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Second yaaa > GI > Flashcards

GI Flashcards

1
Q

Which enzyme converts unconjugated bilirubin to conjugated bilirubin in the liver?

A

UDP-glucuronyl transferase

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2
Q

where is conjugated bilirubin converted to urobilinogen? (and by what?)

A

Intestines (GI bacteria)

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3
Q

What are the 6 main functions of the liver?

A
  1. Amino acid, carbohydrate and lipid metabolism
  2. Plasma protein and enzyme synthesis
  3. Production of bile
  4. Detoxification
  5. Storage of proteins, glycogen, vitamin and metals
  6. Immune functions
    +Coagulation
    +breaks down RBCs
    +Makes hormones
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4
Q

How are bile pigments generated?

A

from the breakdown of harm group from haemoglobin in macrophages of the RES in the spleen/bone marrow/liver

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5
Q

what are some characteristics of unconjugated bilirubin?

A

Hydrophobic (water-insoluble)

cannot be excreted or transported in blood unless bound to albumin

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6
Q

What does stercobilin do?

A

give faeces its brown colour

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7
Q

What is the function of bile salts?

A

To promote emulsification

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8
Q

What are the lipid soluble vitamins?

A

Vitamins D,A,K,E

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9
Q

What is the function of secretin?

A

Stimulates duct cells in the liver to release bicarbonate into the bile and stimulates bile production

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10
Q

What causes PRE-hepatic jaundice?

A

elevated haemolysis- liver cannot cope with increased levels of unconjugated bilirubin

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11
Q

What causes Gilbert’s Disease?

A

reduced glucuronyl transferase activity (conjugating enzyme)

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12
Q

Describe achalasia

A

Failure to relax of the lower oesophageal sphincter leading to a back up of food in the oesophagus
=> regurgitation, malnutrition, eat in secret

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13
Q

Haem iron (red meat) is absorbed straight into the enterocyte in duodenum. How is non-haem iron (white meat, veg etc.) absorbed?

A

Must first be reduced from ferric (Fe3+) to ferrous (Fe2+) to be absorbed.
Requirs duodenal cytochrome B1, a brush border enzyme, influenced by vitamin C. Then taken into enterocytes via a protein transporter known as divalent metal transporter 1 (DMT1)

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14
Q

What is the fate of iron once absorbed in the enterocyte?

A

Either storied in the enterocyte (binds to ferritin), RES or RBC or exported into the circulating plasma (through a transporter called ferroportin).

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15
Q

How is iron transported around the body?

A

Bound to transferrin (plasma protein, synthesised in the liver) which can bind TWO iron atoms. This delivers iron to all tissues (as there are transferrin receptors on all tissue cell surfaces).

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16
Q

What is iron used for in the body?

A 
Bone marrow
RBCs
RES
muscle (in myoglobin)
Formation of enzymes
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17
Q

What is ferritin?

A

protein for storing iron - can be used as marker of iron levels
Acute phase protein (increases in tissue inflammation)

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18
Q

What is the role of hepcidin?

A

Reduces the levels of iron in the plasma through binding with and degrading ferroportin
=> reducing GI iron absorption (enterocyte)
=>reducing macrophage iron release from RES.

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19
Q

Describe the pathophysiology of haemochromatosis

A

Homozygous C282Y mutation of HFE gene => reduces synthesis of hepcidin => iron overload in other tissues
=> cirrhosis, diabetes, bronzing, arthritis, restrictive cardiomyopathy…

(bronze diabetes)

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20
Q

What are the true indicators of liver function?

A

(-)Albumin, (+)prothrombin time + (abnormal)bilirubin

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21
Q

Which is more sensitive for liver disease, AST or ALT?

A

ALT - L for Liver!

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22
Q

What can you confirm if the ALT/AST ratio is normal?

A

hepatocellular problem unlikely

23
Q

When is ALP likely to be raised?

A

cases of Bile Duct Obstruction (ONLY IF GGT IS RAISED TOO- can show chronic alcohol consumption)
(AND BONE PROBLEMS)

24
Q

When would bilirubin likely be high?

A

As a result of hepatocellular or cholestatic disease

25
Q

What are the two main bile salts and their function?

A

Glycholic acid + Taurocholic acid
Promote emulsification
Stimulate lipase action
results in digestion and absorption of lipids and lipid soluble vitamins (DAKE)

26
Q

What does a drop in albumin show?

A

Liver problem is chronic, not acute

27
Q

How can you differentiate between osmotic and secretory diarrhoea?

A

Secretory does not stop on fasting, osmotic does.

28
Q

What are the markers for acute hepatitis?

A

Raised ALT/AST, jaundice, clotting derangement

29
Q

Compare Hep A and E

A

v similar, both RNA virus, face-oral transmission, more common in developing countries
Hep E- pork products, no vaccine
Hep A- effective vaccine, usually self-limiting

30
Q

Which are the blood borne (and sexually transmitted) hepatitis viruses?

A

B, C + D

31
Q

what is the main form of transmission of Hep B?

A

mother to baby, usually at birth

32
Q

How would you confirm if someone has had previous Hep A, or been vaccinated against it?

A

IgG positive (IgM if acute)

33
Q

What are the types of therapy for Hep B and the downsides to each?

A 
Pegylated interferon alpha- gives flu like symptoms for a year
Antiviral drugs (nucleoside/tides) e.g.. Tenofovir/entecavir - one tablet a day for life
34
Q

What does Hep D need to replicate?

A

Hep B

35
Q

What are the histological changes in coeliac disease?

A

-Loss of villus height
-Reduced surface area
=>Reduced absorptive capacity

36
Q

How do you differentiate between small and large intestinal sources of gastroenteritis?

A

small: large volume, lots of cramps, watery, bloating, wind, weight loss, fever and blood rare
large: painful, often has blood in it + fever, frequent small volume

37
Q

what is the most common bacterial cause of gastroenteritis?

A

Campylobacter (chicken)

also salmonella, shigella, E. coli 0157, c Dif

38
Q

what is the most common viral cause of gastroenteritis?

A

noravirus (diarrhoea AND vomiting)

-need soap ad water

39
Q

What specialisation does the jejunum have to churn chyme?

A

plicae circularis (deep, circular folds)

40
Q

what constitutes the foregut and what supplies it?

A

oesophagus, stomach, spleen, liver, pancreas, gall bladder, proximal half of duodenum
-coeliac trunk

41
Q

what constitutes the midgut and what supplies it?

A

distal half of duodenum -> proximal 2/3rds of transverse colon
-superior mesenteric artery

42
Q

what constitutes the hindgut and what supplies it?

A

distal 1/3rd of transverse colon -> anus

-inf. mesenteric a.

43
Q

describe the flow of pancreatic enzymes and fluid from acing cells-> major duodenal papilla

A

acinar cells

  • > intercalated ducts (lined with epithelial cells which also secrete fluid)
  • > intRAlobular ducts
  • > intERlobular ducts
  • > main pancreatic duct
  • > fuses with bile duct
  • > major duodenal papilla
44
Q

which enzyme converts the pancreatic zymogens into their active form

A

enteropeptidase converts trypsinogen to trypsin, which converts the rest

45
Q

what suffix do PPIs end in?

A

prazole (omeprazole)

46
Q

what is the anatomical position of the fungus of the gallbladder?

A

where the rectus abdomens meets the costal margin

47
Q

where is the infra colic compartment?

A

behind the greater omentum + transverse colon

48
Q

what is the function of the greater omentum?

A

to connect the stomach and the duodenum to the liver (also “abdominal policeman”- can stick on to inflamed appendix/hernia to stop spread of infection/ block hole.

49
Q

what is the ligament terms (round ligament) a remnant of?

A

the umbilical vein

50
Q

technically, where does the pylorus begin?

A

past the angular notch

51
Q

what type of epithelium makes up the oesophagus?

A

non keratinising simple squamous

52
Q

as well as HCL, what do the parietal cells secrete and what is its function?

A

intrinsic factor - absorption of B12

53
Q

which parts of the colon are covered in mesentery?

A

transverse + sigmoid

54
Q

which parts of the colon are retroperitoneal?

A

ascending + descending colon

Second yaaa (6 decks)

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