Gastrointestinal question notes Flashcards
What is Barrett’s oesophagus?
- metaplasia of lower oesophageal mucosa
- squamous stratified replaced by columnar
What is metaplasia?
- one differentiated cell type to another
Parietal cell releases?
HCl and intrinsic factor
intrinsic factor binds B12 allowing for its absorption
Paneth cells secrete?
Lysozyme
What is Pernicious Anaemia?
- autoimmune
- antibodies to gastric parietal cells or intrinsic factor
- vitamin B12 deficiency
Describe Crohn’s disease?
What is the gene assocaited with Crohns?
- form of IBD
- affects all layers down to serosa
- inflammation, usually terminal ileum and colon
- NOD-2
What is a direct hernia?
- enters through defect in posterior wall of inguinal canal
- out through superficial ring
- hernia reappears upon cough (rise in intra-abdomonal pressure)
Describe an indirect hernia?
- enters through deep inguinal ring
- exits through superficial ring of inguinal canal
What are desmoid tumours?
who and where might you find them?
- fibrous neoplasms
- show APC mutation
- common post partum women in rectus abdominus
What is courvoisier’s law?
- presence of painless obstructive jaundice, and palpable gallbladder is unlikely due to gallstones
Describe the lymphatics of the prostate gland?
- drain into internal iliac nodes first
- then sacral nodes
blood supply of prostate?
- internal iliac arteries which give rise to inferior vesical arteries
What is cryptorchidism?
- men with history of undescended testis
- 40x more likely to develop testicular cancer
What is the superficial landmark of the femoral artery?
- midway between ASIS and pubic symphysis
What is dysplasia?
- presence of abnormal cells within a tissue
- may signify cancer
Where does the vena cava, oesophagus and aortic hiatus pass through the diaphragm?
T8 - VENA CAVA
T10 - OESOPHAGUS
T12 - AORTIC HIATUS
What kind of bacteria is C.Diff?
What does it cause?
- gram positive rod
- releases exotoxin related to increased raised WBC count
- psuedomembranous colitis
Describe borders of femoral triangle?
SAIL
- Sartorious (lateral)
- Adductor Longus (medial)
- Inguinal ligament
roof: fascia lata
Describe contents of femoral triangle from lateral to medial?
- Femoral nerve
- Femoral sheath
- femoral artery } —————————>
- femoral vein } —————————–>Adductor canal
- femoral canal }———————> Femoral canal
Describe contents of femoral canal? 2 things
Contents
- –> lymphatic vessel
- –> one lymph node (cloquet lymph node)
What are the borders of the femoral canal?
Laterally
Medially
Anteriorly
Posteriorly
FLIP the LMAP
Laterally —> Femoral Vein
Medially —> Lacunar Ligament
Anteriorly —> Inguinal Ligament
Posteriorly —> Pectineal Ligament
What is Trousseau’s syndrome?
- clot that moves around body
- aka migratory thrombophlebitus
What is metoclopramide and why is it given?
- for nausea and vomitting
- antimetics
- dopamine antagonist
Describe divisions of common hepatic artery?
Common hepatic
- –> right hepatic
- —————–> cystic artery
—> left hepatic
What are the divisions of the abdominal aorta?
prostitutes cause sagging swollen red testicles (in men) living in sin
- Phrenic (T12)
- Coeliac (T12)
- Superior Mesenteric (L1)
- Suprarenal (middle) (L1)
- Renal (L1-L2)
- Testicular (in men) (L2)
- Lumbar (L1 -L4)
- Inferior mesenteric (L3)
- Sacral (L4)
ACH acts on what receptors
m3 receptors on parietal cells
- causes increase in intracellular [Ca2+]
What is Gilbert’s syndrome?
- autosomal recessive
- defective bilirubin conjugation
- due to deficiency of UDP glucoronosyltransferase
- causes build up of unconjugated bilirubin
What cells release CCK?
I cells in the small intestine
CCK
- increases enzyme rich secretions
- relaxation of sphincter of ODDi
- decreases gastric emptying
- induces satiety
What is a VIPoma and some features of it?
- large vol of diarrhoea
- weight loss
- dehydration
- hypolipidaemia
three main branches of abdominal aorta?
- Coeliac trunk
- Superior mesenteric
- Inferior mesenteric
Branches of coeliac trunk?
- common hepatic artery
- left gastric artery
- splenic artery
What is FAP?
- more than 100 adenomatous polyps affecting the colon and rectum
- APC = tumour supressor gene
HNPCC
- colorectal cancer without extensive polyps
Which part of the urethra is wider, prostatic or membranous?
significance of this when putting a catheter in
- prostatic bit wider
- therefore resistance will decrease on insertion of catheter
What sign is associated with acute pancreatitis?
- Grey Turner’s
- due to blood pooling in retroperitoneal space
- pancreas head retroperitoneal
- blood collecting in space
- flank bruising
- only really seen in 5% cases though
key features of patient with liver cirrhosis
- heavy alcohol intake
- nausea
- vomiting
- ascites
- palmar erythema
- liver enzymes
What is seen in non-alcoholic fatty liver disease?
- triglyceride accumulation
- proliferation of myofibroblasts
Describe brief pathology of liver cirrhosis?
- excess collagen and ECM in periportal and pericentral zone
- leading to formation of regeneration nodules
key clinical features of oesophageal varices?
- palmar erythema
- spider naevi
- jaundiced sclera
- tachycardia
- tachypnoeic
Oesophgeal varices may lead to…?
- blood loss
- hypovolemic shock
- shock is inadequate tissue perfusion
What is a mallory Weis tear?
- painful episodes of haematemesis
- forceful vomiting could cause it
- painful mucosal lacerations at gastrooesophageal junction
Umbilical vein becomes…
ligamentum teres
describe branches of sciatic nerve
Sciatic
- —> common peroneal
- —> lateral cutaneous - —> posterior tibial
- —> lateral plantar
- —> medial plantar
then:
common peroneal + tibial = sural nerve (lateral foot)
Murphy’s sign
for acute cholecystitis
- RHS, place hand, take patient to take deep breath, should be painful on inspiration
Describe ascending cholangitis key features
- abdo pain
- comes on after eating
- murphys sign
- more acutely unwell with fever
Oculogyuric
prolonged involuntary upward deviation of gaze as a result of drugs
iteric
jaundiced
Describe propanolol
- non selective beta blocker
- can be used for oesophageal varices
describe use of propanolol for oesophageal varices
- causes splanchnic v.constriction
- reducing portal blood flow
duodenal atresia
congenital absence or complete closure of portion of lumen of duodenum
the shitty triad describing bowel obstruction
- vomiting
- abdominal distension
- absolute constipation
Compare large and small bowel obstruction
large bowel
- constipation before vomiting due to distal location of GI tract
causes of small bowel obstruction
- adhesions
2. hernias
causes of large bowel osbtruction?
- malignancy
- diverticular disease
- volvulus
volvulus
loop of intestine twisting around itself and the mesentery
Haematochezia
fresh blood in anus
Melena
dark blood in stool, digested blood
ranitidine
competitive H2 antagonist on gastric parietal cell
Describe sinusitis
- inflammation sinuses
- pain worsens when learning forward
- often maxillary
Intussusception
- invagination of one portion of bowel
- sausage shaped
- child pulls legs up to chest to help
Triple therapy
- PPI
- 2 antibiotics
- —> amoxicillin
- —> clarithromycin
Compare Meckel’s diverticulum and Intussusception
Meckels
- doesn’t typically cause shock
- kids don’t typically bring knees to chest
Intussusception
- shock
- knees to chest
What two ducts join together at the ampulla of vater?
- pancreatic duct
- common bile duct
Describe coeliac’s disease
- triggered by carbohydrates
- villous atrophy
- raised intraepithelial lymphocytes
- dermatitis herpitformas association
Peutz-Jager syndrome
- large, pedunculated benign polyps
- pigmented freckles on lips, face and palms and sole
Harmartomatous polyps
tumour like growth found in organs - often mixture of tumours
Bell’s palsy
unilateral idiopathic facial nerve paralysis
facial nerve paralysis
- chorda tympanic branch innervates sensory 2/3rd tongue so taste impairment
Hershsprung’s disease
- Lack of peristalsis
- due to absence of ganglionic cells in myenteric nerve plexus.
- neonates haven’t passed first poop.
- abdomen slightly distended
Achalasia
- lower oesophageal sphincter doesn’t open on swallowing
Wipples procedure
removal of head of pancreas when infected with adenocarcinoma
Cor Pulmonale
- RHS heart failure.
- SOB, cyanosis, hepatomegaly.
- blood backed up into systemic circulation.
- hepatic vein enlarged.
Pyelonephritis
- bacterial infection from ureter to kidneys
- kidneys retroperitoneal so could spread infection to posterior psoas muscle and cause abcess.
Peritonitis
infected ascitic fluid
Psuedocyst vs cyst
psuedocyst
- surrounded by granulation tissue
cyst
- surrounded by epithelial tissue
surface epithelium of oesophagus
- non-keratinizing stratified squamous epithelium
- normally replaced by columnar epithelium at the gastro-oesophageal junction
which bronchus do foreign bodies fall down more frequently?
- right bronchus
- shorter and wider and more vertical than left bronchus
- thus more likely to aspirate foreign bodies.
3 main characteristics of large bowel?
- haustra
- appendices epiplociae
- taeniae coli
Plicae circulares are features of small bowel rather than large boewl
