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TAS > Gastrology > Flashcards

Gastrology Flashcards

1
Q

What is a choledochal cyst

A

sever liver dysfunction
+ / - abdominal mass

large common channel drainage pancreatic and bile duct - juices cause wall destruction this with stenosis cause cysts

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2
Q

What would be seen in protein-losing enteropathy

A

high levels of alpha-1 antityrptase in stool

Hypoalbuminae

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3
Q

Name a type of protein-losing enteropathy

A

lymphangiectasis

high levels of alpha1 antitryptase in stool
Hypoalbuminae
Loose stools

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4
Q

Embryology of diaphragm

A

formed between 5th and 7th week
Fusion of septum transverse, pleuroperitoneal folds, cervical somites

Septum transverse - central tendon
Pleuroperitoneal folds - parietal membranes surrounding viscera
Cervical somites - C5-C7 muscular components

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5
Q

Embryology of GI tract

A

Endoderm - epithelial lining of GI tract
Mesoderm - smooth muscle
ectoderm - enteric nervous system

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6
Q

What structures make up the foregut

A

Pharynx
Oesophagus
Stomach
Proximal duodenum

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7
Q

What structures make up mid gut

A

forming distal duodenum
Small bowel
Distal colon

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8
Q

What structures Make up hind gut

A

Distal colon
Rectum

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9
Q

Timeline of rotation of GI tract

A

5th week - intestine elongates and form loop - protrudes into umbilicus
6th week - stomach and duodenum rotate 90 degrees
8th week - duodenum and jejunum herniate further from superior mesenteric artery
11th week - GI retracts into abdomen

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10
Q

What is villous atrophy

A

Villi surrounding small intestine erode away

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11
Q

What causes villious atrophy

A

Coeliac disease
NSAIDS
Giardsis
H. pylori gastritis

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12
Q

What produces gastric acid

A

Parietal cells in the stomach

Maintained by H+ / K+ / ATPase pump

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13
Q

What is stomach pH ?

A

around 2

1.5-3.5

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14
Q

Pathophysiology of gastric acid production

A

Sodium and chloride cells secreted from parietal cells to canniculis
Negative gradient - K+ and Na cells move down into it
H20 and CO2 from to make carbonic anhydrase
Carbonic anhydrase dissociates - H + move out of cells into stomach lumen, Na and K+ move into cells - leaves Cl and H+ ions in cannaiculis

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15
Q

What increases gastric cell production

A

Vagal nerve stimulation
Gastrin release
Histmaine release

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16
Q

Where is the gastrin released from

A

Released from G cells in pyloric antrum and duodenum

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17
Q

How does gastrin work

A

Directly- Stimulates parietal cells to release HCL

Indirectly work on enterochromaffin cells - binds to CCK2 receptors -> releases histamines -> parietal cells

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18
Q

Where is pepsinogen released

A

chief cells

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19
Q

Other functions of gastrin

A

Causes chief cells to release pepsinogen -> pepsin
Promotes muscle contraction
Strengthens antrum contractions - > increases rate of gastric emptying
Induces pancreatic secretions

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20
Q

What factors increase gastrin

A

partially digested proteins
Hypercalcaemia
Stomach distension
Vagal stimulation

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21
Q

What inhibits gastrin

A

Too much HCl - negative feedback
Glucagon
Somatostatin
GIP / VIP

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22
Q

What pH of the duodenum

A

7-8

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23
Q

What released CCK

A

presence of proteins, fats and low pH

24
Q

Where is CCK released from

A

I cells of duodenum

25
Q

Where is secretin released from

A

s cells of duodenum

26
Q

How does CCK act

A

inhibits smooth muscle contractions from stomach - slow process of food movement
acts on pancreas to increase digestive enzyme - > protease and amylases (break down of carbs)

27
Q

How does secretin acts

A

Released due to carbs in duodenum
Increase production of bicarbonate ions from pancreases and liver (with CCK)

28
Q

What does bicarbonate do

A

Binds to H+ ions in chyme

Rise pH

29
Q

Cause of acute pancreatitis

A

Mumps - need to test rNA

30
Q

Risk factors of pyloric stenosis

A

Bottle feeding
Male
Macrolide use
White ethnicity
Family Hx
Smoking
Prematurity

31
Q

In pyloric stenosis what affect does hypochlormia have?

A

Increases plasma bicarbonate levels as there is an increase in excretion of bircarbonate to maintain pH

Urine is alkaline

32
Q

In pyloric stenosis what affect does hypovolaemia have

A

Causes stimulation of aldosterone which acts of distal tubule -> retain Na and excrete K+ and hydrogen ions = causing hypokalmaia

33
Q

What defiency is likely to be present in binary atresia

A

Fat-soluble vitamin defiency

A, D, E, K

Reduced absorption lack to bile

34
Q

Pathophysiology biliary areas

A

Progression of obliteration of extra-hepatic biliary duct -> obstruction of bile flow

35
Q

Features of biliary atresia

A

jaundice
pale stools
dark urine

hepatemegly

36
Q

Where is mUCIN 2 produced

A

goblet cells of intestines

37
Q

Action of Mucin 2

A

Act to organise two mucus layers

38
Q

How does lack of fibre affect Mucin 2

A

increase in inner layer mucus degradation due to lack of energy from intestinal microbes

39
Q

Commonest cause of acute pancreaitis

A

gall stones - most common cholesterol

40
Q

When do you complete an UGI biopsy if suspecting coeliac disease with duodenal biopsy

A

If tTG is <10 time s upper limit of normal

41
Q

What HLA is ass. with coeliac disease

A

HLA-DQ2 - DQ 8 - test if tTG >10 times upper limit of normal

42
Q

Histological findings of biliary atresia

A

bile duct proliferation and fibrosis
portal tract oedema a
inflammation
bile duct bile plugs

43
Q

Which type of cells act as a protective layer in stomach

A

mucus neck cells

Produce bicarbonate and mucus

Protect from mechanical trauma from peristalsis auto digestion acid

44
Q

Where is somatostatin produced

A

D cells in stomach
D cells in pancreas

Inhibits everything

45
Q

What are the 6 secretions from the stomach

A

Hcl - parietal cells -> absorb vit B 12 by intrinsic factor
Pepsinogen - chief cells
Gastrin - G cells
Moucous - goblet cells mucus cells - protective, alkaline
Somatostatin - delta cella
Histamine - enterchromffain cells - > pepsinogen

46
Q

What is pernicious anaemia

A

Autoantibodies against parietal cells in stomach -

reduced intrinsic factor
reduced vit B12
macrocytosis

47
Q

Where does CCK act in pancreas

A

acincar cells

48
Q

Where does secretin act in pancreas

A

duct

49
Q

Vasoactive intestinal peptide

A

Relaxes smooth muscle

Vasodilation of blood cells

Decrease gastric motility and secretions

50
Q

Glucose dependent insulinotropic peptide

Gastric inhibitory peptide

where is it secreted from

A

K cells upper part of SI

51
Q

GIP function

A

helps release insulin when eaten glucose

52
Q

motilin

A

Pro - motility

from M cells of upper part of SI

53
Q

What is octreotide

A

mimics somatostatin

54
Q

What is octreotide used for

A

Treatment for
oesophageal varice
gastronoma
insulinoma
glucagonoma

55
Q

What absorbs first - iron folate vit b12

A

Iron your clothes - iron
Fold you clothes - folate
then you put them in your closest - cobalamin vit b12

56
Q
A

TAS (18 decks)

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