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Passmed 1-3Yr > GI > Flashcards

GI Flashcards

1
Q

what is a colostomy?

A

a surgical procedure that brings one end of the large intestine out through the abdominal wall. During this procedure, one end of the colon is diverted through an incision in the abdominal wall to create a stoma. A stoma is the opening in the skin where a pouch for collecting feces is attached.

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2
Q

what is a stoma?

A

A stoma is the opening in the skin where a pouch for collecting feces is attached.

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3
Q

what does the superior rectal artery supply?

A

the sigmoid mesocolon and not lower part of the anal canal

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4
Q

what does the middle rectal artery branch off from?

A

internal iliac artery

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5
Q

what does the internal rectal artery branch off from?

A

internal pudental artery

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6
Q

what does the inferior rectal artery supply?

A

muscle and skin of the anal and urogenital trigangle

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7
Q

what is Child-Pugh classification?

A

used to classify the severity of liver cirrhosis.

in recent years the Model for End-Stage Liver Disease (MELD)

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8
Q

what is the pathological feature is typical of liver cirrhosis? (histology)

A

Excess collagen and extracellular matrix deposition in periportal and perientral zones leading to the formation of regenerative nodules

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9
Q

what is a pathological feature of alcohol consumption? (doesn’t indicate cirrhosis and reversible if the person stops drinking)

A

macrovesicular fatty change with giant mitochondria, spotty nercrosis and fibrosis

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10
Q

what is a feature of non-fatty liver disease? (common in those with insulin resistance, dyslipidemia and a fatty diet)

A

triglyceride accumulation with the proliferation of myofibroblasts

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11
Q

what is a pathological feature of viral hepatitis?

A

mononuclear infiltration of liver ( characteristic of inflammatory lesions) lobules with hepatocytes necrosis and kupffer cells hyperplasia

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12
Q

what is the pathological feature of primary biliary cirrhosis?

A

dense lymphoid infiltration of hepatic portal tracts with chronic inflammation and hepatocytes necrosis.

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13
Q

how does peristalsis work?

A

Longitudinal smooth muscle propels the food through the oesophagus. (contraction dilates the oesophagus)

Circular smooth muscle contracts behind the food bolus

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14
Q

what is primary peristalsis?

A

triggered by the swallowing centre when the bolus enters the esophagus during swallowing

moves the food from the oesophagus into the stomach (9 seconds)

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15
Q

what is secondary peristalsis?

A

Secondary peristalsis refers to peristalsis activated by esophageal distention. This can occur physiologically by food left behind after the primary peristaltic wave has passed, or by refluxed contents from the stomach

stimulates stretch receptors to cause peristalsis

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16
Q

what happens to peristalsis in the small intestine?

A

peristalsis slows and causes mixing of chyme

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17
Q

what are the three colonic peristalsis?

A

> > > Segmentation contractions:
Localised contractions in which the bolus is subjected to local forces to maximise mucosal absorption

()
()
()
()

> > > Antiperistaltic contractions towards ileum:
Localised reverse peristaltic waves to slow entry into colon and maximise absorption

> > > Mass movements:
Waves migratory peristaltic waves along the entire colon to empty the organ prior to the next ingestion of food bolus

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18
Q

what are the features of Peutz-jeghers syndrome?

A

> > > hamartomatous polyps(benign tumourlike malformation) in GI tract (mainly small bowel)

> > > pigmented lesions on lips, oral mucosa, face, palms and soles

> > > intestinal obstruction e.g. intussusception

> > > gastrointestinal bleeding

Peutz-Jeghers syndrome is an autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract. It is also associated with pigmented freckles on the lips, face, palms and soles. Although the polyps themselves don’t have malignant potential, around 50% of patients will have died from another gastrointestinal tract cancer by the age of 60 years.

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19
Q

does the oesophagus have a serosa?

A

The oesophagus has no serosa covering and hence holds sutures poorly.

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20
Q

what artery supplies the caecum?

A

The ileo - colic artery supplies the caecum, itself is a branch from superior mesenteric artery.

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21
Q

what is the epiploic foramen?

A

The epiploic foramen (also called the foramen of Winslow) is a passage between the greater (general peritoneal space) and lesser sac (omental bursa), allowing communication between these two spaces.

The posterior boundary of the epiploic foramen is the inferior vena cava. Anterior boundary - hepatoduodenal ligament (containing bile duct, portal vein and hepatic artery). Inferior boundary - first part of duodenum. Superior boundary - caudate process of liver

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22
Q

does sulfasakzine cause oligospermia?

A

yes

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23
Q

what are aminosalicylate drugs?

A

5-aminosalicyclic acid (5-ASA) is released in the colon and is not absorbed. It acts locally as an anti-inflammatory. The mechanism of action is not fully understood but 5-ASA may inhibit prostaglandin synthesis (low prostaglandin closes ductus arteriosis).

many side-effects are due to the sulphapyridine moiety: rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis

24
Q

what is coeliac disease?

A

Coeliac disease is an autoimmune condition caused by sensitivity to the protein gluten

Repeated exposure leads to villous atrophy which in turn causes malabsorption.

Nutritional deficiencies, such as iron deficiency and folate deficiency are common due to autoimmune villous atrophy leading to malabsorption. Hence, villous atrophy will be observed on histology along with crypt hyperplasia. Iron and folate deficiency can lead to a normocytic anaemia due to mixed micro- and macrocytic anaemias. Additionally, iron deficiency accounts for the conjunctival pallor. Positive anti-transglutaminase antibodies (Anti-tTG) are specific for coeliac disease.

25
Q

signs and symptoms f coeliac disease?

A

Chronic or intermittent diarrhoea
Failure to thrive or faltering growth (in children)
Persistent or unexplained gastrointestinal symptoms including nausea and vomiting
Prolonged fatigue (‘tired all the time’)
Recurrent abdominal pain, cramping or distension
Sudden or unexpected weight loss
Unexplained iron-deficiency anaemia, or other unspecified anaemia

Conditions associated with coeliac disease include dermatitis herpetiformis (a vesicular, pruritic skin eruption) and autoimmune disorders (type 1 diabetes mellitus and autoimmune hepatitis). It is strongly associated with HLA-DQ2 (95% of patients) and HLA-DQ8 (80%).

26
Q

in what conditions are Crypt abscess and mucosal ulcers seem?

A

ulcerative colitis

27
Q

what is odynophagia?

A

painful swallowing

28
Q

what is oesophagus candidiasis?

A

Characterised by white spots in the oropharynx with extension into the oesophagus. Associated with broad spectrum antibiotic usage, immunosupression and immunological disorders.

Patients may present with oropharyngeal symptoms, odynophagia and dysphagia.

Treatment is directed both at the underlying cause (which should be investigated for) and with oral antifungal agents.

Ix: viral serology

29
Q

what are the risk factors for developing oesophagus cancer?

A 
smoking
alcohol
GORD
Barrett's oesophagus
achalasia
Plummer-Vinson syndrome
squamous cell carcinoma is also linked to diets rich in nitrosamines
rare: coeliac disease, scleroderma
30
Q

what are the features of oesophagus cancer?

A

dysphagia: the most common presenting symptom
anorexia and weight loss
vomiting
other possible features include: odynophagia, hoarseness, melaena, cough

31
Q

what is the investigation for oesophagus cancer?

A

Upper GI endoscopy is the first line test
Contrast swallow may be of benefit in classifying benign motility disorders but has no place in the assessment of tumours

Staging is initially undertaken with CT scanning of the chest, abdomen and pelvis. If overt metastatic disease is identified using this modality then further complex imaging is unnecessary

If CT does not show metastatic disease, then local stage may be more accurately assessed by use of endoscopic ultrasound
Staging laparoscopy is performed to detect occult peritoneal disease.

PET CT is performed in those with negative laparoscopy. Thoracoscopy is not routinely performed.

32
Q

treatment for oesophagus cancer?

A

managed by surgical resection.

33
Q

what is the plummer vinson syndrome?

A

a triad of microcytic hypochromic anaemia (iron deficiency), atrophic glossitis, and oesophageal webs or strictures.

Patients usually present with dysphagia to solids, odynophagia and weakness. Its identification and follow-up are considered relevant due to increased risk of squamous cell carcinomas of the oesophagus.

Plummer-Vinson syndrome increases risk of squamous cell cancer of the oesophagus

34
Q

what is the prostate gland lymphatic drainage?

A

internal iliac nodes and sacral nodes

35
Q

what is thrombophlebitis?

A

an inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs. The affected vein might be near the surface of your skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT)

36
Q

what is the most common presentation of pancreatic cancer?

A

ver 80% of pancreatic tumours are adenocarcinomas which typically occur at the head of the pancreas.

37
Q

what is pancreatic cancer associated with?

A

increasing age
smoking
diabetes
chronic pancreatitis (alcohol does not appear an independent risk factor though)
hereditary non-polyposis colorectal carcinoma
multiple endocrine neoplasia
BRCA2 gene

38
Q

what are the features of pancreatic cancer?

A

painless jaundice

Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones

patients typically present in a non-specific way with anorexia, weight loss, epigastric pain

loss of exocrine function (e.g. steatorrhoea)

loss of endocrine function (e.g. diabetes mellitus)

atypical back pain is often seen

migratory thrombophlebitis (Trousseau sign) is more common than with other cancers

39
Q

what is diverticulitis?

A

The infection of a diverticulum (singular, diverticula is plural), an out-pouching of the intestinal mucosa.

40
Q

what causes diverticula?

A

Diverticula are thought to be due to increased intra-colonic pressure and usually occur along the weaker areas of the wall such as where the penetrating arteries enter the colonic wall;

almost all diverticula are found in the sigmoid colon, although they may be found in the right colon in Asian patients. Diverticula are incredibly common and it is thought that 30% of Westerners will have diverticula by the age of 60. Only about 25% of people with diverticulosis will experience symptoms but 75% of these will experience an episode of diverticulitis.

41
Q

which part of the colon is the most susceptible to diverticula?

A

sigmoid colon

42
Q

what are the factors for developing diverticulitis?

A 
Age
Lack of dietary fibre
Obesity: especially in younger patients 
Sedentary lifestyle
Smoking
NSAID use
43
Q

what are the chronic symptoms of diverticulitis?

A

Intermittent abdominal pain: particularly in the left lower quadrant
Bloating
Change in bowel habit: constipation or diarrhoea

Nausea and vomiting (20-60%): this may be due to ileus or complicated diverticulitis with colonic obstruction

Change in bowel habit: constipation is more common (seen in 50%) but diarrhoea is also reported (25%)

Urinary frequency, urgency or dysuria (10-15%): this is due to irritation of the bladder by the inflamed bowel.

PR bleeding (in some cases).
Symptoms such as pneumaturia or faecaluria may suggest colovesical fistula while vaginal passage of faeces or flatus may suggest a colovaginal fistula.
44
Q

what is the management of diverticulitis?

A

oral antibiotics, liquid diet and analgesia

45
Q

investigations of diverticulitis?

A

FBC: raised WCC
CRP: raised
Erect CXR: may show pneumoperitoneum in cases of perforation
AXR: may show dilated bowel loops, obstruction or abscesses
CT: this is the best modality in suspected abscesses

46
Q

what structures do the direct inguinal hernia pass through?

A

posterior wall of the inguinal canal, so the tranversalis fascia (which makes up the posterior wall of the inguinal canal)

and the superficial ring.

Passing through these structures would result in the hernia re-appearing upon generation of increased intra-abdominal pressure (cough) despite pressure on the deep inguinal ring as entry to the canal is not obstructed.

Direct hernias travel through Hesselbachs triangle

Hesselbach’s triangle is an anatomical region in the anterior abdominal wall. It is an area of potential weakness where bowel can then enter the inguinal canal, causing a direct inguinal hernia.

47
Q

what structures do the indirect inguinal hernia pass through?

A

enters the inguinal canal through the deep inguinal ring and exits the inguinal canal at the superficial inguinal ring so would not be able to reappear if the deep inguinal ring was occluded.

48
Q

what is the quadrate lobe of the liver?

A

the quadrate lobe is
Part of the right lobe anatomically, functionally is part of the left

functionally part of the left lobe of the liver. The liver is largely covered in peritoneum. Posteriorly there is an area devoid of peritoneum (the bare area of the liver). The right lobe of the liver has the largest bare area (and is larger than the left lobe).

49
Q

is polythaemia a feature of renal cell carcinoma?

A

yes

50
Q

where is bile salt absorbed?

A

terminal ileum

51
Q

what does bile acid malabsorption a cause of?

A

ile acid malabsorption can then be caused by an ileal resection or by Crohn’s disease

52
Q

what is the complications of a david0llyod procedure?

A

Lloyd Davies position is associated with increased risk of common peroneal nerve damage

53
Q

where is diverticulosis least likely

A

Rectum

Because the rectum has a circular muscle coat (blending of of the tenia marks the recto-sigmoid junction), diverticular disease almost never occurs here.

54
Q

What is the correct surface landmark for locating the femoral artery?

A

midway between the ASIS (anterior superior iliac spine) and pubic symphysis. This is also known as the mid-inguinal point.

55
Q

injury to recurrent larygeal nerve causes what?

A

njury to the recurrent laryngeal nerves can result in a weakened voice (hoarseness) or loss of voice (aphonia) and cause problems in the respiratory tract.

Passmed 1-3Yr (2 decks)

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