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Gastro intestinal tract > general > Flashcards

general Flashcards

1
Q

Upper GI bleeds is proximal the ligament of

A

ligament of Trietz

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2
Q

lower GI bleeds is distal to the

A

ligament of Trietz

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3
Q

upper GI bleeds clinical features

A

haematemesis, melaena, elevated urea, dyspepsia, reflux, epigastric pain, NSAIDS use

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4
Q

lower GI bleed features

A

fresh, magenta stools, normal urea, painless, common in elderly

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5
Q

most common cause of an upper GI bleed?

A

peptic ulcer

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6
Q

Zollinger Ellison syndrome is

A

gastrin secreting pancreatic tumour that causes recurrent poor healing duodenal ulcers

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7
Q

Mallory Weiss tear is typically at the

A

oesophago-gastric junction

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8
Q

diuelafoy refers to

A

submucosal arteriolar vessel eroding through mucosa

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9
Q

lower GI haemorrhage Angiodysplasia treatment

A

Aargon phototherapy, tranexamic acid, thalidomide

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10
Q

acute GI bleeding Meckel’s diverticulum diagnostic investigation

A

nuclear scintigraphy

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11
Q

treatment of GI bleed in terms of circulation

A

wide bore access for fluids and blood
blood samples
catheter
tranexamic acid

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12
Q

haemorrhagic stroke features

A 
high respiratory rate
rapid pulse
anxiety
clammy, cool skin
low urine output 
low blood pressure
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13
Q

bleeding uncontrolled at endoscopy treatment

A

sengstaken-blakemore tube trnasjugular intrahepatic porto-systemic shunt

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14
Q

recommended units of alcohol

A

6

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15
Q

FAST positive score to perform an AUDIT

A

> 3

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16
Q

AUDIT SCORE OF >20

A

possible dependence

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17
Q

AUDIT SCORE OF 16-19

A

higher risk

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18
Q

AUDIT SCORE OF 8-15

A

increasing risk

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19
Q

AAT to ALT ratio

A

> 2

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20
Q

causes of hepatic encephalopathy

A 
Infection
Drugs
Constipation
GI Bleed
Electrolyte Disturbance
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21
Q

Glasgow hepatitis score criteria

A 
Age
WCC
urea
INR
bilirubin
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22
Q

alcoholic hepatitis nutritional support requires

A

thiamine

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23
Q

small intestine is how long?

A

6m

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24
Q

small bowel is renewed every

A

4-6 days

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25
Q

large bowel turnover is every

A

3-8 days

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26
Q

intrinsic neuromuscular control of the small and large bowel

A

myenteric plexus via Meissener’s plexus

Auerbach Plexus

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27
Q

Meissener’s plexus location

A

base of submucosa

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28
Q

Auerbach plexus location

A

inner circular, and outer longitudinal layers of the muscularis propria

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29
Q

Crohn’s disease genetic association

A

NOD 2 gene

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30
Q

Ulcerative Colitis gene association

A

HLA

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31
Q

pANCA positive in which patients of IBD

A

75% in UC

11% in CD

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32
Q

ulcerative have granulomas?

A

no

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33
Q

Crohn’s disease granulomas

A

yes non-caseating granulomas

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34
Q

dysplasia in hindgut commonly

A

adenoma tubular

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35
Q

low grade adenoma dysplasia of the lower gut

A

increased nuclear number and size, reduced mucin

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36
Q

high grade dysplasia adenoma of the lower gut

A

carcinoma in situ, crowded, irregular, not yet invasive.

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37
Q

genetics of colorectal carcinoma

A

FAP
HNPCC
Peutz-Jeghers

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38
Q

congenital ano-rectal abnormalities

A

imperforate anus
uro-genital fistulae
hirschprung’s myenteric plexus deficiency

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39
Q

acquired ano-rectal abnormalities

A

haemorrhoids, fissure, abscesses, fistula in ano, ulceration, cancer, control of continence

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40
Q

procedure for prolapse and haemorrhoids

A

stapled anopexy

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41
Q

most likely site for a colo-rectal cancer site

A

left colon

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42
Q

anal squamous cancer treatment

A

radiotherapy

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43
Q

rectal adenocarcinoma treatment

A

neo adjuvant chemorad

laparoscopic resection

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44
Q

Dukes A 5yr survival

A

> 90% submucosa

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45
Q

drugs for acid suppression

A

antacids, H2 receptor antagonists, proton pump inhibitors

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46
Q

drugs affecting GI motility

A

anti-emetics, anti-muscarinics, anti motility

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47
Q

drugs affecting IBD

A

aminosalicylates, corticosteriods, immuno- suppressants, biologics

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48
Q

drugs affecting intestinal secretions

A

bile acid sequestrates and ursodeoxycholic acid

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49
Q

antacids contain what metals?

A

magnesium or aluminium

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50
Q

alginates mechanism for working

A

gel that floats on stomach

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51
Q

H2 receptors antagonists block which receptor

A

histamine

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52
Q

H2 receptor antagonists indicated for

A

GORD/peptic ulcer disease

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53
Q

side effects of PPI’s

A

GI upset, C.difficile infection hypomagnesaemia, B12 deficiency

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54
Q

mechanism of prokinetic agents on GI motility

A

parasympathetic control of smooth muscle and sphincter tone via Ach

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55
Q

vomiting centre is located

A

medulla

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56
Q

anti-motility drug mechanism for GI

A

opiate receptors to decrease ACh release

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57
Q

anti spasmodics mechanisms

A
  1. anti-cholinergic muscarinic antagonists
  2. direst smooth muscle relaxants
  3. Calcium CB’s
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58
Q

types of laxatives

A

bulk
osmotic
stimulant
softeners

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59
Q

contraindications and side effects of aminosalicylates in IBD

A

caution in renal impairment

may cause GI upset, blood dyscasias, renal impairment

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60
Q

IBD corticosteriods concerns

A

osteoporosis, weight gain, infection, addisonian crisis

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61
Q

IBD immunosuppressants mechanism

A

prevents formation of purines for Dna synthesis

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62
Q

adverse effects of immunosuppressants in IBD

A

bone marrow suppression, hypersensitivity, organ damage, drug interactions

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63
Q

biologics name

A

anti TNF alpha antibodies infliximab

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64
Q

cautions and effects of infliximab

A

TB, MS, pregnancy and infections.

effects are infection, reactions, anaemia, demyelination, malignancy, thrombocytopenia

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65
Q

drugs affecting biliary secretions

A

cholestyramine, ursodexycholic acid

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66
Q

mechanism of cholestyramine for biliary secretions

A

reduces bile salts, enables excretion as insoluble complex

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67
Q

cholestyramine side affects

A

reduces absorption of other drugs, affects fat soluble vitamin absorption and decrease vitamin K levels

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68
Q

ursodeoxycholic acid uses in what conditions

A

gallstones, Primary biliary cirrhosis

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69
Q

ursodeoxycholic acid mechanism for action

A

inhibits enzymes for cholesterol formation, slowly dissolves non-calcified stones

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70
Q

factors affecting absorption in the GI- drugs

A

pH, gut length, transit time

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71
Q

distribution GI affects - drugs

A

low albumin

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72
Q

metabolism GI affects -drugs

A

liver enzymes, increased gut bacteria, liver blood flow, gut wall metabolism

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73
Q

excretion affects in GI - drugs

A

biliary excretion

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74
Q

severity of liver disease classification

A

child-pugh classification

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75
Q

criteria for child Pugh classification

A

bilirubin, albumin, PT, encephalopathy, ascites

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76
Q

dangerous drugs to consider with liver disease

A

warfarin, aspirin, opiates

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77
Q

second leading cause of cancer death in the western world is

A

colorectal cancer

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78
Q

95% of colorectal cancers are what pathology?

A

adenocarcinomas

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79
Q

strongest risk factor for colorectal cancer

A

sporadic with no familial/genetic influence

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80
Q

2 histological types of colorectal adenoma polyps

A

tubular(75%) /villous

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81
Q

oncogenes involved in colorectal adenoma

A

k-ras, c-myc

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82
Q

loss of tumour suppressor genes in colorectal adenoma

A

APC, p53, DCC

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83
Q

Chemotherapy for treatment in colorectal cancer for

A

adjuvant, DUKES C +B, cleans up micrometastases

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84
Q

agent for chemotherapy in colorectal cancer

A

5-FU

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85
Q

radiotherapy in colorectal cancer is used only for

A

rectal cancer

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86
Q

Dukes stage A colorectal cancer 5yr survival percentage

A

83%

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87
Q

DUKES stage D colorectal cancer 5yr survival percentage

A

3%

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88
Q

age 50-74 receive a FOBT every how many years?

A

2 years

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89
Q

heritable conditions for colorectal cancer

A

FAP - familial adenomatous polyposis

HNPCC- hereditary non-polyposis colorectal cancer

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90
Q

FAP is a … condition (penetration)

A

autosomal dominant

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91
Q

FAP receives what medication as a form of prevention

A

NSAIDS chemoprevention

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92
Q

out of 2000 people in regards to bowel cancer how many people have cancer?

A

1

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93
Q

high risk features in rectal bleeding

A

persistent changes in bowel habit, with anal symptoms (>6 weeks), right sided abdominal mass, palpable rectal mass, unexplained iron deficiency

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94
Q

5 ethics

A

autonomy, equity, justice, beneficence, malfeasance

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95
Q

functional GI disorder’s examples

A

oesophageal spasm, non-ulcer dyspepsia, biliary dyskinesia, irritable bowel syndrome, slow transit constipation, drug related effects

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96
Q

causes of non-ulcer dyspepsia

A

reflux, low grade duodenal ulceration, delayed gastric emptying, irritable bowel syndrome

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97
Q

functional causes of vomiting

A

migraine, drugs, pregnancy, cyclical vomiting syndrome, alcohol.

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98
Q

alarming symptoms for functional bowel diseases and stools

A 
age >50
short symptom history
unintentional weight loss
nocturnal symptoms 
male sex
cancer history
anaemia 
rectal bleeding
recent antibiotics
mass
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99
Q

investigations for functional bowel diseases

A

FBC, blood glucose, U+E, thyroid, coeliac, FIT, sigmoidoscopy, colonoscopy

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100
Q

functional causes of constipation

A

megacolon, idiopathic constipation, depression, psychosis, and institutionalised patients

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101
Q

organic causes of constipation

A

stricture, tumours, diverticular disease, proctitis and anal fissures

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102
Q

systemic causes of constipation

A

diabetes, hypothyroidism, hypercalcaemia

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103
Q

neurogenic causes of constipation

A

autonomic neuropathies, Parkinson’s disease, strokes, MS, spina bifida

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104
Q

clinical features of IBS

A

pain, altered habit, bloating, belching, wind, flatulence, mucus

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105
Q

NICE diagnostic criteria

A

mucus, abdominal bloating, symptoms made worse by eating, altered stool passage

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106
Q

calprotectin is released by

A

inflamed gut mucosa, differentiates by IBS and IBD

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107
Q

FODMAP

A

fermentable oligo, di, and mono saccharides and polyols

fructose, lactose, fructans, galactans and polyols

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108
Q

IBS drugs for pain

A

antispasmodics, linaclotide, antidepressants

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109
Q

IBS drugs for bloating

A

probiotics, linaclotide

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110
Q

IBS drugs for constipation

A

laxatives (bulking, softeners, stimulants, osmotic), linaclotide

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111
Q

diarrhoea IBS treatment

A

antimotility agents

FODMAP

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112
Q

psychological interventions for functional bowel disease

A

relaxation, hypnotherapy, CBT, psychodynamic

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113
Q

relaxation training for functional bowel disease uses

A

diarrhoea and psychological co-morbidity

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114
Q

hypnotherapy for functional bowel disease uses

A

pain, constipation, flatulence, anxiety

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115
Q

CBT for functional bowel disease uses

A

abdominal pain, bloating, flatulence

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116
Q

psychodynamic interpersonal therapy for functional bowel disease uses

A

history of abuse

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117
Q

IBS - D impact on intestinal motility

A

stronger frequent contractions

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118
Q

IBS -C impact on intestinal motility

A

contractions reduced

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119
Q

peristaltic rhythm is generated by pacemaker cells in the longitudinal muscles is every .. minutes

A

~3 minutes

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120
Q

function of somatostatin

A

controls secretion of insulin and glucagon

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121
Q

what is the name of the membrane bound enzyme that convers trypsinogen to trypsin

A

enterokinase

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122
Q

enzyme that cleaves peptide bonds

A

proteases

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123
Q

nucleases enzyme function

A

hydrolyses DNA/RNA

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124
Q

enzyme responsible for collagen digestion

A

elastases

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125
Q

phospholipids into fatty acids enzymes

A

phospholipases

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126
Q

starch to maltose + glucose enzyme

A

alpha amylase

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127
Q

zymogen secreted by what hormone?

A

Cholecystokinin

128
Q

what converts CO2 + H2O into H2CO3

A

carbonic anhydrase

129
Q

adenosine cyclase converts ATP into what?

A

cAMP

130
Q

ATP conversion into cAMP is regulated by

A

histamine and prostaglandins via G proteins and adenosine cyclase

131
Q

gastrin and acetylcholine regulate protein kinases via

A

Ca

132
Q

defect in absorbing an intrinsic factor results in

A

pernicious anaemia

133
Q

oesophagus mucosa is

A

stratified squamous non-keratinised epithelium

134
Q

in the small intestine there is the crypts of

A

Leiberkuhn

135
Q

lymphoid aggregations in the small intestine are called

A

peyer’s patches

136
Q

Paneth cells

A

synthesize antimicrobial peptides and proteins

137
Q

intestinal cells that synthesize antimicrobial peptides and proteins in crypts

A

Paneth cells

138
Q

innate immune cells

A

neutrophil, eosinophil, basophil, mast cell, monocyte, dendritic cell, macrophage, natural killer cell

139
Q

adaptive immune cell

A 
CD4 T cell
CD 6 T cell
B Cell
memory cell
plasma Cell
140
Q

what are the three signals that determine a T Cell response

A

MHC peptide-TCR
CD80-CD28
cytokine

141
Q

integrins are

A

transmembrane proteins

142
Q

bedside investigations

A

BMI, pulse oximetry, ECG, capillary glucose, urinalysis

143
Q

urine collections analyse what

A

5HIAA, catecholamines

144
Q

risks for upper GI endoscopic investigations

A

aspiration, perforation, haemorrhage

145
Q

risks for colonoscopy investigations

A

perforation, haemorrhage, renal impairment

146
Q

ECRP investigation risks

A

pancreatitis, haemorrhage, perforation, infection, mortality

147
Q

submucosal neurone plexus

A

Meissner’s plexus parasympathetic

148
Q

myenteric plexus is between what two muscular layers

A

circular and longitudinal muscle

149
Q

antibiotic use impact on the GI microbiome

A

reduces diversity and increases Enterobacteriaceae

150
Q

mechanisms of action for probiotics

A

competition, bioconversion, production of vitamins, direct antagonisms, competitive exclusion, barrier function, reduce inflammation, immune stimulation

151
Q

selected prebiotics

A

FOS & Inulin, galactose, lactulose

152
Q

endoscopy ALARMS

A 
anorexia
loss of weight
anaemia
recent onset
melaena
swallowing problems
153
Q

H. Pylori +/- and description

A

negative spiral shaped microaerophilic flagellated

154
Q

H. Pylori has infected how many people

A

50% of the world

155
Q

H. pylori urease dependent diagnostic tests

A

breath tests 13C or 14C carbon dioxide
or
ammonia utilised in urease tests

156
Q

gastritis causes

A

autoimmune
bacterial
chemical bile

157
Q

H. pylori triple therapy

A

clarithromyocin 500mg
amoxycillin
PPI omeprazole
7 days

158
Q

complications of peptic ulcer

A

acute bleeding, chronic bleeding, perforation, fibrotic stricture, gastric outlet obstruction

159
Q

gastric outlet obstruction blood key markers

A

low cl
low na
low K
renal impairment

160
Q

cholangiocarcinoma risk factors

A

PSC, congenital cystic disease, Biliary enteric drainage, thorotrast, hepatolithiasis, carcinogens

161
Q

acute inflammation of hepatitis A, and E on the liver outcome

A

resolution

162
Q

acute inflammation of hepatitis A, B, E, on the liver outcome

A

failure if severe damage

163
Q

acute inflammation of the liver outcome via hepatitis b, C

A

progression to chronic hepatitis and cirrhosis B, C

164
Q

haemoglobin is broken down in the

A

Spleen

165
Q

haemoglobin forms

A

haem and globin

166
Q

Primary biliary cholangitis is what disease?

A

auto-immune

167
Q

PBC normally affects

A

females 9:1

168
Q

PBC normally has what biomarkers in serum?

A

anti-mitochondrial auto-antibodies, and Raised serum alkaline phosphatase

169
Q

pathology of PBC

A

granulomatous inflammation involving bile ducts, loss of intrahepatic bile ducts, progression to cirrhosis

170
Q

metabolic disorders that may lead to cirrhosis

A

primary haemochromatosis ( excess iron) Wilson’s disease (excess copper)

171
Q

Crohn’s and UC classification

A

Montreal classification

172
Q

ulcerative colitis markers - specific

A 
fever > 37.5C
tachycardia >90/min
ESR(CRP) raised
anaemia hb <10g/dl
albumin <30g/l
leucocytosis, thrombocytosis
173
Q

IBD inflammatory indices

A 
high ESR, CRP
high platelet
high WCC
low Hb
low albumin
Calprotectin
174
Q

Crohn’s disease specific histological markers

A

granulomas

175
Q

IBD extra intestinal manifestations

A 
eyes (uveitis, episcleritis, conjunctivitis)
joints (sacroiliitis, monoarticular arthritis ankylosing arthritis)
Renal calculi (CD)
liver and biliary tree (fatty change, pericholangitis, sclerosing cholangitis, gallstones) 
Skin (pyoderma gangerosum, erythema nodosum, vasculitis)
176
Q

IBD differential diagnosis

A

chronic diarrhoeas, Ileo-caecal TB, colitis (infective, amoebic, ischaemia colitis)

177
Q

IBD out patient management

A

5ASA
steroids
immunosuppression

178
Q

IBD hospital managment

A 
steroids
anticoagulation
infliximab
surgery
cyclosporine
179
Q

mild to moderate UC 1st line therapy is

A

5ASA

180
Q

optimal dosage of prednisolone for UC

A

40mg per day

181
Q

what antibiotic is offered in Crohn’s peri-anal disease

A

metronidazole

182
Q

Crohn’s surgical indications

A 
failure of medical management
relief of obstructive symptoms
management of fistulae
management of intra-abdominal abscess
management of anal conditions
183
Q

Crohn’s recurrence post surgery

A

50%

184
Q

synthetic function of liver

A

clotting factors, bile acids, carbohydrates, proteins, lipids, hormones

185
Q

what hormones are formed in the liver

A

angiotensinogen and insulin like growth factor

186
Q

detoxification liver functions

A

urea production from ammonia, detoxification of drugs, bilirubin metabolism, breakdown of insulin and hormones.

187
Q

liver storages

A

glycogen, vitamins A, D, B12, K and stores copper and iron.

188
Q

raised aminotransferases suggests what involvement?

A

parenchymal

189
Q

what drugs can raise Gamma GT

A

NSAIDS

190
Q

differential diagnosis for Jaundice

A

carotenemia

191
Q

bilirubin detectable when exceeding …umol/L

A

34

192
Q

complications of ERCP

A

sedation related
pancreatitis
cholangitis
sphincterotomy

193
Q

chronic liver disease is when the disease persists longer than …months

A

6 months

194
Q

presentation of compensated chronic liver disease

A

routinely detected on screening tests, abnormality of liver function tests

195
Q

decompensated chronic liver disease clinical presentation

A

ascites
variceal
hepatic encephalopathy

196
Q

new onset ascites requires what investigation

A

diagnostic paracentesis

197
Q

SAAG >1.1g/dl

A

portal hypertension
massive metastatic spread
constrictive pericarditis

198
Q

SAAG < 1.1g/dl

A

malignancy
Tb
pancreatic

199
Q

uncontrolled variceal bleeding management

A

endoscopic band ligation
terlipressin
sengstaken-blakemore tube

200
Q

hepatocellular carcinoma is associated with which viral hepatitis

A

B & C

201
Q

hepatocellular tumour marker

A

AFP

202
Q

external anal sphincter is comprised of

A

skeletal muscle

203
Q

colon actively transports when from lumen into blood

A

sodium

204
Q

bacterial fermentation in the colon produces

A

short chain fatty acids, vitamin K and gas

205
Q

following retention of faecal material in constipation is there absorption of toxins

A

no

206
Q

enterotoxigenic bacteria in the gut work through what mechanism

A

protein enterotoxins turn of intestinal chloride secretions from crypt cells increasing H20 secretions

207
Q

enterotoxigenic bacteria via increasing chloride secretion through what secondary messengers

A

cAMP
cGMP
calcium

208
Q

ligament separating the right and left liver lobes

A

falciform ligament which leads onto the round ligament

209
Q

which lobe is next the gallbladder

A

quadrate lobe

210
Q

which lobe is next to the inferior vena cava

A

caudate lobe

211
Q

what components of bile is secreted by hepatocytes?

A 
bile acids
lecithin
cholesterol
bile pigments 
toxic metals
212
Q

what components of bile solubilise fat and are synthesised in the liver?

A

bile acids
lecithin
cholesterol

213
Q

how many grams of cholesterol is synthesised in a day?

A

0.5g

214
Q

bile acids are conjugated with what prior to secretion?

A

glycine or taurine

215
Q

1 word to describe the action of secretin

A

neutralisation

216
Q

1 word to describe the action of Cholecystokinin

A

digestion

217
Q

hepatic A and E are what sort of viruses?

A

enteric

218
Q

hepatic B, C and D are what sort of viruses?

A

parental

219
Q

hepatic A and E are what sort of infections?

A

self limiting acute

220
Q

hepatic B, C and D are what sort of infections?

A

chronic

221
Q

how many people a year die from hepatitis?

A

1 million

222
Q

acute hepatitis A is diagnosed by what antibodies?

A

IgM

223
Q

who receives a HAV immunisation?

A

travellers, patients with chronic liver disease, haemophiliacs, occupational exposure and gay community

224
Q

HBV antigen HBsAg is indicative of what?

surface antigen

A

presence of virus

225
Q

HBV antigen e HBeAg is indicative of what?

A

active replication

226
Q

hepatitis core antigen HBV HbcAg is indicative of what

A

active replication

227
Q

HBV DNA is indicative of what

A

active replication

228
Q

IgM anti HBc antibody indicates what?

A

acute infection

229
Q

IgG anti HBc HBV antibody indicates what?

A

chronic infection

230
Q

anti HBe HBV antibody indicates what

A

inactive virus

231
Q

HDV often co-infects with which virus?

A

HBV

232
Q

HDV viral description

A

small RNA virus, no protein coat enveloped by HBsAg

233
Q

NAFLD criteria

A 
AGE
diabetes
BMI
AST:ALT
platelet count
albumin
234
Q

high risk NALFD stats

A 
>45
diabetic
>30BMI
AST:ALT >1
low platelet count <150
low albumin <34
235
Q

treatment for NAFLD

A 
weight and exercise
insulin sensitizers
glucagon like peptides
vitamin E 
farnesoid X nuclear receptor ligand
236
Q

autoimmune hepatitis is influenced by which antibody

A

IgG

237
Q

PSC is which gender dominant

A

male

238
Q

what disease is pANCA positive

A

PSC

239
Q

anti-liver transplant rejection drugs are

A

steroids
azathiopurine
cyclosporine

240
Q

facultative anaerobic bacteria definition

A

can grow in presence and absence of O2

241
Q

obligate anaerobe definition

A

cannot grow in presence of oxygen

242
Q

what are the three short chain fatty acids produced by bacteria in the gut

A

butyrate, propionate, acetate

243
Q

butyrate function in cells

A

epithelial cell growth and regeneration

244
Q

propionate role in the liver

A

gluconeogenesis in the liver

satiety signalling

245
Q

acetate role in the tissues and lipids

A

transported to peripheral tissues and involved in lipogenesis

246
Q

right side of the colon in comparison to the left side of the colon in terms of microbiota metabolism

A

right is more carbohydrate rich
mildly acidic
rapid turnover

247
Q

left side microbiota metabolism of the colon

A

little fermentable carbs
pH neutral
turnover slow

248
Q

two mechanism of colonisation resistance against pathogens by microbes in the gut

A

barrier effect

active competitive exclusion

249
Q

at what pH do pathogens optimally grow at

A

> 6

250
Q

which side of the colon is more susceptible to disease?

A

left side

higher pH
slower transit
less substrate

251
Q

name hexose sugars

A

glucose, galactose, fructose

252
Q

lactose consists of

A

glucose + galactose

253
Q

sucrose consists of

A

glucose + fructose

254
Q

maltose consists of

A

glucose + glucose

255
Q

alpha amylose is glucose linked in …

A

straight chains

256
Q

amylopectin is glucose linked in

A

highly branched chains

257
Q

glycogen and starch are monomers linked by

A

alpha 1,4, glyosidic bonds

258
Q

alpha 1,4, glyosidic bonds in glycogen and starch are broken down by what enzyme and mechanism

A

hydrolysed by amylase

259
Q

cellulose molecular structure

A

unbranched linear chains of glucose monomers linked by beta 1,4 glycosidic bonds

260
Q

what transmembrane protein channels does fructose travel through

A

GLUT 5 then GLUT 2

261
Q

what transmembrane protein channel does glucose exit the cell via

A

GLUT 2

262
Q

triacylglycerol consists of

A

a glycerol and 3 stearic acids

263
Q

fat soluble vitamins are

A

A, D,E, K

264
Q

water soluble vitamins are

A

B group, C and folic acid

265
Q

iron is transported across a brush border membrane ..

A

DMT1

266
Q

iron in the blood binds to

A

transferrin

267
Q

stored iron is incorporated into

A

ferritin

268
Q

fixed components for nutritional demand

A

basal requirements membrane function
mechanical work
substrate turnover

269
Q

variable component for nutritional demand

A

processing intake
physical activity
body temp
growth

270
Q

BMI =

A

weight KG/ height squared (m)

271
Q

BMI > 25 is

A

overweight

272
Q

BMI > 30 is

A

obese

273
Q

BMI <20

A

underweight

274
Q

BMI < 16

A

severe consequences

275
Q

high risk of refeeding problems criteria

A

BMI <16
no nutritional intake for 10 day
low potassium, phosphate or magnesium
history of drug use or alcohol

276
Q

treatment to avoid refeeding problems

A

correct fluid depletion
thiamine before feeding
feed 5-10kcal/kg
gradual increase

277
Q

acute pancreatitis is associated with a rise in which serum biomarker

A

amylase

278
Q

75% of carcinoma of the pancreas is

A

duct cell mucinous adenocarcinoma

279
Q

mean survival of pancreatic carcinoma inoperable

A

<6months

280
Q

oesophagus ends at what vertebral level

A

T11-T12

281
Q

hypermotility oesophageal disorders often present with what appearance on a BA swallow

A

corkscrew

282
Q

cause of a hypermotility disorder is often

A

idiopathic

283
Q

hypomotility often caused by

A

connective tissue disease, diabetes and neuropathy

284
Q

complications of motility disorders

A

aspiration pneumonia, squamous cell oesophageal carcinoma

285
Q

squamous cell carcinoma often occurs in the what part of the oesophagus

A

proximal and middle third

286
Q

survival rate of oesophageal cancer

A

<10% 5yr

287
Q

demographic details on a X-ray

A 
name
ID
gender
DOB
date
time
location
288
Q

GALT stands for

A

Gut Associated Lymphoid Tissue

289
Q

vitamin A deficiency results in

A

night blindness

290
Q

thiamine deficiency signs

A

memory, dementia

291
Q

niacin deficiency signs

A

dermatitis, unexplained heart failure

292
Q

vitamin C deficiency

A

scurvy

293
Q

what is a skin manifestation of Coeliac disease

A

dermatitis herpetiformis

294
Q

pathology of dermatitis herpetiformis

A

IgA deposit in skin

295
Q

IgA or IgG more reliable in coeliac disease?

A

IgA if you make IgA

296
Q

97% of coeliacs are positive in which genes?

A

HLA

297
Q

Coeliacs are sensitive to which fraction of gluten?

A

Gliadin

298
Q

Gluten is found in

A

wheat, rye and barley

299
Q

Giardia Lamblia is responsible, is what, for what and responds to

A

unicellular parasite that causes malabsorption and responds t metronidazole

300
Q

causative agent in whipples disease is

A

tropheryma whippelii

301
Q

iron absorption takes place in what part of the small intestine

A

duodenum

302
Q

crypt cells secrete

A

Cl + water

303
Q

intracellular messengers involved in CFTR secretion of Cl

A

ATP into cAMP by adenylate Cyclase which then stimulates PKA which activates CFTR

304
Q

pacemaker cells for segmental contractions are embedded in the

A

longitudinal muscle layer

305
Q

migrating motility complex is initiated by what hormone

A

motilin

306
Q

tumour markers for pancreatic cancer are

A

Ca19-9

307
Q

O-A-TIGER causes of chronic pancreatitis

A 
obstruction
autoimmune
toxin
idiopathic
genetic
environmental
recurrent injury
308
Q

borborygmic stands for

A

rumbling/gurgling noise in the intestines

309
Q

EUS investigation In oesophageal cancer is good for which staging

A

T/N

310
Q

PET CT scan is good for which stage

A

M

311
Q

side effects of laparoscopic hiatus hernia repair and fundoplication

A 
dysphagia
difficulty to belch
gas bloating
excessive flatulence
diarrhoea
312
Q

spread of oesophageal cancer via blood goes to

A

liver

313
Q

autoimmune gastritis results in the loss of

A

intrinsic factor

decreased acid production

314
Q

high mucous content glands are controlled by which receptors

A

sympathetic alpha 1 adrenoreceptors

315
Q

high amylase content glands are controlled by which receptors

A

sympathetic amylase content beta 2 adrenoreceptors

Gastro intestinal tract (3 decks)

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