GI Flashcards
1
Q
role of brunners glands
A
in duodenum, produce alkaline mucus to neutralise chyme
2
Q
order of small intestine
A
duodenum, jejunum, ileum
3
Q
acronym for retroperitoneal organs
A
SADPUCKER
surpaadrenal glands
aorta
duodenum (lower1/3)
pancreas
ureter
colon (ascending and descending)
kidney
eosophagus
rectum
4
Q
describe s and ps innervation gut
A
s- T5-L2. pre sympathetic splanchnic nerves synapse with Sm, Im, and pelvic splanchnic nerves.
ps- vagus to transverse colon and then pelvic beow. release ACh, Gip and VIP
5
Q
describe the endocrine, paracrine and neurocrine gut hormones
A
endocrine- gastrin
paracrine- somatostatin
neurocrine- GIP
6
Q
role gastrin
A
released from g cells in antrum of stomach in response to stretch, vagus or H+. increases partietal cell action
7
Q
role CCK
A
released from I cells in response to increased FA, AA and H+. this causes increased bile and enzyme release
8
Q
role secretin
A
released when H+ levels from s cells are high to increase HCO3- release from pancreas
9
Q
role GIP
A
increases insulin and decreases glucose.
10
Q
role somatostatin
A
inhibits G cells, stimulated by low pH
11
Q
what do crypts contain
A
enteroendocrine cells that secrete hormones, paneth cells which produce antibacs to protect stem cells, and stem cells
12
Q
what are the 2 plexus and where are they lo0cated
A
myenteric (motility) in Muscularis mucosa.
submucosal (blood flow) in submucosa
13
Q
innervation abdo msucles
A
anterior rami T7-T12, Io and Ta have L1 also
14
Q
compare above and below arcuate line
A
above- RA enclosed by EO, TA and IO
below- EO, TA, IO anterior to RA
15
Q
boundaries inguinal canal
A
floor- inguinal and lacunar ligament
anterior- external oblique
roof- inferior oblique and transversus abdomonis
posterior- transversalis fascia and conjoint tendon
16
Q
compare indirect and direct inguinal hernia
A
direct- medial
indiret- lateral
17
Q
boundaries hesselbachs triangle
A
L- inferior epigastric vessels
M- rectus abdomonis
I- inguinal ligament
18
Q
boundaries femoral canal
A
M- lacunar ligament
L- femoral vein
A- inguinal ligament
P- pectineal ligament
19
Q
common incisional sites for hernias
A
midline, paramedian, gridion
20
Q
what forms greater and lesser omenta
A
greater- dorsal
lesser- ventral
21
Q
what contains liver and spleen
A
liver- ventral
spleen- dorsal
22
Q
what membranes form from ventral mesentry and dorsal mesentry
A
ventral- lesser omentum and falciform ligament
dorsal- splenorenal and gastrosplenic
23
Q
describe abnormalities of midgut rotation
A
one clockwise rotation- small intestine in front of TC
one rotation anticlockwise- LHS colon
24
Q
what does the cloaca develop into
A
urogenital sinus and anorectal space
25
what is the producteum
ectoderm covering anal depression
26
what is gastrochesis
failure of abdominal wall to form
27
what is the 2 rule for merkels diverticulum
under 2s, 2 foot proximal to ileocecal valve, 2%, 2:1 ratio male to female
28
describe the pharyngeal phase of swallowing
pharyngeal constrictors push food back, soft pallets seals off the nasopharynx, epiglottis elevates and seals off larynx, vocal cords adduct, opening of UOS
29
describe the role of ductal cells and how this varies at high/low flow speeds
ductal cells add HCO3- and K+, and remove Cl- and Na+. this makes solution hypotonic.
slow flow speeds- more contact- more modification- more hypotonic
high flow speeds- less contact- less modification- less hypotonic
30
describe the resting and active phases of parietal cells
resting- K+ impermeable. tubulovesicles not associated with apical membrane.
active- tubulovesicles in contact with apical membrane
31
what 3 things stimulate parietal cells
gastric, histamine, ach
32
describe muscles stomach outside to inside
oblique, circular, longitudinal
33
blood supply to stomach
lesser curve- R/L gastric
greater curve- gastroepiploic
neck- short gastric
34
4 causes GORD
LOS weakness, slow gastric emptying, pregnancy, obestiy
35
symptoms of immune gastritis
anorexia, glossitis, anaemia (due to no b12 as no intrinsic factor)
36
how is h pylori adapted to survive
produces urea which forms ammonium. raises local pH
37
symptoms PUD
epigastric/back pain, night pain, bleeding, early satiety, weight loss
38
causes of non alcoholic fatty liver disease
diabetes, metabolic syndrome, obestiy
39
willsons disease
deposition of copper in liver due to reduced biliary secretion
40
3 signs of portal hypertension
splenomegaly, jaundice, ascites
41
3 portosystemic anastomoses
porto systemic
umbilical- veins of ligamentum teres, epigastric
rectal- superior rectal, m/I rectal
oesophogeal- left gastric, azygous
42
hepatorenal syndrome
portal hypertension
arterial vasodilation
kidney recieves as reduced circulatory volume
RAAS activates
renal artery vasoconstriction and so reduced kidney functon
43
biliary colic
CCK causes contraction of gall bladder around compared stone in cystic duct. RUQ pain
44
acute cholecystitis
infection of compacted gall stone in cystic duct. caused by e coli. RUQ and inflammation
45
acute cholangitis
infection of biliary tree. chariots triad- pain, inflammation, jaundice
46
what are ALT and ALP specific go
ALT- liver (hepatocyte)
ALP- biliary tree
47
gross pathology chrons disease
Hyperaemia
- Cobblestone Appearance
- Discrete superficial ulcers & deep ulcers
- Fistulae (bowel – bowel, bladder, vagina, skin)
- Mucosal Oedema
- Transmural inflammation
48
gross pathology UC
- Chronic inflammatory infiltrate of lamina propria
- Crypt abscesses
- Crypt distortion
- Goblet cells
- Pseudopolyps
- Loss of haustra
49
what forms bile
Bile acid-dependent: bile acids and pigments
- Bile-acid independent: alkaline solution
50
2 primary bile acid
- Cholic acid
- Chenodeoxycolic acid
51
2 amino acids that bind to bile
glycine, taurine
52
what zymogens does pancreas produce
trypsin, elastase, chymotrypsin
53
what damages zone 1/3 of liver
1- toxins
3- ischameia
54
where is b12 absorbed
terminal ileum. bound to intrinsic factor
55
how is
glucose
galactose
fructose
amino acids
di/tripeptides absorbed
glucose/galactose- SGLT-1 with Na+
fructose- GLUT5
amino acids- co transport with Na
di/tripeptides- peptide transporter with H+
56
3 effects of coeliac disease
crypt hypertrophy, loss microvilli, lymphocytes in epithelium
57
diagnosis coeliac
serum IgA, upper gi endoscopy
58
effects and causes of b12 deficency
- not enough in diet, chrons causing terminal ileum inflammation, lack IF
- megaloblastic anaemia, neurological problems
59
X-ray signs chrons vs uc
chrons- sign of kantour
uc- lead pipe colon
60
describe difference types of pain felt in appendicitis
normal- poorly localised umbillical
retrocaecal/pelvic- suprapubic/rectal/vaginal
61
what is diverticulosis vs diverticulitis
diverticulosis- presence of diverticula
diverticulitis- infection and inflammation of diverticula
62
red flag symptoms duodenal cancer
Anaemia
Loss weight
Anorexia
Recent and progressive
Malena
63
left sided colon cancer
• Left sided colon cancer
◦ Descending
◦ Lumen is narrower and contents more solid so more bowel obstruction
◦ Tenesmus
◦ Early change in bowel habit
◦ More obvious PR bleeding
◦ Less advanced disease at presentation
◦ Stenosing growth.
‣ Causes apple core sign.
64
right sided colon cancer
• Right sided colon cancer
◦ Ascending
◦ Less likely to have bowel obstruction as the lumen is bigger and contents are more liquid
◦ Less likely to have change in bowel habit early on
◦ More advanced disease at presentation.
◦ Fungating growths. On stalk with ball. Grow out into lumen of bowel.
65
cause of primary and secondary peritonitis
primary- ascites
secondary
non bacterial
-ectopic pregnancy
-blood
bacterial
- peptic ulcer
- diverticulitis
- appendicitis
66
symptoms acute mesenteric ischemia
left sided pain (blood supply to splenic flexure ,most fragile), abdominal pain disproportionate to findings, nausea
67
symptoms collapsed AAA
cardiovascular collapse, pulsatile abdominal mass, abdominal or back pain
68
3 SCFA produced by microbiota
propinoate- satiety
butyrate- energy source colonocytes
acetate- cholesterol
69
compare type of diarrhoea caused by bacteria
bloody- shigella, campylobacter
watery- ETEC, salmonella
70
which bacteria can cause haemolytic uraemia syndrome
shigella, campylobacter
71
which virus under 5s
rotavirus
72
which parasite persistent diarrhoea
giardia
73
mechanism cyrptospiridium
Cl- secretion and malabsorption cause watery diarrhoea
74
mechanism emtamoeba
- cyst injested, spreads to liver and mucosa
- causes bloody diarrhoea and inflammation
75
predominant cell type in stomach
surface mucus cell
76
describe the components of the lower oesophageal sphincter mechanism
- acute angle of entry stomach
- smooth muscle of the LOS
- right crus of diaphragm forms a sling around the lower oesophagus which tightens when intraabdominal pressure rises.
- smooth muscle elements of the LOS contract when pressure in the stomach rises
77
which receptor does gastrin bind to in parietal cell
CCK receptor
78
When the parietal cell is in its resting phase, what cytosolic structures contain the proton pumps?
tubulovesicles
79
What region of the stomach has the greatest density of G cells?
antrum
80
What is different about the muscularis propria in the stomach compared with the rest of the gut tube?
Has an additional layer of obliquely orientated muscle
81
CT landmarks
T12
L1
L3
L4
T12- aorta and coeliac trunk
L1- SMA, transpyloric plane
L3- IMA
L4- iliac crest, bifurcation of abdominal aorta
82
which mutation
- lung cancer
- FAP
- breast
- colon
lung- ALK
FAP- APC
breast- BRACA1
colon- KRAS
83
which tumour marker colon cancer
carcinoembryonic antigen
84
layers to reach CSF
skin, fat, supraspinous ligament, interspinous. ligamentum flavum, extradural fat, dura mater, arachnoid mater, subarachnoid space
85
where are bile salts reabsorbed
terminal ileum
86
painless scrotal lump?
indirect inguinal hernia
87
risk factor UTI
diabetes mellitus
88
first line antibiotic simple uti
nitrofurantoin
89
first line antibiotic complicated uti
co-amoxiclav
90
where do
-jugulo-omohyoid
-jugulo-digastric
-submandibular
-pre-auricular
-occipital
drain
- jugulo-omohyoid posterior tongue
- jugulo-digastric tonsils
- submandibular cheek/nose
- pre-auricular cheek/eyelid
- occipital occipital scalp
91
which ACEi causes dry cough
ramipril
92
high defect causes higher pressure in arms than legs
corarction aorta
93
resting potential
- neurones
- skeletal muscle
- cardiac
- smooth muscle
- SAN
- neurones -70
- skeletal muscle -90
- cardiac -80
- smooth muscle -50
- SANc -60
94
where to insert needle decomppression
2nd ICS, mid clavicular line above 3rd rib
95
side effects rifampicin
peripheral neuropathy
96
side effects ethambutol
colour blindness, loss visual acuity, headaches
97
essential amino acids
: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.
98
risk factors pre eclampsie
twin pregnancy,History of preeclampsia. A personal or family history of preeclampsia significantly raises your risk of preeclampsia.
Chronic hypertension. ...
First pregnancy. ...
New paternity. ...
Age. ...
Race. ...
Obesity. ...
Multiple pregnancy.
99
compare omphalocoele vs gastrochises
omphalocoele- persistance of physiological herniation. peritoneal covering
gastrochises- failure of abdominal wall to form
100
3 types of mesoderm
paraxial- somites
lateral plate- splanchnic and somatic
intermediate- kidneys/gonad
101
what forms the viscera
splanchopleuric mesoderm formed of splanchnic mesoderm and endoderm.
102
what forms the body wall and dermis
somatopleuric mesoderm formed of splanchnic and ectoderm
103
what is the space between the viscera and body wall called and what does it form
intraembryonic coelum, forms abdominal and thoracic cavity
104
what forms the peritoneum
lateral plate mesoderm. somatic forms parietal, splanchnic forms visceral
105
which part of the gut has both a ventral and dorsal mesentry
the foregut
106
what forms the greater sac
the area with no ventral mesentry
107
what forms the lesser sac
the area formed by rotation of stomach
108
what connects greater and lesser sac
epiploic foramen at the free edge of the lesser omentum
109
describe development of ligaments from the dorsal and ventral mesentries
ventral
- falciform and lesser omentum
dorsal
-splenorenal and gastrosplenic
110
what structure connects umbillicus and midgut initially
yolk sac
111
prior to rotation of foregut what is the posterior vagal trunk called
Right vagal fibres
112
describe 2 constituents of developing pancreas and how they rotate
ventral and dorsal buds. ventral rotates as stomach rotates
113
sac contents and coverings of hernia
sac- peritoneum
contents- gut
covering- muscles
114
what remnant of processus vaginalis persists as part of normal development?
tunica vaginalis
115
Which liver marker is specific to hepatocyte damage
ALT
116
Foregut, midgut and hindgut pain
Foregut- epigastric
Midgut- periumbillical
Hindgut- suprapubic
117
describe saliva at rest
At rest, the acinar secretion is highly modified and has the following characteristics:
Low volume
Very hypotonic
Neutral or slightly acidic
Few enzymes
118
describe saliva that is highly modified
When the production of saliva is stimulated, flow exceeds the ductal cells maximum rate of modification and so the acinar secretion is modified less:
High volume
Less hypotonic than resting saliva
Alkaline
Many enzymes
119
mechanism rotavirus
sglt1 disruption, chloride hypersecretion, brush border enzyme dysruption
120
how does salmonella cause symptoms
- enter enterocyte
- encounter macrophage iin submucosa
- enter RES
- lymphoid hyperplasia
- re enter gut from liver
121
how does campylobacter cause symptoms
releases a cytotoxin
122
how does shigella cause symptoms
- invades colonocyte
- multiplies
- forms abscess
- kills colonocyte
123
how does ETEC cause symptoms
hypersecretion of chloride ions
124
how does norovirus cause symptoms
diarrhoea due to anion secretion, vomiting due to slowed gastric emptying
125
common route of infection for cryptosporidium
bodies of water
126
how does cyrptosporidum cause symptoms
- oocyst ingested
- reproduces in small intestine epithelial cells
- causes malabsorption and chloride secrtion
127
how does giardia cause symptoms
- cyst ingested
- damages small intestine cause diarrhoea
128
what can giardia cause post infection
lactase deficiency
129
symptoms entamoeba histolytica
diarrhoea
liver abscess
130
people at risk entamoeba histolytica
- tropical travel
- institutions with poor sanitation
- MSM
131
how does entamoeba histolytica cause disease
- cyst ingested
- invade mucosa, causes inflammatory changes
- spread to liver
132
treatmetn entamoeba histolytica
anti protozoals and severe colitis
133
t12
aorta, coeliac trunk
134
1- liver
2- coeliac trunk and aorta
3- spleen
4- stomach
5- kidney
6- vena cava
135
L1, SMA
136
1- liver
2- kidney
3- SMA
4- IVC
5- stomach
6- kidney
7- spleen
137
L3 - IMA
138
1- liver
2- psoas
3- IVC
4- aota
5- colon
6- psoas
7- small intestine
8- ureter
139
140
Describe alcoholic liver disease/steatosis
- fatty change (weeks). Excess fat converted to TAG, deposited in liver. NADH formed which inhibits lipid breakdown -
alcoholic hepatitis (years). Inflammation of liver. Have jaundice/RUQ pain/hepatomegaly - cirrhosis. Irreversible, end stage
141
Other causes of chronic liver disease
- non alcoholic fatty liver disease. Deposition of fat and inflammation Insulin resistance, metabolic syndrome If inflammation present- non alcoholic steatohepatitis.
142
Antibody autoimmune hepatitis
- antibody= ASMA/AMA
143
PBC
Primary biliary cirrhosis - anti mitochondria
144
PSC
Primary sclerosis cholangitis - UC LINK!! - anti mitochondrial -ve
