa

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81
Q

what does somatostatin do?

A

decreases gastric acid and pepsinogen
secretions from pancreas and small intestine
decreases gallbladder contraction
decreases insulin and glucagon release

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82
Q

when is somatostatin stimulated and inhibited?

A

stimulated by acid

inhibited by vagus

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83
Q

what is a somatostatin analog and when is it used?

A

octreotide

acromegaly, carcinoid, variceal bleeding

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84
Q

Where is CCK from?

A

I cells in duodenum and jejunum

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85
Q

What does CCK do?

A

increases pancreatic secretion (muscarinic activation), increases gallbladder contraction, decreases gastric emptying, relaxes the sphincter of Oddi

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86
Q

what stimulates CCK

A

fatty acids, amino acids

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87
Q

where is secretin from?

A

S cells in the duodenum

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88
Q

what does secretin do?

A

increases pancreatic bicarbonate secretion, decreases gastric acid secretion, increasesbile secretion

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89
Q

what is secretin stimulated by?

A

acid, fatty acids in duodenum

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90
Q

Where do you find glucose-dependent insulinotropic peptides?

A

K cells in duodenum and jejunum

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91
Q

what do GDIPs (GIP) do?

A

decrease H+ secretion, increase insulin release

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92
Q

what are GDIPs (GIP) stimulated by?

A

fatty acids, amino acids, oral glucose

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93
Q

where is motilin found?

A

SI

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94
Q

what does motilin do?

when is motilin increased?

A

migrating motor complexes

fasting state

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95
Q

what is a motilin receptor agonist?

A

erythromycin

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96
Q

Where does VIP come from?

A

parasympathetic ganglia in sphincters, gallbladder and SI

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97
Q

what does VIP do?

A

increases water and electrolyte secretion

relaxes smooth muscle

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98
Q

what is VIP stimulated and inhibited by?

A

distension, vagus

adrenergic input

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99
Q

What are the signs of a VIPoma and where is it?

A

pancreas

Watery diarrhoea, hypokalaemia, achlorhyria

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100
Q

what is thought to affect patients in achalasia

A

loss of NO secretion

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101
Q

where is Gherelin made?

A

stomach

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102
Q

when is gherelin high?

A

prader-willi syndrome

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103
Q

What stimulates gastric acid?

inhibits

A

histamine, ACh, gastrin

somatostatin, GIP, prostaglandin, secretin

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104
Q

where does pepsin come from?

A

chief cells

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105
Q

what is pepsin stimulated by?

A 
vagus
local acid (activates pepsinogen)
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106
Q

chymotrypsin

A

protease

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107
Q

how are proteases secreted? (inactive)

A

zymogens

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108
Q

what is trypsinogen?

how is it activated?

A

precursor protease

enterokinase/enteropeptidase

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109
Q

How is glucose taken into cells?

A

SGLT1

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110
Q

how are sugars transported into the blood?

A

GLUT-2

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111
Q

How and where is iron absorbed?

A

As Fe2+, duodenum

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112
Q

What special cells are found in peyer’s patches?

A

M cells

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113
Q

what are bile salts conjugated to?

A

glyceine, taurine

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114
Q

direct bilirubin

A

conjugated - water soluble

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115
Q

pleomorphic adenoma

A

most common salivary gland tumour

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116
Q

chondromyxoid stroma and epithelium

A

pleomorphic adenoma

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117
Q

most common malignant salivary gland tumour

A

mucoepidermoid carcinoma

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118
Q

salivary tumour with mucinous and squamous components

A

mucoepidermoid carcinoa

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119
Q

warthin tumour

A

benign cyctic tumour with germinal centres

papillary cystadenoma lymphomatosum

120
Q

loss of myenteric plexus stopping relaxation of sphincter

A

achalasia

121
Q

secondary achaliasia

A

chagas, malignancy, plummer-vinsent

122
Q

Boerhaave syndrome

A

transmural oesophageal rupture (distal) with pneumomediastinum
from violent retching

123
Q

Boerhaave syndrome

A

transmural oesophageal rupture (distal) with pneumomediastinum
from violent retching

124
Q

endoscopy show eosophageal rings and linear furrows

A

eosinophilic esophagitis

125
Q

eosinophilic oesophagitis doesn’t respond to

A

GERD Rx

126
Q

Candida esophagitis

A

white pseudomembrane

127
Q

HSV-1 esophagitis

A

punched out ulcers

128
Q

CMV eosophagitis

A

linear ulcers

129
Q

dysphagia, iron deficiency anaemia, oesophageal webs

A

plummer-vinsent syndrome

130
Q

increased risk with plummer-vinsent syndrome

A

squamous cell carcinoma

131
Q

what is the cell transition in Barrett’s?

A

nonkeratinisaed stratified squamous –> non ciliated columnar with goblet cells

132
Q

Upper 2/3 oesophageal cancer

A

squamous

133
Q

risk factors oesophageal cancer (upper 2/3)

A

alcohol, hot liquids, causticstricture, smoking, achalasia

134
Q

lower 1/3 oesophageal cancer

A

adenocarcinoma

135
Q

risk factors adenocarcinoma of oesophagus

A

chronic GORD, Barrett’s, obesity, smoking, achalasia

136
Q

What is a curling ulcer?

A

a burn causing acute gastritis

137
Q

what can curling ulcers lead to?

A

mucosal ischaemia

138
Q

what is a cushing ulcer?

A

acute gastritis from brain injury increaing H+ oproduction through vagal stimuation

139
Q

menetrier disease

A

gastric hyperplasia causing hypertrophied rugae

precancerous

140
Q

increased mucus, protein loss, parietal cell atrophy, decreased acid production

A

menetrier disease

141
Q

most common gastric cancer

A

adenocarcinoma

142
Q

leser-trelat sign

A

stomach cancer

143
Q

acanthosis nigricans

A

stomach cancer

144
Q

where are gastric cancers commonly found?

A

lesser curvature

145
Q

signet ring cells
are
signal

A

mucin filled cells with peripheral nuclei

diffuse stomach cancer

146
Q

linitis plastica

A

thick leathery stomach lining

147
Q

krukenbery tumour

A

bilateral mets to ovearies from stomach

signet ring cells

148
Q

sister mary josephine nodule

A

subcut periumbilical mets from stomach ca

149
Q

pain
decreases with meal
increases with meal

A

ulcer
duodenal
gastric

150
Q

hypertrophy of brunner’s glands

A

duodenal ulcer

151
Q

most common bleeding site of gastric ulcers

A

left gastric artery

152
Q

gliadin intolerance

A

coeliac

153
Q

villous atrophy, crypt hyperplasia

A

coeliac’s

154
Q

d-xylose test

A

coeliac’s - shows absorption issue

155
Q

osmotic diarrhoea with low stool pH

A

lactose intolerance

156
Q

Positive lactose H breath test figure

A

> 20 ppm

157
Q

decreases duodenal pH and fecal elastase

A

pancreatic insufficiency

158
Q

malabsorptioin, megaloblastic anaemia, travel

A

tropical spure

159
Q

foamy mpg in intestinal lamina propria

A

whipple’s disease

160
Q

symptoms of whipple disease

A

cardiac
arthralgias
neuro

161
Q

cobblestone mucosa

A

crohn’s

162
Q

string sign on Ba swallow

A

Crohn’s

163
Q

which types of kidney stones are seen in crohn’s disease

A

calcium oxalate

164
Q

freely hanging mesentery

A

UC

165
Q

crypt abscess

A

UC

166
Q

risks of UC

A

colitic, toxic megacolon, perforation

167
Q

biliary association with UC

A

primary sclerosing cholangitis

168
Q

cause of appendicitis in
adults
children

A

fecalith

lymphoid hyperplasia

169
Q

false diverticulae

A

lack muscularis externa

170
Q

true diverticulae

A

all 3 gut wall layers

171
Q

Rx diverticulitis

A

abx

172
Q

risks of diverticulitis

A

abscess, fistula, obstruction, perforation

173
Q

Zenker diverticulum =

type of diverticulum

A

pharyngeal pouch

false

174
Q

where is the weakness in a pharyngeal pouch?

A

thyropharyngeal and cricopharyngeal muscles

175
Q

meckel diverticulum is

type

A

persistance of vitelline duct
incomplete obliteration of omophalo-mesenteric duct
true

176
Q

melena, RLQ pain, intissusception, volvulus, obstruction

A

meckel divericulum

177
Q

Rule of meckel’s divertuculum

A 
the 6 2s
2 times as likely in males
2 inches long
2 feet from ileocecal valve
2% of population
presents on first 2 years of life
may have 2 types of epithelia (gastric/ pancreatic)
178
Q

What is lacking in Hirschsprung’s?

A

auerbach and meissner plexuses in distat colon

179
Q

Which areas are more common for volvulus?
children
elderly

A

midgut

sigmoid

180
Q

where does intissusception commonly occur?

A

ileocoecal junction

181
Q

currant jelly stools

A

intussception, acute mesenteric ischaemia

182
Q

typical case of intussusception

A

child after viral infection anwith peyer patch hypertrophy

183
Q

bull’s eye appearance on USS, child with abdo pain

A

intissusception

184
Q

abdo pain out of proportion to findings

A

acute mesenteric ischaemia - blocks SMA

185
Q

when do you get pain in chronic mesenteric ischemia?

A

after meals

186
Q

crampy abdo pain + fresh blood

A

colonic ischaemia

187
Q

where and who does colonic ischaemia affect?

A

splenic flexure, distal colon

elderly

188
Q

angiodysplasia is

common areas

A

tortuous dilation of vessels

cecum, terminal ileum, ascending colon

189
Q

what can angiodysplasia cause?

A

fresh blood in stools

190
Q

ileus

A

hypomotility without obstruction

191
Q

bowel trouble in premature formula fed infant

what is it due to?

A

necrotizing enterocolitis

immature immune system

192
Q

hyperplastic polyp

A

small, rectosigmoidal

193
Q

harmatomatous polyp

A

solitary lesion, normal tissue but distorted architecture, Peutz-Jeghers and juvenile polyposis

194
Q

adenomatous polyp

A

neoplastic, APC and KRAS genes

tubular > villous (bad)

195
Q

serrated polyp

A

premalignant, CpG methylation, BRAF

196
Q

saw tooth crypts polyp

A

serrated

197
Q

FAP due to

A

APC mutation on chr. 5q

198
Q

when do you see FAP?

A

in thousands after puberty, involving rectum

199
Q

Gardner syndrome

A

FAP + osseous and soft tissue tumours

hypertrophy of retinal pigment epithelium

200
Q

hypertrophy of retinal pigment epithelium

A

Gardner syndrome

201
Q

impacted/supernumerary teeth

A

Gardener’s syndrome

202
Q

FAP + CNS tumour

A

Turcot syndrome

203
Q

Peutz-Jeghers syndrome

A

GI harmatomas

hyperpigmentation of mouth, lips, hands, genetalia

204
Q

what is Peutz-Jegher’s associated with?

A

breast and GI cancers

205
Q

Juvenile polyposis syndrome

A

AD < 5yrs

harmatomatous polyps in GI tract

206
Q

Lynch syndrome =

caused by

A

HNPCC

DNA mismatch repair gene mutation

207
Q

What proortion of lynch syndrome get CRC?

A

80%

208
Q

what cancers are associated with lynch syndrome?

A

endometrial, ovarian, skin

209
Q

places to find colorectal cancer

A

rectosigmoid > ascending > descending

210
Q

descending CRC

A

infiltrating mass, partial obstruction, colicky pain, fresh blood in stool

211
Q

ascending CRC

A

exophytic mass, iron deficiency anaemia, weight loss

212
Q

streptococcus bovis bacteraemia and constipation

A

colorectal cancer

213
Q

what cells are involved in cirrhosis?

A

stellate cells

214
Q

non alcoholic cirrhosis causes

A

steatohepetitis, chronic viral hepatitis, autoimmune hepatitis, biliary disease, genetic/ metabolic disorders

215
Q

portal vein thrombosis

A

Budd-Chiari syndrome

216
Q

what is an infective cause of portal htn?

A

schistomiasis

217
Q

bad breath and jaundice

A

liver cirrhosis

218
Q

serum marker raised most in liver disease

A

ALT

219
Q

AST > ALT in nonalcoholic liver disease

A

progression to advanced fibrosis/ cirrhosis

220
Q

marker raied most in alcoholic liver disease

A

AST

221
Q

ALP raied in

A

cholestasis, infiltrative disorders, bone disease

222
Q

gamma-gT raised in, not raised in, associated with

A

liver and biliary
bone disease
alcohol use

223
Q

raised prothrombin

A

advanced liver disease

224
Q

child with mt abnormality, fatty liver, hypoglycaemia, vomiting, hepatomegaly
associated with

A

Reye syndrome

VZV and influenza B treated with aspirin

225
Q

swollen and necrotic hepatocytes with neutrophilic infiltration

A

alcoholic hepatitis

226
Q

mallory bodies are

due to

A

intracytoplasmic eosinophilic inclusions of damaged keratin filaments
alcoholic hepatitis

227
Q

what causes non-alcoholic fatty liver disease?

A

insulin resistance, obesity

228
Q

hepatic encepalopathy due to

A

decreased ammonia metabolism causing neuro dysfunction

229
Q

treatment for hepatic encephalopathy

A

lactulose (increase NH4+ generation), rifazimin/ neomycin (decrease NH3 bacteria in gut)

230
Q

HCC associated with

A

HBV, cirrhosis, autoimmune disease, hemochromatosis, a1-antitrypsin deficiency

231
Q

aflatoxin

A

aspergillus

RF for HCC

232
Q

benign liver tumour 30-50 yrs

A

cavernous hemangioma

233
Q

liver cancer RF oral contraceptive, anabolic steroid use

A

hepatic adenoma

234
Q

liver tumour - exposed to arsenic/ vinyl chloride

A

angiosarcoma

235
Q

nutmeg liver

A

Budd-Chiari syndrome

236
Q

cirrhosis with PAS positive globules

A

a1 antitrypsin deficiency

237
Q

unconjugated hyperbilirubinemia

A

hemolytic, crigler-najjar, Gilbert syndrome, newborns

238
Q

syndromes causing conjugated hyperbilirubinaemia due to impaired bile excretion

A

Dubin-Johnson, Rotor

239
Q

kernicterus

A

bilirubin deposition in the brain (basal ganglia)

240
Q

what is the cause of neonatal jaundice?

A

immature UDP-glucoronoslytransferase

241
Q

decreased UDP-glucuronoslytransferase conjugation and impaired bilirubin uptake

A

Gilbert syndrome

242
Q

absent UDP-glucuronosyltransferase

consequences

A

Crigler-Najjar syndrome type I

die within a few yeras

243
Q

grossly black liver, conjugated hyperbilirubinemia

A

Dubin-Johnson

244
Q

impaired hepatic uptake and excretion of bilirubin

A

Rotor syndrome

245
Q

Hepatolenticular degeneration

A

Wilson disease

246
Q

ATP7B gene, chr.13

A

Wilson’s

247
Q

where does Cu accumulate in Wilson’s?

A

liver, brain, cornea, kidneys, joints

248
Q

Rx Wilson disease

A

chelation with penicillamine or trientine

zinc (PO)

249
Q

recessive mutation in HFE gene is

found on chr.

A

Hemochromatosis

chr. 6

250
Q

what does hemochromatosis cause?

A

increases Fe absorbtion

251
Q

where does iron acumulate?

A

liver, pancreas, skin, heart, pituitary, joints

252
Q

when do hemochromatosis patients present?

A

toal body iron >20g

253
Q

why is hemochromatosis found later in women?

A

mensturation

254
Q

cirrhosis, diabetes mellitus, skin pigmentation

A

hemochromatosis

255
Q

bronze diabetes

A

hemochromatosis

256
Q

which joints are particularly affected by hemochromatosis and how?

A

MCP, calcium pyrophosphate deposition

257
Q

Rx hemochromatosis

A

chelation with deferasirox, oral deferiprone, phlebotomy

258
Q

onion skin bile duct

A

primary sclerosing cholangitis

259
Q

beading of bile duct

A

PSC

260
Q

who gets PSC?

A

middle aged men with IBD

261
Q

what gallbladder condition is UC associated with?

A

PSC

262
Q

what is the cause of primary biliary cirrhosis

A

autoimmune

more likely female

263
Q

lymphocytic infiltrate and granuloma of bile duct

A

PBC

264
Q

cholesterol stones

A

radiolucent

80% of stones

265
Q

what are cholesterol stones associated with?

A

obesity, crohn’s, age, oestrogen, multiparity, rapid weight loss, native americans

266
Q

black pigment stones

A

radiopaque - Ca bilirubinate

267
Q

brown pigment stones

A

radiolucent, infection

268
Q

gallstone ileus

A

obstruction of ileocecal valve due to gallstone passing into intestinal tract

269
Q

primary cholecystitis infective cause

A

CMV

270
Q

porcelain gallbladder is

Rx

A

calcification from chronic cholecystitis

removal, risk of adenocarcinoma

271
Q

drugs RF for pancreatitis

A

sulfa drugs, NRTIs, protease inhibitors

272
Q

racial RF for pancreatic adenocarcinoma

A

Jewish, African American males

273
Q

Courvoisier sign

A

obstructive jaundice with nontender gallbladder

274
Q

Ranitidine

s.e.

A

reversible histamine H2 blocker

decreases Cr clearance

275
Q

SE cimetidine

A

inhibits P-450, antiandrogenic, crosses BBB and placenta, decreases Cr clearance

276
Q

irreversibly inhibits H/K ATPase in stomach

acts on

A

omeprazole

parietal cells

277
Q

SE of omeprazole

A

increases risk of C diff infection, decreases Mg with long term use

278
Q

SE antacids

A

hypokalaemia

279
Q

SE aluminium hydroxide

A

constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures

280
Q

SE calcium carbonate

A

hypercalcaemia, rebound acidosis, decreases effects of tetracyclines

281
Q

SE Mg hydroxide

A

diarrhoea, hyporeflexia, hypotension, cardiac arrest

282
Q

bismuth

A

binds to ulcer base, physical barrier, allows HCO3 secretion

283
Q

use bismuth/ sucralfate

A

ulcer healing, travelers’ diarrhoea

284
Q

misoprostol
use
s.e.

A

PGE1 analog
prevention of NSAID ulcers, ripens cervix, maintains PDA
diarrhoea, pregnant women

285
Q

use octreotide

s.e.

A

acute variceal bleedy, acromegaly, VIPoma, carcinoid

nausea, cramps, steatorrhea, cholelithiasis

286
Q

osmotic laxatives

A

Mg hydroxide, Mg citrate, polyethylene glycol, lactulose

287
Q

sulfasalazine se

A

malaise, nausea, sulphonamide toxicity, oligospermia (reversible)

288
Q

loperamide, use

A

mu-opioid receptor agonist, slows gut motility

diarrhoea

289
Q

ondansetron

s.e.

A

5-HT3 antagonist, antiemetic

headache, constipation, QT lengthened

290
Q

metoclopramide

A

D2 antagonist, increasing tone and contractility

291
Q

use metoclopramide
s.e.
drug interactions
CI

A

diabetic/ post surgery gastroparesis, antiemetic
parkinsonian, dyskinesia, restless, drowsy, fatigue, depression, diarrhoea
digoxin, diabetic agents
small bowel obstruction, parkinson’s

292
Q

orlistat

A

inhibits gastric/pancreatic lipase

293
Q

ursodiol

use

A

increases bile secretion, decreases cholesterol secretion and reabsorption
PBC, gallstone prevention/ dissolution

294
Q

double bubble on USS

A

duodenal atresia

295
Q

wheeze + flush + diarrhoea

A

carcinoid

296
Q

technetium-99 pertechnetate scan

A

Meckel’s diverticulum

297
Q

5-HIAA

A

carinoid tumours

breakdown product of seratonin

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