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GI Flashcards

1
Q

What do the parotid glands secrete?

What percentage of the saliva is this?

A

serous saliva
enzymes and electrolytes

25%

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2
Q

What do the submandibular glands secrete?

What percentage of the saliva is this?

A

mucous

5%

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3
Q

What do the sublingual glands secrete?

What percentage of the saliva is this?

A

serous and mucous

70%

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4
Q

What do the acinar cells of salivary glands secrete?

A

isotonic fluid

enxymes

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5
Q

How is a hypotonic saliva created from an isotonic solution?

A

ductal cells in the salivary glands remove Na+ and Cl-. adding HCO3-
How many salts are removed depends on the flow rate
high flow = less salts removed = less hypotonic

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6
Q

How does the autonomic nervous system affect salivary gland secretion?

A 
Para = increased production. increased addition of HCO3-
Symp = decreased production
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7
Q

What are the boundaries of the oesophagus?

A

inferior border of the cricoid cartilage, C6

cardiac orifice of the stomach T11

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8
Q

What type of muscle is the external longitudinal layer of the oesophagus?

A

superior third = voluntary striated
middle third = voluntary striated and smooth
inferior third = smooth

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9
Q

Describe the muscular layers of the oesophagus

A

external longitudinal layer

internal circular

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10
Q

How is the upper oesophageal sphincter created?

A

this is an anatomical striated muscle sphincter

produced by cricopharyngeus

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11
Q

How is the lower oesophageal sphincter created?

A

physiological sphincter
angle of His = oesophagus entering stomach at an acute angle
positive intra-abdominal pressure causes compression of the walls of the intra-abdominal section of the oesophagus
right crus of the diaphragm
folds of the mucosa occlude the lumen

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12
Q

At what vertebral level is the lower oesophageal sphincter found?

A

T11

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13
Q

What are the three phases of swallowing?

A

voluntary
pharyngeal
oesophageal

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14
Q

What happens in the voluntary phase of swallowing?

A

the tongue moves the bolus into the pharynx

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15
Q

What happens in the pharyngeal phase of swallowing?

A

breathing inhibited
larynx raised
glottis closes
upper oesophageal sphincter opens

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16
Q

What happens in the oesophageal phase of swallowing?

A

peristalsis sweeps down the oesophagus

lower oesophageal sphincter opens

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17
Q

define odynophagia

A

pain whilst swallowing

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18
Q

Why does dysphagia of solids happen?

A

oesophageal dysphagia

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19
Q

Why does dysphagia of fluids happen?

A

oropharyngeal dysphagia

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20
Q

What weakens the LOS?

A

being obese - increased P on stomach
fatty foods - stomach takes longer to dispose of acid
tobacco, alcohol, coffee, chocolate - relax LOS
pregnancy - increased P on stomach
hiatus hernia
stress

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21
Q

What are the consequences of a weakened LOS?

A

heart burn
acid reflux
dysphagia

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22
Q

What is Barrett’s Oesophagus?

A

metaplasia of the epithelial cells of the oesophagus
from non-keratinised stratified squamous to columnar with goblet cells
attempt to better resist the harmful acid of the stomach

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23
Q

What is a complication of Barrett’s Oesophagus?

A

adenocarcinoma

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24
Q

What are boundaries of the anterolateral abdominal wall?

A

cartilages of the 7th to 10th ribs and xiphoid process of sternum
inguinal ligaments

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25
From superficial to deep, what are the layers of the anterolateral abdominal wall?
``` skin subcutaneous tissue external oblique internal oblique transversus abdominis extraperitoneal fat parietal peritoneum ```
26
At what spinal level is the umbilicus?
L3
27
Where is the linea alba found?
in the midline aponeurosis of abdominal muscles, separating right and left rectus abdominis extends from the xiphoid process to the pubic symphysis
28
Where are the semilunar lines found?
vertical lines either side of the rectus abdominis
29
Where are the tendinous intersections found?
horzontal lines between sections of the rectus abdominis
30
What is the rectus sheath?
aponeuroses of external oblique, internal oblique and transversus abdomis combine between the midclavicular line and the midline surrounds the rectus abdominis
31
When does the posterior wall of the rectus sheath disappear?
the arcuate line | one third of the way between the umbilicus and the pubic symphysis
32
Where is MvBurney's point?
1/3rd of the distance between the ASIS and the umbilicus
33
What is a patent urachus?
the allantois persists | communication between the bladder and umbilicus
34
What is a patent vitelline duct?
communication between midgut and umbilicus
35
What is Meckel's diverticulum?
small portion of vitelline duct persists outpocketing of ilium can contain gastric or pancreatic tissue
36
What is the rule of twos is relation to Meckel's diverticulum?
``` 2% of population affected 2 feet from ileocecal valve 2 inches long detected in inder 2's 2:1 male:female ```
37
What type of cancer is oesophageal cancer?
squamous cell carcinoma | adenocarcinoma
38
What are the risk factors for oesophageal carcinoma?
``` tobacco alcohol Barrett's oesophagus - AC chronic inflammation - SCC obesity - AC ```
39
Why do oesophageal carcinomas present late?
approximately 75% of the circumference of the oesophagus must be involved before symptoms of 'food sticking' are experienced.
40
What are the symptoms and signs of oesophageal carcinoma?
* Dysphagia * Weight loss * Loss of appetite * Odynophagia * Hoarseness * Melaena * Retrosternal pain * Intractable hiccups * Lymphadenopathy
41
Which region of the stomach do most gastric cancers involve?
pylorus - 50% | lesser curve - 25%
42
What are the risk factors for gastric cancer?
``` increasing age male low SE status H pylori poor diet smoking familial risk - E-cadherin gene mutations ```
43
What are the symptoms and signs of gastric cancer?
``` dysphagia dyspepsia weight loss anaemia vomiting ```
44
What are the macroscopic features of a gastric cancer?
Fungating Ulcerating Infiltrative
45
Where does gastric cancer spread to?
Through gastric wall into duodenum, transverse colon, pancreas left supraclavicular lymph node transcoelomic spread to peritoneum/ovaries venous to liver
46
What is the progression of H pylori infection to gastric cancer?
``` acute gastritis chronic gastritis atrophic gastrisis intestinal metaplasia dysplasia gastric cancer ```
47
What type of cancer are most colorectal cancers?
adenocarcinomas
48
What are the most common sites of spread of colorectal cancers?
liver - most common lungs brain bone
49
What are the risk factors of colorectal cancer?
``` family history of colorectal carcinoma past history of colorectal neoplasm IBD polyposis syndromes hormonal factors - nulliparity, late age at first pregnancy, early menopause diet rich in meat and fat sedentary lifestyle smoking obesity alcohol diabetes ```
50
Describe the presentation of a right colon cancer
weight loss anaemia, blood in stool but only detectable by testing, mass in right iliac fossa disease more likely to be advanced at presentation
51
Describe the presentation of a left colon cancer
``` often colicky pain, rectal bleeding, bowel obstruction, continual or recurrent inclination to evacuate the bowels mass in left iliac fossa, early change in bowel habit, less advanced disease at presentation. ```
52
What are the most common symptoms and signs of colorectal cancer?
rectal bleeding, persisting change in bowel habit anaemia
53
Describe the T staging of colorectal cancer
T0: no evidence of primary carcinoma in situ (Tis) - intraepithelial or lamina propria only. T1: invades submucosa. T2: invades muscularis propria. T3: invades subserosa or non-peritonealised pericolic tissues. T4: directly invades other tissues and/or penetrates visceral peritoneum
54
Describe the N staging of colorectal cancer
N0: no regional nodes involved. N1: 1-3 regional nodes involved. N2: 4 or more regional nodes involved.
55
Describe the M staging of colorectal cancer
M0: no distant metastasis. M1: distant metastasis present (may be transcoelomic spread).
56
Which lymph nodes does colorectal cancer spread to?
mesenteric
57
Which organ does colorectal cancer most commonly spread to?
liver
58
What type of cancer are most pancreatic cancers?
ductal adenocarcinoma
59
where are most pancreatic cancers found?
head of the pancreas
60
What are the risk factors for pancreatic cancer?
``` smoking poor diet diabetes alcohol chronic pancreatitis family history IBD peptic disease ```
61
What are the early symptoms of pancreatic cancer
epigastric discomfort dull backache painless, progressive, obstructive jaundice steeatorrhoea
62
What are the symptoms of advanced pancreatic cancer?
``` rapid weight loss, persistent back pain, ascites, an epigastric mass enlarged supraclavicular node ```
63
What type of cancer is most common for liver cancers?
hepatocellular carcinomas
64
What are the risk factors for hepatocellular carcinoma?
``` Hep B Hep C cirrhosis alcoholism aflatoxins produced by Aspergillus flavus and Aspergillus parasiticus diabetes smoking ```
65
What are the signs and symptoms of hepatocellular carcinoma?
``` Pruritus - severe itching of the skin Splenomegaly. Bleeding oesophageal varices. Weight loss. Jaundice. Confusion and hepatic encephalopathy. Abdominal distension due to ascites. Right upper quadrant abdominal pain. Hepatomegaly. Ascites. Spider naevi. Peripheral oedema. Anaemia. Periumbilical collateral veins. Flapping tremor. ```
66
What is a vitelline fistula?
direct communication between the umbilicus and the intestinal tract
67
What is an omaphalocoele?
persistence of physiological herniation. part of the gut tube fails to return to the abdominal cavity covered by a reflection of the amnion
68
What is gastroschisis?
protrusion of the abdominal contents through the body wall directly into the amniotic cavity due to the failure of closure of the abdominal wall There is no covering over the gut tube The bowel may be damaged by exposure to the amniotic fluid
69
What is referred pain?
pain perceived at a site distant from the site causing the pain
70
How is visceral pain perceived to be coming from a somatic portion of the body?
visceral sensory nerve joins sensory spinal nerve before spinal cord pain is perceived as being from the somatic areas that are supplied by the same spinal segment
71
If pain is felt in the epigastric region, which region of the gut is causing the pain?
foregut
72
If pain is felt in the periumbilical region, which region of the gut is causing the pain?
midgut
73
If pain is felt in the suprapubic region, which region of the gut is causing the pain?
hindgut
74
Where does pain in the liver refer to?
right hypochondrium | right middle back
75
Where does pain in pancreas and abdominal aorta refer to?
periumbilical region | through to back
76
Where does pain in the gall bladder refer to?
right back below shoulder epigastric right hypochondrium
77
Where does pain in the spleen refer to?
left hypochondrium and behind
78
Where does pain in the stomach/duodenum refer to?
epigastric
79
Where does pain in the oesophageal pain refer to?
retrosternal
80
Where does pain in the appendix pain refer to?
periumbilical (midgut)
81
Where does pain in the uterus/ovary pain refer to?
suprapubic | lower back
82
Where does pain in the bladder pain refer to?
suprapubic
83
Why does the presence of fluid in the peritoneum cause pain in the left shoulder?
referred pain from diaphragm = C345 liver in way of right diaphragm
84
Where does pain in the Kidney refer to?
groin | lower back
85
Where is the rectovesical pouch found?
between the rectum and the bladder in males
86
Where is the rectouterine pouch found?
between the rectum and the posterior wall of the uterus
87
Where is the vesicouterine pouch found?
between the anterior surface of the uterus and the bladder.
88
State the boundaries of the inguinal canal
anterior wall = aponeurosis of the external oblique. reinforced by the internal oblique muscle laterally. posterior wall = transversalis fascia. roof = transversalis fascia, internal oblique and transversus abdominis. floor = inguinal ligament. thickened medially by the lacunar ligament. opening = deep inguinal ring exit = superficial inguinal ring
89
Describe the anatomical relations of the deep inguinal ring
above the midpoint of the inguinal ligament, | lateral to the epigastric vessels
90
Describe the anatomical relations of the superficial inguinal ring
lies just superior to the pubic tubercle
91
How does a direct inguinal hernia form?
the peritoneal sac enters the inguinal canal though the posterior wall of the inguinal canal, the transveralis fascia = Hesselbach's tirangle medial to epigastric vessels
92
What are the boundaries of Hesselbach's triangle?
``` anterior = inguinal ligament lateral = inferior epigastric vessels medial = rectus abdominis ```
93
How does an indirect inguinal hernia form?
due to the failure of the processus vaginalis to regress. The peritoneal sac enters the inguinal canal via the deep inguinal ring. As the sac moves through the inguinal canal, it acquires the same three coverings as the contents of the canal. lateral to epigastric vessels
94
Name some bacteria present in the mouth
``` Streptococcus mutans Staph aureus Candida albicans Enterococcus Lactobacillus ```
95
Name pathogens present in the throat
``` Strep viridans Strep pyogenes Strep pneumoniae Neisseria meningitidis H influenzae Lactobacillus Candida albicans ```
96
Which bacteria travels from the throat to cause surface infections?
Streptococcus viridans
97
Which bacteria are always present in the colon?
``` Bacteroides fragilis Bacteroides oralis Bacteroides melaninogenicus E. coli Enterococcus faecalis ```
98
Describe the flora of the vagina
Lactobacillus - converts glycogen to lactic acid, creating acidic environment
99
Name bacteria present on the perineal skin
E. coli Enterococcus faecalis Lactobacillus NOT bacteroides as cannot survive oxygen
100
Which organisms cause gastroenteritis?
Salmonella Campylobacter Listeria Toxins from staphylococcus and clostridium
101
What are the symptoms of cholera?
Rice water diarrhoea | Sever dehydration

ESA3 (5 decks)

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