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ESA3 > GI > Flashcards

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
Q

From superficial to deep, what are the layers of the anterolateral abdominal wall?

A 
skin
subcutaneous tissue
external oblique
internal oblique
transversus abdominis
extraperitoneal fat
parietal peritoneum
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26
Q

At what spinal level is the umbilicus?

A

L3

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27
Q

Where is the linea alba found?

A

in the midline
aponeurosis of abdominal muscles, separating right and left rectus abdominis
extends from the xiphoid process to the pubic symphysis

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28
Q

Where are the semilunar lines found?

A

vertical lines either side of the rectus abdominis

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29
Q

Where are the tendinous intersections found?

A

horzontal lines between sections of the rectus abdominis

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30
Q

What is the rectus sheath?

A

aponeuroses of external oblique, internal oblique and transversus abdomis combine between the midclavicular line and the midline
surrounds the rectus abdominis

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31
Q

When does the posterior wall of the rectus sheath disappear?

A

the arcuate line

one third of the way between the umbilicus and the pubic symphysis

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32
Q

Where is MvBurney’s point?

A

1/3rd of the distance between the ASIS and the umbilicus

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33
Q

What is a patent urachus?

A

the allantois persists

communication between the bladder and umbilicus

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34
Q

What is a patent vitelline duct?

A

communication between midgut and umbilicus

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35
Q

What is Meckel’s diverticulum?

A

small portion of vitelline duct persists
outpocketing of ilium
can contain gastric or pancreatic tissue

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36
Q

What is the rule of twos is relation to Meckel’s diverticulum?

A 
2% of population affected
2 feet from ileocecal valve
2 inches long
detected in inder 2's
2:1 male:female
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37
Q

What type of cancer is oesophageal cancer?

A

squamous cell carcinoma

adenocarcinoma

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38
Q

What are the risk factors for oesophageal carcinoma?

A 
tobacco
alcohol
Barrett's oesophagus - AC
chronic inflammation - SCC
obesity - AC
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39
Q

Why do oesophageal carcinomas present late?

A

approximately 75% of the circumference of the oesophagus must be involved before symptoms of ‘food sticking’ are experienced.

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40
Q

What are the symptoms and signs of oesophageal carcinoma?

A
  • Dysphagia
  • Weight loss
  • Loss of appetite
  • Odynophagia
  • Hoarseness
  • Melaena
  • Retrosternal pain
  • Intractable hiccups
  • Lymphadenopathy
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41
Q

Which region of the stomach do most gastric cancers involve?

A

pylorus - 50%

lesser curve - 25%

42
Q

What are the risk factors for gastric cancer?

A 
increasing age
male
low SE status
H pylori
poor diet
smoking
familial risk - E-cadherin gene mutations
43
Q

What are the symptoms and signs of gastric cancer?

A 
dysphagia
dyspepsia
weight loss
anaemia
vomiting
44
Q

What are the macroscopic features of a gastric cancer?

A

Fungating
Ulcerating
Infiltrative

45
Q

Where does gastric cancer spread to?

A

Through gastric wall into duodenum, transverse colon, pancreas

left supraclavicular lymph node

transcoelomic spread to peritoneum/ovaries

venous to liver

46
Q

What is the progression of H pylori infection to gastric cancer?

A 
acute gastritis
chronic gastritis
atrophic gastrisis
intestinal metaplasia
dysplasia
gastric cancer
47
Q

What type of cancer are most colorectal cancers?

A

adenocarcinomas

48
Q

What are the most common sites of spread of colorectal cancers?

A

liver - most common
lungs
brain
bone

49
Q

What are the risk factors of colorectal cancer?

A 
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
Q

Describe the presentation of a right colon cancer

A

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
Q

Describe the presentation of a left colon cancer

A 
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
Q

What are the most common symptoms and signs of colorectal cancer?

A

rectal bleeding,
persisting change in bowel habit
anaemia

53
Q

Describe the T staging of colorectal cancer

A

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
Q

Describe the N staging of colorectal cancer

A

N0: no regional nodes involved.
N1: 1-3 regional nodes involved.
N2: 4 or more regional nodes involved.

55
Q

Describe the M staging of colorectal cancer

A

M0: no distant metastasis.
M1: distant metastasis present (may be transcoelomic spread).

56
Q

Which lymph nodes does colorectal cancer spread to?

A

mesenteric

57
Q

Which organ does colorectal cancer most commonly spread to?

A

liver

58
Q

What type of cancer are most pancreatic cancers?

A

ductal adenocarcinoma

59
Q

where are most pancreatic cancers found?

A

head of the pancreas

60
Q

What are the risk factors for pancreatic cancer?

A 
smoking
poor diet
diabetes
alcohol
chronic pancreatitis
family history
IBD
peptic disease
61
Q

What are the early symptoms of pancreatic cancer

A

epigastric discomfort
dull backache
painless, progressive, obstructive jaundice
steeatorrhoea

62
Q

What are the symptoms of advanced pancreatic cancer?

A 
rapid weight loss, 
persistent back pain, 
ascites, 
an epigastric mass 
enlarged supraclavicular node
63
Q

What type of cancer is most common for liver cancers?

A

hepatocellular carcinomas

64
Q

What are the risk factors for hepatocellular carcinoma?

A 
Hep B
Hep C
cirrhosis
alcoholism
aflatoxins produced by Aspergillus flavus and Aspergillus parasiticus 
diabetes
smoking
65
Q

What are the signs and symptoms of hepatocellular carcinoma?

A 
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
Q

What is a vitelline fistula?

A

direct communication between the umbilicus and the intestinal tract

67
Q

What is an omaphalocoele?

A

persistence of physiological herniation.
part of the gut tube fails to return to the abdominal cavity
covered by a reflection of the amnion

68
Q

What is gastroschisis?

A

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
Q

What is referred pain?

A

pain perceived at a site distant from the site causing the pain

70
Q

How is visceral pain perceived to be coming from a somatic portion of the body?

A

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
Q

If pain is felt in the epigastric region, which region of the gut is causing the pain?

A

foregut

72
Q

If pain is felt in the periumbilical region, which region of the gut is causing the pain?

A

midgut

73
Q

If pain is felt in the suprapubic region, which region of the gut is causing the pain?

A

hindgut

74
Q

Where does pain in the liver refer to?

A

right hypochondrium

right middle back

75
Q

Where does pain in pancreas and abdominal aorta refer to?

A

periumbilical region

through to back

76
Q

Where does pain in the gall bladder refer to?

A

right back below shoulder
epigastric
right hypochondrium

77
Q

Where does pain in the spleen refer to?

A

left hypochondrium and behind

78
Q

Where does pain in the stomach/duodenum refer to?

A

epigastric

79
Q

Where does pain in the oesophageal pain refer to?

A

retrosternal

80
Q

Where does pain in the appendix pain refer to?

A

periumbilical (midgut)

81
Q

Where does pain in the uterus/ovary pain refer to?

A

suprapubic

lower back

82
Q

Where does pain in the bladder pain refer to?

A

suprapubic

83
Q

Why does the presence of fluid in the peritoneum cause pain in the left shoulder?

A

referred pain from diaphragm = C345

liver in way of right diaphragm

84
Q

Where does pain in the Kidney refer to?

A

groin

lower back

85
Q

Where is the rectovesical pouch found?

A

between the rectum and the bladder in males

86
Q

Where is the rectouterine pouch found?

A

between the rectum and the posterior wall of the uterus

87
Q

Where is the vesicouterine pouch found?

A

between the anterior surface of the uterus and the bladder.

88
Q

State the boundaries of the inguinal canal

A

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
Q

Describe the anatomical relations of the deep inguinal ring

A

above the midpoint of the inguinal ligament,

lateral to the epigastric vessels

90
Q

Describe the anatomical relations of the superficial inguinal ring

A

lies just superior to the pubic tubercle

91
Q

How does a direct inguinal hernia form?

A

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
Q

What are the boundaries of Hesselbach’s triangle?

A 
anterior = inguinal ligament
lateral = inferior epigastric vessels
medial = rectus abdominis
93
Q

How does an indirect inguinal hernia form?

A

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
Q

Name some bacteria present in the mouth

A 
Streptococcus mutans
Staph aureus
Candida albicans
Enterococcus 
Lactobacillus
95
Q

Name pathogens present in the throat

A 
Strep viridans
Strep pyogenes
Strep pneumoniae
Neisseria meningitidis 
H influenzae 
Lactobacillus 
Candida albicans
96
Q

Which bacteria travels from the throat to cause surface infections?

A

Streptococcus viridans

97
Q

Which bacteria are always present in the colon?

A 
Bacteroides fragilis 
Bacteroides oralis
Bacteroides melaninogenicus
E. coli
Enterococcus faecalis
98
Q

Describe the flora of the vagina

A

Lactobacillus - converts glycogen to lactic acid, creating acidic environment

99
Q

Name bacteria present on the perineal skin

A

E. coli
Enterococcus faecalis
Lactobacillus

NOT bacteroides as cannot survive oxygen

100
Q

Which organisms cause gastroenteritis?

A

Salmonella
Campylobacter
Listeria

Toxins from staphylococcus and clostridium

101
Q

What are the symptoms of cholera?

A

Rice water diarrhoea

Sever dehydration

ESA3 (5 decks)

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