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First Year Dundee Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Name the sections of the small and large intestines in order.

A 
duodenum
jejunum
ileum
Caecum
Appendix
Colon
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2
Q

Name the neurones/plexus found in the following:
mucosa
submucosa
muscularis externa

A

mucosa- enteric neurones
submucosa- submucous plexus
muscularis externa- myenteric plexus

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3
Q

From which cells does excitation originate in the circular and longitudinal smooth muscle of the gut? Name the waves that are produced

A

Interstitial cells of Cajal

Slow waves

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4
Q

With ______ _______ contraction in the gut, the longer the excitation exceeds the threshold for an action potential, the greater the strength of __________.

A

smooth muscle

contraction

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5
Q

Which three types of neurones are located in the enteric nervous system apart from autonomic nerves.

A

Sensory
Interneurones
motor

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6
Q

Name the six main sphincters of the alimentary canal.

A

Upper and lower oesophageal
pyloric
ileocaecal
internal and external anal

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7
Q

Name the two tissues in which glycogen is stored in the body.

A

Liver

muscle

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8
Q

when does glycogenesis, glycogenolysis and glucogenesis occur

A

glycogenesis- during/after meals
glycogenolysis- in between meals
glucogenesis- overnight/fasting

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9
Q

Name the main enzyme involved in glygogenesis and glycogenolysis

A

glycogenesis- glycogen synthase

glycogenolysis- glycogen phosphorylase

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10
Q

Insulin causes an increase in _______ ________ and a decrease in ________ ________. Glucagon has the opposite effect.

A

glycogen synthase

glycogen phosphorylase

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11
Q

Which four vitamins are stored transported in lipids

A

Vitamins A D E K

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12
Q

Name the compound that facilitates long chain fatty acid transport into the mitochondria.

A

Carnitine

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13
Q

Name the histological feature that is characteristic of the following: duodenum, jejunum, ileum

A

Duodenum- Brunners glands- secrete alkaline liquid to neutralise chyme
Jejunum- plicae terminalis- folds covered in villi
Ileum- Peyer’s patches- GALT

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14
Q

What is the longitudinal muscle of the large intestines called?

A

teniae coli

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15
Q

What does the portal triad consist of?

A

hepatic artery, hepatic portal vein, Bile duct

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16
Q

The central vein at the centre of each hepatocyte is a venule of what vein?

A

the hepatic vein

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17
Q

What cells line the bile ducts?

A

Cholangiocytes

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18
Q

Through what channels does blood flow to the central vein of the hepatocyte? What is the space beside these channels called?

A 
sinusoids
perisinusoidal space (space of Disse)
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19
Q

What do you call the resident macrophages of the liver?

A

Kupffer cells

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20
Q

What is bilirubin and how is it produced?

A

A brown pigment produced by the breakdown of red blood cells in the spleen

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21
Q

How is bile transported to the bile ducts in the hepatocytes of the liver?

A

through bile cannaliculi

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22
Q

In what way is the bile modified in the gall bladder?

A

It is made more concentrated. Na+ and Cl- ions are actively transported into out of the bladder setting up an osmotic gradient which the water within the lumen follows.

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23
Q

What are zymogens?

A

Precursors of enzymes

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24
Q

What effect does histamine, gastrin and acetylcholine have on the gastric secretion of H+ ions.

A

Increase H+ secretion

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25
Q

How do you calculate BMI?

A

BMI=mass/height2

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26
Q

What area of the brain mediates body mass?

A

Hypothalmus

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27
Q

What is Ghrelin and by which cells is it produced?

A

A hunger signal molecule produced by the Oxyntic cells of the gastric mucosa

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28
Q

_______ and ______ are ________ signals. They increase in concentration in the blood when more fat is stored.

A

Leptin
insulin
adiposity

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29
Q

peptide YY and Glucagon-like peptide 1 _______ gastric emptying and food intake

A

decrease

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30
Q

The Orad stomach exhibits _____ contraction while the caudad stomach exhibits ______ contraction.

A

tonic

phasic

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31
Q

What do you call the peristaltic contraction/relaxation of the caudad stomach?

A

Antral pump

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32
Q

What cells are found in 1.Pyloric glands and 2. oxyntic glands

A
  1. D cells (somatostatin) G cells (Gastrin)

2. Parietal glands (HCL) Chief cells (enzymes)

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33
Q

What effect does Somatostatin have on gastric HCL secretion?

A

Decreases it

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34
Q

What is the migrating motor complex?

A

strong peristaltic contractions that slowly pass the length of the intestine

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35
Q

Polysaccharides are catabolised to _____________ by __________ within the lumen. They are subsequently broken down to monosaccharides by ______________ integrated with the membrane.

A

Oligosaccharides e.g. sucrose, maltose, Lactose
Alpha-amylase- breaks down 1,4 glycosidic bonds
oligosaccharidases

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36
Q

Intrinsic factor is needed for the absorption of what vitamin?

A

Vitamin B12

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37
Q

Name a proton pump inhibitor

A

Omeprazole, Iansoprazole

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38
Q

Name a Histamine (H2) receptor antagonist

A

Ranitidine

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39
Q

Name an anti-muscarinic drug.

A

Buscopan

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40
Q

Name an anti-diarrhoeal drug

A

Loperamide

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41
Q

Name two Aminosalicylates. they are the firstline treatment of what disease?

A

Sulfalazine, Mesalazine

Ulcerative colitis

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42
Q

Name a Dopamine receptor antagonist.

A

Domperidone, metaclopramide

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43
Q

Ondansetron is an example of what drug?

A

A 5-HT3 receptor antagonist

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44
Q

Name an immunosuppressive drug used in the treatment of UC and CD

A

Azathioprine

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45
Q

Name two Anti-TNF therapy drugs used to treat UC and CD

A

Infliximab

adalimumab

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46
Q

What clinical sign is caused by an excess of bilirubin in the blood?

A

Jaundice

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47
Q

The liver has __ segments and __ lobes. name the anatomical lobes.

A

8
4
right lobe, left lobe, quadrate lobe, caudate lobe

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48
Q

The IVC and Hepatic veins have no ______. Back pressure on the liver causes __________. this can occur as a result of heart failure

A

valves

hepatomegaly

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49
Q

What leukocyte cell is found between roughly every 10 enterocytes?

A

Intraepithelial lymphocytes

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50
Q

Apart from intraepithelial lymphocytes, what other immune cells are found in the mucosa?

A

Dendritic cells

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51
Q

After _________, T cells within the gut mucosa migrate to the __________ lymph nodes and then enter the bloodstream and return in numbers to the intestines. T cells bind to ____________ on the capillary endothelium of the lamina propria then they bind to _________ and initiate ________.

A 
activation
mesenteric
MAdCAMs
enterocytes
necrosis
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52
Q

The ratio of different immunoglobulins in the intestines is the opposite of that in the gut. list the three main immunoglobulins from greatest abundance to least.

A

IgA:IgM:IgG

53
Q

The gut is said to be ___________ to accommodate for the commensal bacteria.

A

Hyporesponsive

54
Q

Patients with Coeliac disease possess intraepithelial T-cells which are specific to ______ _________. These cells proliferate and destroy epithelial cells leading to _____ _______ and ___________of the small intestines

A

Gamma Interferon
Villus atrophy
Scalloping

55
Q

Vomiting is mediated by the ______ centre of the brainstem. emetic stimulus is mainly sensed in the ________ _______ ______.

A

emetic

Chemoreceptor trigger zone

56
Q

Name three types of antagonists which are used as anti-emetic drugs.

A

dopamine receptor
muscarinic receptor
H2 receptor
5-HT3

57
Q

The combination of circular muscle and longitudinal muscle contraction in the large intestine creates bulges called ________.

A

Haustra

58
Q

The cells of the colon are known as _________ which are responsible for __, ___ and ____ absorption the colonic crypts are responsible for __ and _____ secretion.

A 
Na+
Cl-
H20
K+ 
HCO3-
59
Q

Name four important proteins that are synthesised in the liver.

A

albumin
complement proteins
apoproteins

60
Q

Define diarrhoea.

A

Loss of 500ml of fluid and solutes in one day from the GI tract.

61
Q

State three dangerous effects of diarrhoea.

A

dehydration, hypokalaemia, metabolic acidosis (HCO3- loss)

62
Q

State three causes of diarrhoea.

A

hypermotility, impaired NaCl absorption, poorly absorbable solutes.

63
Q

The protrusion of the sphincter of Oddi into the duodenum is known as the ________________.

A

hepatopancreatic ampulla

ampulla of Vater

64
Q

ERCP is used to investigate what vessels?

A

Those associated with the pancreas and gall bladder

65
Q

Jaundice occurs when the _____ ___ is blocked because the _________ returns to the liver and then into the __________.

A

bile duct
bilirubin
bloodstream

66
Q

Reflux Oesophagitis causes superficial squamous epithelial damage leading to_________. If this continues, _______ oesophagus may ensue. Metaplasia occurs and the stratified squamous epithelium transitions to ________ epithelium. This appears _____ macroscopically. If the disease progresses there is a risk of developing ____________ where the metaplasia becomes dysplasia.

A 
hyperplasia
Barrett's
Columnar
red
adenocarcinoma
67
Q

State the three causes of chronic gastritis

A

Bacterial- H. Pylori infection
Autoimmune-antibodies to parietal cells
Chemical- NSAIDS, Alcohol, bile reflux

68
Q

How do H. Pylori cause Chronic gastritis?

A

They occupy an ecological niche between the mucus and epithelial cells. They damage these cells leading to reduced mucus production, therefore the wall is exposed to the gastric acid and pepsin leading to peptic ulceration.

69
Q

As well as causing Chronic gastritis, H. Pylori is also a risk factor for ___________ and __________.

A

Adenocarcinoma

lymphoma

70
Q

Acute ischaemia of the small bowel is classified by the degree of infarction. Identify the effect of mucosal, mural and transmural infarction.

A

MUCOSAL- resolution
MURAL- fibrosis–stricture–chronic ischaemia–obstruction
TRANSMURAL- gangrene–perforation–peritonitis–sepsis

71
Q

What causes Meckel’s diverticulum?

A

Incomplete regression of the vitello-intestinal duct

72
Q

What does GORD stand for? name three possible causes of this condition

A

Gastro-Oesophageal Reflux Disease
raised intra-abdominal pressure
dysfunctional LOS
abnormal oesophagus motility

73
Q

What is gastroparesis?

A

delayed gastric emptying

74
Q

Dyspepsia is associated with what condition?

A

Peptic ulcer disease

75
Q

Identify three hallmarks of oral malignancy

A

red and white patches, bleeding, ulceration

76
Q

What is melaena and what is haematemesis?

A

Melaena- black faeces discoloured by digested blood

Haematemesis- vomiting up fresh blood

77
Q

Where is Crohn’s disease most common in the body?

A

ileum and colon

78
Q

CD presents with __________ lesions throughout the GI tract. They cause deep ________ within the mucosa which cause a macroscopic ____________ pattern. It exhibits _________ inflammation and non-caseating __________.

A 
skip
fissures
cobblestoning
transmural
granulomas
79
Q

UC presents with __________ lesions and is restricted to the _______ and _______ in the GI tract. It exhibits ________ and _________ inflammation. Inflammatory cell influx destroys the mucosa, and the tissue left forms _________.

A 
continuous
rectum
colon
mural
mucosal
pseudopolyps
80
Q

What is the MUST score used for?

A

Score determining level of malnutrition.

81
Q

Refeeding Syndrome can occur after prolonged starvation. What electrolyte shifts occur as a result of this condition?

A

hypokalaemia
hypophosphataemia
hypomagnesaemia

82
Q

McBurney’s point marks the position of what part of the bowel?

A

appendix

83
Q

What symptoms characterise Appendicitis?

A

Central abdominal pain radiating to the right iliac fossa

84
Q

Name one potentially fatal complication of appendicitis

A

peritonitis

85
Q

In most cases appendicitis is treated by ___________ _______________. However, if an appendix mass is present it is treated with _________ and __ ____________.

A

Laparoscopic appendectomy
analgesics
antibiotics

86
Q

Repeated/major small bowel resection can cause ____- _______ _________.

A

Small Bowel syndrome

87
Q

The sigmoid colon possesses a mesentery called the ________ _________. This allows a significant amount of movement which may lead to a _______ ________.

A

Sigmoid Volvulus

88
Q

What is the name of the premalignant precursor to adenocarcinoma?

A

Adenoma

89
Q

Define Diverticula

A

A mucosal herniation through the muscle coat. diverticulosis is the presence of diverticulum

90
Q

How do you treat uncomplicated Diverticulitis?

A

Oral antibiotics

91
Q

What virus commonly causes diarrhoea and vomiting in young children?

A

Rotavirus

92
Q

What virus is known as the winter vomiting bug?

A

Noravirus

93
Q

What is the main bacterial cause of gastroenteritis? How is it mainly spread?

A

Campylobacter

94
Q

What is the main cause of bacterial gastroenteritis? How is it mainly spread?

A

Campylobacter

faecal-oral spread

95
Q

What bacteria causes Dysentery? Identify the characteristic symptom of dysentery.

A

Shigella

Diarrhoea with blood and mucus

96
Q

In addition to the external anal sphincter, name a skeletal muscle that acts as a sphincter of the rectum

A

Puborectalis

97
Q

The Truelove and Witt criteria are used to assess the severity of what condition?

A

Ulcerative Colitis

98
Q

The Rome III criteria is used for the diagnosis of irritable bowel syndrome. Identify what this criteria states

A

Patient experiences abdominal pain three times a month associated with 2/3 of the following:
improves with defaecation
change in stool frequency
change in stool appearance

99
Q

Identify the three types of IBS

A

IBS-D diarrhoea
IBS-C constipation
IBS-M mixed

100
Q

What dietary advice is given to IBS patients?

A

High soluble fibre diet

Low FODMAPS

101
Q

Name two anti-diarrhoeal drugs

A

Loperamide, imodium

102
Q

Laxido and movicol are examples of what type of drug?

A

Osmotic laxatives

103
Q

Name two anti-spasmodics used in the treatment of IBS.

A

colofac, colpermin

104
Q

What is Anorexia Nervosa?

A

Psychiatric condition- Self-induced weight loss due to an overvalued idea- fear of fatness

105
Q

What is Bulimia Nervosa?

A

Psychiatric condition- failure to restrict eating leading to binges

106
Q

Name a characteristic symptom of Right sided colorectal cancer

A

Unexplained Iron deficient anaemia

107
Q

Identify three investigations of colorectal cancer

A

Barium enema
colonoscopy
sigmoidoscopy

108
Q

Identify three symptoms of bowel obstruction

A

abdominal distension- due to trapped swallowed air
colicky abdominal pain
constipation

109
Q

Jaundice is classified by the site of origin- identify the three types

A

pre-hepatic, hepatic, post-hepatic

110
Q

________ is the endpoint of liver disease where bands of ___________ separate the hepatocyte nodules.

A

Cirrhosis

fibrosis

111
Q

Portal hypertension is a complication of liver disease. Identify the signs that this creates.

A

Oesophageal varices
medusa
ascites
haemorrhoids

112
Q

Pathology of Alcoholic liver disease:
alcohol induces ____ _________ appearance in the liver. Continued alcohol use results in hepatitis which exhibits _________ inflammation, _________ bodies and fibrosis. Fatty liver and hepatitis are reversible but fibrosis and cirrhosis are not.

A

Fat vacuoles
neutrophilic
Mallory bodies

113
Q

What is Haemochromatosis

A

Excess of Iron in the liver

114
Q

Identify the four stages of NAFLD

A

steatosis- steatohepatitis- fibrosis- cirrrhosis

115
Q

identify the intermediate in alcohol metabolism between ethanol and acetate

A

Acetaldehyde

116
Q

Name the site of an inguinal hernia

A

Hesselbach’s triangle

117
Q

identify some of the main symptoms of Cholestasis

A

Biliary colic
-RUQ pain radiates to shoulder
jaundice

118
Q

What acid is used in the treatment of cholestasis?

A

Ursodeoxychloric acid

119
Q

What is acute cholecystitis and how is it treated?

A

Inflammation of the gall bladder because the bile duct is blocked by a gallstone. treated by urgent cholecystectomy

120
Q

Acute pancreatitis is caused by obstruction of the _______ _________ ______. The proteases and lipases within the organ become activated meaning autodigestion occurs

A

Common bile duct

121
Q

What is the best investigation for cholestasis and pancreatitis?

A

Ultrasound scan

122
Q

What type of colitis is caused by C. difficile infection

A

Pseudomembranous colitis

123
Q

What is Rovsing’s sign?

A

pressing the LIF causes pain in the RIF

124
Q

Most appendix are found in which position?

A

Retrocaecal

125
Q

Hyperamylasaemia is a sign of disease in which organ?

A

Pancreas

126
Q

What is the most common cause of pernicious anaemia?

A

Loss of the parietal cells which produce intrinsic factor for vitamin B12 absorption

127
Q

Identify three tests for H. pylori

A

Serological tests-IgG antibodies
C-Urea breath tests
CLO- biopsy urease test

128
Q

Under 55s with H. Pylori peptic ulceration can move straight to __________ therapy meanwhile elderly patients require an __________.

A

Eradication

endoscopy

129
Q

What characterises stools of cholera patients?

A

Rice water stools

First Year Dundee Medicine (4 decks)

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