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Medicine MBBS year 2 > GI > Flashcards

GI Flashcards

1
Q

What system defends against reduction of body fat?

A

Central circuit - involves leptin

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2
Q

Weight gain causes ____ in sympathetic nervous activity, ___ in energy expenditure. This prompts weight ____. The reverse is also true for weight loss.

A

Increase

Increase
Loss

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3
Q

___ is an altered microbiota composition. It represents when ____ start producing bacterial metabolites and toxins.These can cause systemic diseases, intestinal, liver, lung and brain conditions and problems with adipose tissue.

A

dysbiosis

pathobionts

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4
Q

what are the cause of non-infectious diarrhoea

A
  • Antibiotics side effect
  • post infectious irritable bowel syndrome
  • IBD
  • microscopic colitis
  • ischeamic colitis
  • coeliac disease
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5
Q

how do you determine esophageal motility?

A

Manometry (pressure measurements)

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6
Q

Describe and name the sign seen in cholecystitis

A

Murphy’s sign - inspiratory arrest on RUQ palpation due to pain

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7
Q

How do osmoreceptors bring about ADH release?

A
  1. Cells shrink when plasma more concentrated
  2. Proportion of cation channels increases -> membrane depolarises
  3. Signals sent to ADH producing cells to increase ADH
  4. Fluid retention, invokes drinking
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8
Q

State the two types of peptides released from Arcuate nucleus in hypothalamus . what are their functions?

A

Orexigenic - appetite stimulant

Anorectic - appetite suppressive

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9
Q

Describe the mechanism involved in the development of IBD.

A

impaired mucosal immune response to the gut microbiota in a genetically susceptible host. Dysbiosis present

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10
Q

What do diagnostic tests show in esophageal perforation?

A

CXR and CT - shows pneumomediastinum

  • OGD - blood
  • Gastrograffin Swallow (it is water soluble)
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11
Q

A patient with severe acute pancreatitis and duodenal stenosis is being fed with NJT. Develops increased bowel frequency. Type 7 stool that is yellow in colour. Dietician adds pancreatic enzymes to the feed to support absorption but minimal improvement in bowel frequency . How do we continue to feed our patient?

A

Start parenteral nutrition, reduce the NJT feeding to a ‘trophic’ rate

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12
Q

Describe how naproxen can be used to treat knee pain

A

Target = COX enzymes (naproxen is non-selective i.e. inhibits COX1 and COX2).

Location = peripheral nociceptive nerve endings

Effect - COX produces PGs. PGs mediate inflammation by sensitising peripheral nociceptors mediators like bradykinin, histamine

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13
Q

State 2 sources of Immunological defense in GI tract

A

MALT

GALT

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14
Q

how do you manage/prevent RFS

A

Provide 10-20 kcal energy. CHO 40-50%. Micronutrients from onset

Monitor and correct electrolytes daily

Administer thiamine from onset of feeding

Monitor fluid shifts and minimise risk of fluid and Na+ overload

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15
Q

The ventromedial hypothalamus is associated with which food related feeling?

A

satiety

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16
Q

What is the most abundant circulating protein in human plasma?

A

albumin

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17
Q

What is the effect of body fat on leptin?

A

Low when low body fat

High when high body fat

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18
Q

state 4 risk factors for GERD

A
  1. Smoking (reduces buffering capacity of saliva - decrease ph)
  2. Alcohol - damages mucosa
  3. Hiatus hernia - sliding UP vs Rolling
  4. Conditions that decrease LES tone
  5. Obesity, fatty foods
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19
Q

How do you diagnose and treat a norovirus infection?

A

PCR diagnosis

Treatment not usually required

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20
Q

___ bowel obstruction Xray shows ladder pattern of dilated loops with striations that pass completely across the width

A

small

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21
Q

The main cause of ulcers is __ infection

A

H. pylori

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22
Q

State two things that cause microbiota cell reduction

A

Chemical digestive factors -> lysis

Peristalsis, contraction, defecation

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23
Q

The adipostat mechanism states that hormone is produced by __. The hypothalamus senses the concentration of hormone then alters __ to increase or decrease food intake.

A

fat

neuropeptides

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24
Q

what are the complications associated with enteral feeding?

A

Mechanical - misplacement, blockage, buried bumper

Metabolic - hyperglycemia, deranged electrolytes

GI - aspiration, nasopharyngeal pain, laryngeal ulceration, vomiting, diarrhoea

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25
Q

diabetes mellitus, gallstones and steatorrhea are clinical features of which NET?

A

somatostatinoma

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26
Q

What is choledocholithiasis?

A

Gallstones in common bile duct.

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27
Q

Effect of congenital leptin deficiency?

A

obesity

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28
Q

How many types of Adipsia are there? Which is most common?

A

4

Type A most common

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29
Q

Is albumin a valid marker of malnutrition in the acute hospital setting?

A

no- as it decreases in response to inflammation

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30
Q

Describe how naproxen (NSAID) can cause an adverse effect within the stomach

A

Target - COX I enzyme
Location - gastric mucosal cells
Effect - inhibition of PG so inhibition of PG mediated protection of gastric mucosa. PGs increase mucus production, blood flow, bicarb release

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31
Q

What is a major cause of C.diff dysbiosis?

A

long term antibiotic use

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32
Q

What conditions can cause a strangulating bowel obstruction instead of simple?

A

Strangulated hernia, volvulus, intussusception

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33
Q

What urinary sodium value indicates dehydration?

A

<20 mmol/L

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34
Q

Causes of primary polydipsia?

A
  1. Mental illness - schizophrenia, mood disorders, anorexia, drug use - can be psychogenic or acquired
  2. Brain injuries
  3. Organic brain damage
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35
Q

What do diagnostic tests show in esophageal scleroderma?

A

Manometry

  • decreased LES resting pressure
  • absent peristalsis
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36
Q

In which type of IBD is there mucosal and submucosal inflammation only, ulcers and pseudopolyps and loss of haustra on gross morphology and crypts abscesses on microscopic morphology?

A

ulcerative colitis

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37
Q

what groups are at highest risk of malnutrition?

A 
Elderly 
Cancer patients 
Patients with dementia 
Patients with chronic illness 
Patients who abuse drugs or alcohol
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38
Q

what are the signs and symptoms of bowel obstruction?

A
  1. Abdominal pain - colicky or constant
  2. nausea/Vomiting
  3. Absolute constipation
  4. Abdominal distention

(Dehydration, increased tinkling bowel sounds or absent bowel sounds, diffuse abdominal tenderness)

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39
Q

what are the causes of IDA in order of frequency?

A 
Aspirin/NSAID use
Colonic adenocarcinoma 
Gastric carcinoma 
Benign gastric ulcer
Angiodysplasia
 Coeliac disease
 Gastrectomy (decreased absorption)
H.pylori
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40
Q

In peyers patches, B-cells class switch from __ to IgA

A

IgM

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41
Q

What are the 3 areas of anatomical constriction in the esophagus?

A

Cricopharyngeal constriction
Aortic and bronchial constriction
diaphragmatic/LES constriction

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42
Q

how does inflammatory pain present?

A

Constant pain, made worse by movement, persists until inflammation subsides

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43
Q

What is the mechanism of Histamine (H2) receptor antagonists in treating PUD? Give an example.

A

inhibit the stimulatory action of histamine released from enterochromaffin-like (ECL) cells on the gastric parietal cells. So inhibit gastric acid secretion

E.g. Ranitidine

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44
Q

a patient is suspected of gallstone pancreatitis, what is your first investigation?

if after treatment for gallstone pancretitis, their LFTs remain deranged after 5 days, what would be your next investigation?

following this next investigation, if the patient is found to have stones in bile duct, what is the next investigation?

Following an ERCP, if a patient is still unwell days later, what is the next investigation and treatment?

A

USS abdomen

MRCP - check for stones in bile duct

ERCP

CT abdomen/pelvis
If only changes associated with pancreatitis on CT -> laparoscopic cholecystectomy

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45
Q

state 2 risks of a hellers myotomy

A

Esophageal and gastric perforation - most common

Division of vagus nerve

Splenic injury

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46
Q

State 3 functional disorders of GI tract when there is an absence of stricture (at least initially)

A
  1. Hypermotility - Achalasia
  2. Hypomotility - Scleroderma
  3. Disordered contraction -Diffuse esophageal spasm (corkscrew esophagus)
  4. GORD
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47
Q

what 3 things stimulate gastric acid secretion?

A

Gastrin
Acetylcholine - via vagus nerve
Histamine

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48
Q

differentiate between the common causes of bowel obstruction in small intestine vs large intestine

A 
SBO: more common 
A - adhesions (60%)
B - bulge (hernia) 
C - cancer/ neoplasia
chrons disease, intussusception, intraluminal (foreign body, bezoar)

LBO:
colorectal carcinoma, volvulus, diverticulitis, hirschsprung disease, feacal impaction

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49
Q

What are the 4 methods of stomach protection from ulcers?

A

Mucus film
HCO3- secretion
Mucosal blood perfusion
Epithelial barrier

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50
Q

what investigation is ordered if acute mesenteric ischemia is suspected?

A

CT abdomen and pelvis with contrast

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51
Q

which part of stomach secretes HCL?

A

body and fundus

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52
Q

___ bowel obstruction Xray shows distended bowel with haustrations of taenia coli

A

large

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53
Q

what are the symptoms of achalasia?

A

Progressive dysphagia to solids then liquids

(also, weight loss, pain, aspiration pneumonia, esophagitis)

Increased esophageal cancer risk

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54
Q

What are the symptoms and lab results in acute pancreatitis?

A

Acute EPIGASTRIC pain often radiating to back

Increase in serum amylase or lipase

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55
Q

What is the mechanism of paracetamol/acetaminophen? What is the main side effect?

A

possibly involving interaction with a COX-3 isoform (inhibition of PG synthesis), cannabinoid receptors or the endogenous opioids

Overdose -> hepatotoxicity

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56
Q

what are the symptoms of gastric adenocarcinoma?

A 
A nemia 
L oss of weight or appetite 
A abdominal mass on examination 
R ecent onset of progressive symptoms 
M alaena or haematemesis 
S wallowing difficulty 
55 years or >
* dyspepsia most common
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57
Q

what bloods are done to investigate GI perforation?

A

FBC - neutophilic leukocytosis
Possible elevation of urea, creatinine
VBG: lactic acidosis

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58
Q

What is acute pancreatitis?

A

Autodigestion of pancreas by pancreatic enzymes

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59
Q

What is the most common cause of diarrhoea in infants and young children worldwide?

A

rotavirus

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60
Q

what imaging is carried out for appendicitis?

A

CT

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61
Q

Side effect of PPIs?

A

The use of these drugs may mask the symptoms of gastric cancer.

Omeprazole is an inhibitor of cytochrome P2C19 and has been reported to reduce the activity of e.g. clopidogrel, when platelet function is monitored.

Decrease in calcium absorption -> fracture risk

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62
Q

pain on swallowing is ___

A

Odynophagia

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63
Q

What human CNS mutations affect appetite?

A

POMC deficiency and MC4-R mutations cause morbid obesity

No NPY or Agrp mutations associated with humans

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64
Q

what is the function of secretory IgA?

A

Binds luminal antigen -> prevents its adhesion and invasion

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65
Q

state 4 anatomical contributions to LOS

A
  1. Angle of his
  2. Phrenoesophageal ligament
  3. Diaphragm surrounds LOS
  4. Distal oesophagus within abdomen
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66
Q

How does the epithelium repair itself after ulcers?

A

Epithelial migration

Cell division to close gap

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67
Q

State 4 eating disorders

A

Binge eating disorder
Anorexia nervosa
Bulimia nervosa
Pica
Rumination syndrome - regurgitate food deliberately and swallow again
Avoidant/restrictive food intake disorder

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68
Q

Which two regions are osmoreceptors found in?

A 
Organum vasculosum of the lamina terminalis (OVLT) 
Subfornical organ (SFO)
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69
Q

what are the clinical features of a VIPoma ?

A

VM syndrome= watery diarrhea, hypokalemia, achlorhydria

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70
Q

What is the main treatment for gallstones when they cause complications?

A

cholecystectomy

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71
Q

State 2 indications for surgery in a patient with toxic megacolon

A

Colonic perforation

Necrosis or full-thickness ischaemia

Intra-abdominal hypertension or abdominal compartment syndrome

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72
Q

Which hormone regulates plasma osmolality?

A

ADH

osmoreceptors

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73
Q

what are some lab values that may indicate a severe c. difficile case?

A

WCC>15, Creat >150

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74
Q

__ is made by adipocytes and enterocytes. It acts on the hypothalamus to regulate appetite and thermogenesis.

A

leptin

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75
Q

What do diagnostic tests show in diffuse esophageal spasm?

A

Manometry - intermittent high pressures associated with peristalsis (400-500). Normal LES pressure

Barium swallow - corkscrew esophagus

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76
Q

Whenever you are managing a gI perforation surgically, you always lavage and do a __

A

MC&S

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77
Q

what is oesophageal scleroderma?

A

An autoimmune disease

Neuronal defects -> smooth muscle ATROPHY of oesophagus -> hypomotility

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78
Q

26F, otherwise healthy. 3 months history of diarrhoea (4x / day) with rectal bleeding.
Associated urgency and mucous secretion.
no recent travel.

High WCC, Platelets, CRP. What are the differential diagnoses? What investigation(s) should be ordered next?

A

infectious - C.difficile, shigella, etc

Non-infectious - IBD, haemorrhoids, post-infectious irritable bowel syndrome etc

INVESTIGATIONS: Stool culture, calprotectin & FIT

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79
Q

when is parenteral nutrition indicated?

A

Inadequate or unsafe oral and/or enteral nutritional intake

A non-functioning, inaccessible or perforated GI tract

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80
Q

is enteral or parenteral nutrition better?

A

enteral

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81
Q

diabetes mellitus and necrolytic migratory erythema are clinical features of which NET?

A

glucagonoma

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82
Q

A patient is being treated with vancomycin for C.difficile. Despite this she has ongoing diarrhoea, blood in stool, WCC and creatinine and CRP increased further. Low blood pressure. Abdominal X-ray now shows dilation of bowel. What is the most likely diagnosis? What is the treatment?

A

Fulminant colitis with Toxic megacolon

First line = antibiotics

Then ITU monitoring -> IV fluid resuscitation & inotropic support

After improvement, discharge with extended course of oral vancomycin

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83
Q

What are the symptoms of inflammatory bowel disease?

A

Abdominal pain, bloody diarrhea (may not be bloody in Chrons)

Fistulas in Crohn’s disease can cause perianal disease

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84
Q

state 4 medical consequences of re-feeding syndrome

A

Arrhythmia, tachycardia, CHF -> Cardiac arrest, sudden death
Respiratory depression
Encephalopathy, coma, seizures, rhabdomyolysis
Wernicke’s encephalopathy

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85
Q

__ ___ is an infection of the biliary tree due to obstruction that leads to stasis/bacterial overgrowth

A

acute cholangitis

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86
Q

Lateral hypothalamus only produces __ peptides

A

orixogenic

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87
Q

How do you manage acute pancreatitis?

A

IV fluids

NPO - pancreatic rest

Analgesia

Determine underlying cause

If severe pancreatitis scoring -> HDU

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88
Q

what are the causes of infectious diarrhoea

A

C.difficile
klebsiella oxytoca
salmonella
clostridium perfringens

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89
Q

___ nutrition is the delivery of nutrients, electrolytes and fluids directly into the ____.

A

Parental

Blood - central venous catheter with tip in SVC

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90
Q

What screening tests are there for colorectal cancer?

A

FIT which detects haemoglobin ages 60-74

One off sigmoidoscopy >55 to remove polyps

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91
Q

state 3 sources of antigen load to the gut

A

Dietary antigens
Exposure to pathogens
Resident microbiota

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92
Q

What is the most common cause of food poisoning in the UK?

A

campylobacter

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93
Q

Return of oesophageal contents from above an obstruction is ____

A

regurgitation

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94
Q

ghrelin function?

A

stimulates appetite, increases gastric emptying

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95
Q

What happens if there is a loss of cation influx in osmoreceptors?

A

Hyperpolarization -> inhibition of firing

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96
Q

What are the symptoms and lab results with acute cholangitis?

A

Charcot’s triad: RUQ pain, fever, jaundice

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97
Q

State 3 signs/symptoms in anorexia

A 
Low BMI/ continuous weight loss
Amenorrhea
Halitosis
mood swings
dry hair, skin & hair thinning
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98
Q

state 3 effects of malnutrition on hospitalised patients

A

Increased mortality
Increased septic risk and post-surgical complications
Increased length of hospital stays/re-admissions
Decreased wound healing & response to treatment

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99
Q

State 4 clinical outcomes of H pylori infection

A

asymptomatic/chronic gastritis

Chronic atrophic gastritis (intestinal metaplasia)

Gastric or duodenal ulcer

Gastric adenocarcinoma

MALT lymphoma

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100
Q

how do steroids treat IBD?

A

Increase anti-inflammatory gene products. Block pro-inflammatory genes.

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101
Q

What questions do you ask to narrow down the causes of Iron deficiency aneamia?

A

Any overt bleeding noticed?- Blood in stool, Haematuria, Epistaxis, Haemoptysis

Generic symptoms of malignancy? - Weight loss, anorexia, malaise

Symptoms that might suggest colorectal cancer?- Change in bowel habit, Blood or mucus in stool, Faecal incontinence, Feeling of incomplete emptying of bowels (tenesmus)

Symptoms that might suggest an upper GI cancer? - Dysphagia, Dyspepsia

Is there blood in the stool or urine that the patient has not noticed?- Perform a digital rectal examination.- Dip the urine to check for blood.

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102
Q

How does blood control thirst?

A
  1. Blood pressure drops -> juxtaglomerular cells of renal afferent arteriole secrete renin
  2. Renin cleaves angiotensinogen from liver to angiotensin 1
  3. Angiotensin I converted to II bye ACE in lungs
  4. Angiotensin II causes thirst, aldosterone secretion, and activates the sympathetic nervous system leading to vasoconstriction/increase in sympathetic activity
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103
Q

how do you treat H. Pylori infection?

A

Triple therapy - PPI + amoxicillin + clarithromycin

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104
Q

State 3 extraintestinal manifestations seen in both types of IBD.

A
  1. Arthritis (axial like Ankylosing Spondylitis or Peripheral)
  2. Skin rash (Erythema nodosum, Pyoderma gangrenosum)
  3. Eye inflammation (Anterior uveitis, Episcleritis/Iritis)
  4. Liver (Primary Sclerosing Cholangitis (PSC) associated with ulcerative colitis only - causes jaundice) and (autoimmune hepatitis)
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105
Q

Mrs smith 84. Had several coronal angiplasties. SOB which doctor prescribed medication for. very forgetful. Lips always dry despite drinking a large amount of water. What could be causing this?

A

diuretic

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106
Q

what do diagnostic tests show in achalasia?

A

Manometry:

  • HIGH LES resting pressure
  • Uncoordinated or absent peristalsis (receptive relaxation sets in late during pharyngeal phase. Swallowed food collects in oesophagus causing dilation)

Barium swallow:
“Birds beak esophagus”

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107
Q

What are the symptoms of diffuse esophageal spasm?

A

Dysphagia and ANGINA-LIKE chest pain

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108
Q

how do you treat a non severe C.diff?

A

Isolate patient
Metronidazole and oral Vancomycin
FMT

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109
Q

What screening tests are there for hepatocellular cancer?

A

Regular ultrasound & AFP - for individuals with cirrhosis as a result of viral or alcoholic hepatitis

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110
Q

In a patient with a jejunostomy, what is the target stoma output 6 weeks after surgery?

A

<1.5L/day

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111
Q

What are the symptoms of carcinoid syndrome? What causes this?

A

vasodilation -> flushing

Bronchoconstriction -> wheezing
diarrhea

Right sided heart disease - PR & TR

Could present with abdominal pain if in GI tracts

Release of serotonin from tumours such as in lungs as hormones released directly into systemic circulation

112
Q

how is IBD treated?

A

5 ASA

Steroids -E.g prednisolone short term in acutely unwell patients - adverse effects e.g cushings disease.

Immunosuppressants - Azathioprine, Methotrexate

Diet (e.g. liquid therapy diet), antibiotics, probiotics, FMT

Biologics - e.g. Anti-TNFα (infliximab, adalimumab)

113
Q

What is the LES resting pressure? And peristaltic wave value on manometry?

A

LES = 20 mmHg

Peristaltic wave = 40

114
Q

Other than cholera, name 3 other causes of infectious diarrhoea

A

Viral - rotavirus, norovirus

Protozoa parasitic

Other bacteria - campylobacter jejuni, e coli, salmonella, shigella, C diff.

115
Q

what are some things in a history that can make you think of a diagnosis of acute mesenteric ischemia?

A

ex-smoker – ↑ed risk of cardiovascular disease
Short history
Central pain with guarding
No previous abdominal scar or hernia
No bowel sounds
Poor general condition
↑ed serum lactate - ischemic metabolic acidosis sign

116
Q

what are the risk factors for RFS?

A
  1. low BMI
  2. very little/no nutrition over a couple days
  3. unintentional weight loss
  4. PMHx alcohol drug abuse
  5. Low K+, Mg2+, PO4 prior to refeeding

*check notes/NICE guidelines for specific number of criteria or values you need.

117
Q

Which membrane protein plays a pivotal role in cholera enterotoxin induced diarrhoea?

A

Cystic Fibrosis Transmembrane conductance regulator

CFTCR

118
Q

State 3 parts of the epithelial barrier that provide protection

A

Mucus layer

Tight junctions of epithelial monolayer

Paneth cells (small intestine - secrete defensins & lysozyme)

119
Q

what is the difference between visceral and parietal pain?

A

Visceral:

  • autonomic
  • embryological
  • dull, crampy, burning

parietal:
- somatic
- well-localised
- sharp ache

120
Q

What bloods are ordered for bowel ischaemia and what do they show?

A

FBC - neutrophilic leukocytosis

VBG - lactic acidosis possible

121
Q

What is the effect of starvation on electrolytes and how can this lead to re-feeding syndrome?

A

Increase in extracellular water, total body water and sodium. During refeeding carbohydrate reduces sodium and fluid excretion causing oedema

Decrease in K+, Mg2+, and phosphate. Serum concentrations maintained whilst intracellular stores depleted. Shift into cells upon refeeding causing low levels

Thiamine deficiency can occur upon refeeding if patient had low Vitamin B levels

122
Q

treatment for acute peritonitis?

A

Pre-operative -NGT NBM & IV fluids. Antibiotics

Operative:
identification of cause of peritonitis, eradication of contamination source, peritoneal lavage and drainage.
Treatment of the perforated ulcer present

123
Q

what are the indications for surgical management of bowel ischemia?

A 
Small bowel ischaemia 
Signs of peritonitis or sepsis 
Hemodynamic instability 
Massive bleeding 
Fulminant colitis with toxic megacolon
124
Q

What are the lab results and symptoms in choledocholithiasis?

A

Elevated ALP (&raquo_space; elevation of AST or ALT)

Elevated direct/conjugated bilirubin ->JAUNDICE

Elevated GGT

Abdominal pain

125
Q

how do you ensure an NGT is not misplaced and is in the stomach?

A

aspirate must be obtained from NGTs which indicates a pH < or equal to 5.5 showing that it is in the stomach

126
Q

What type of virus are Rotaviruses? How many types are there and which is most common?

A

RNA
They replicate in enterocytes
5 types - A to E
A most common

127
Q

What is erosive & hemorrhagic gastritis?

causes?

A

Gastritis resulting in acute ulcer -> gastric bleeding, perforation

-> Alcohol, NSAIDs, burns, brain injury, ischemia

128
Q

what are the complications associated with parenteral nutrition?

A

Catheter related infections

Mechanical - pneumothorax, hemothorax, thrombosis, cardiac arrhythmias, catheter occlusions, thrombophlebitis, extravasion

Metabolic - deranged electrolytes, hyperglycemia, abnormal liver enzymes, oedema, hypertriglyceridemia

129
Q

risk factors for bowel ischemia?

A 
>65 
Cardiac arrhythmias (mainly AF), atherosclerosis 
Hypercoagulation 
Vasculitis 
Sickle cell 
Shock causing hypotension
130
Q

peptide YY function?

A

inhibits food intake

131
Q

state 3 conditions that can develop as a result of GERD

A
  1. Reflux esophagitis
  2. Epithelial metaplasia (barretts) -> esophageal cancer
    (Ulcers which heal and form)
  3. peptic strictures
132
Q

what bacteria causes cholera?

A

Vibrio cholerae serogroups 01 & 0139

133
Q

State 3 protective mechanisms in body following reflux.

A

Volume clearance-esophageal peristalsis reflex

pH clearance - saliva

Epithelium - barrier properties

134
Q

State 2 examples of clinical signs elicited for acute appendicitis

A

McBurney’s point

obturator sign

135
Q

What is the role of a radiologist in cancer?

A

Reviews scans
Provides radiological tumour STAGE
Provides re-staging after treatment
Interventional radiology

136
Q

15 year old girl, gingival bleeding. Wanted to see a dentist but parents did not allow her to. Lost weight, often hungry and would like to eat more, under some pressure at school. What is the likely cause of lost weight and bleeding?

A

child neglect and scurvy

137
Q

How is a campylobacter infection spread?

A

Undercooked meat especially poultry, untreated water, unpasterised millk

138
Q

__ is inappropriate lack of thirst

A

adipsia

139
Q

what part of the stomach secretes gastrin?

A

antrum

140
Q

What covers peyers patches?

A

Follicle associated epithelium

141
Q

hypoglycemia and whipples triad are clinical features of which NET?

A

insulinoma

142
Q

what are the symptoms in oesophageal scleroderma?

A

Dysphagia
Acid reflux (GERD)
Associated with CREST syndrome

143
Q

How does the body prevent reflux?

A

LES closure

Increased LES pressure

144
Q

If initial treatment for ulcers doesn’t work, what do you do?

A
  1. Measure serum gastrin - check for antral G-cell hyperplasia or zollinger ellison syndrome.
  2. OGD - biopsy for malignant ulcer
145
Q

If after upper GI surgery, a patient develops SOB and bibasal creps on auscultation and white region on CXR. The most likely diagnosis is _____

A

pneumonia

146
Q

Malnutrition results from a lack of __ or intake of nutrition

A

uptake

147
Q

what does a nutritional assessment by a dietician use/consider?

A

Anthropometry - mid arm muscle circumference, scale, CTs, handgrip strength etc

Biochemistry

Clinical - PHx, signs, symptoms, medications

Dietary - allergies, dietary restrictions, aversions, cultural etc

Social + physical - should include disabilities, smoking and alcohol use

Nutrition requirements - estimate the patients resting metabolic requirement

148
Q

what is the management of esophageal perforation?

A

Primary - NBM, IV fluids, broad spectrum antibiotics and antifungals, bloods (including G&S/group and save)

Definite - surgery:

  • Esophagectomy with reconstruction
  • Esophagostomy & delayed reconstruction

No surgery if small contained perforation or unfit

149
Q

State important planes of the abdomen and structures they are associated with

A

Transpyloric plane - L1

Subcostal plane - L3 - origin of inferior mesenteric artery

Supracristal plane - L4 - bifurcation of the aorta

Intertubercular plane

Interspinous plane

150
Q

state causes of acute pancreatitis

A 
I - diopathic 
G - ALLSTONES - obstruct common bile duct - cause back-up of enzymes - common. LFTs affected.   
E - thanol - common 
T - rauma
S - teroids 
M - umps (infections)
A - utoimmune disease (AIP)
S - corpion sting (toxins from some arachnids and reptiles)
H -ypercalcemia/hypertroglyceridemia 
E - RCP 
D - rugs
151
Q

where do NETs arise from?

A

GEP tract or bronchopulmonary system

152
Q

Where long term enteral tube feeding is required (>3months), what is inserted?

A

gastrostomy/jejunostomy feeding tube

153
Q

which type of IBD involves continuous inflammation always with rectal involvement?

A

ulcerative colitis

154
Q

What are the two neuronal populations in the arcuate nucleus? how does leptin act on them?

A

Stimulatory - NPY/Agrp neuron
Inhibitory - POMC neuron - decreases neuron
Leptin act on them. Stimulates POMC, inhibits NPY
And both neuronal populations go through paraventricular nucleus

155
Q

Without the consumption of water, what in the body can help to relieve thirst?

A

Receptors in mouth, pharynx, oesophagus

156
Q

Differentiate between acute mesenteric ischemia and ischaemic colitis

A 
Acute mesenteric ischemia: 
- Small bowel 
- Usually occlusive due to thromboemboli
- Sudden onset 
Abdominal pain out of proportion of clinical signs

Ischeamic colitis:

  • Large bowel
  • Usually due to non-occlusive low flow states or atherosclerosis
  • Mild and gradual onset
  • Moderate pain and tenderness
157
Q

state 3 causes of malnutrition in hospitals

A

Depression
Inactivity
Inflexibility of meal times
Quality of food

158
Q

what causes achalasia?

A 
Primary
 - unknown 
Secondary:
- CHAgas disease can cause aCHAlasia!!
- (Protozoa infection)
- (Amyloid/Sarcoma/Eosinophilic
Oesophagitis)
159
Q

What are the side effects of NSAIDS?

A

gastric ulcers and bleeding, perforation; reduced creatinine clearance, acute interstitial nephritis; bronchoconstriction in susceptible individuals (contraindicated in asthma)

Prolonged use -> risk of Adverse cardiovascular effects, chronic renal failure

Aspirin linked with post-viral encephalitis (Reye’s syndrome) in children

160
Q

In a patient suffering from
osteoporosis alongside osteoarthritis and developed PUD from NSAID use, the GP would have chosen a histamine (H2) receptor antagonist instead of a proton pump inhibitor. Why?

A

Acid imbalance causes osteoporosis and H2 receptor antagonists are less effective/ cause a smaller acid imbalance than PPIs. PPIs increase risk of fracture which is more likely if a patient has osteoporosis

161
Q

what things decrease LES pressure?

A

Smoking, fat, NO

162
Q

What do diagnostic tests show in a perforated viscus?

A

CXR - free subdiaphragmatic air

AXR - Rigler’s sign - free intraperitoneal air

163
Q

MALT are found in the ____. They are surrounded by __ ___ ___ allowing passages of lymphocytes. The ___ cavity is rich in immunological tissue. In particular palatine and lingual tonsils.

A

Submucosa
HEV postcapillary venules
Oral

164
Q

One cause of ____ _______ is as a result of a perforation such as a perforated ulcer. CT scan may show free fluid around the liver.

A

acute peritonitis

165
Q

What is Achalasia?

A

Failure of LES to relax due to degeneration of inhibitory neurons (containing NO and VIP) of myenteric plexus

166
Q

What are the potential effects on polydipsia on the body?

A

Kidney and bone damage, Headache
Nausea, Cramps, Slow reflexes, Slurred speech
Low energy, Confusion, Seizures

167
Q

State 4 physical barriers in the GI tract

A

Anatomical

  • epithelial barrier
  • persitalsis

Chemical

  • Enzymes
  • Acidic pH
168
Q

_ is a microorganism that benefits from an association with a host but has no effects on host. __ live with host without any benefits or harm either way. __ are symbionts that have the potential to elicit inflammation

A

Commensals
Symbionts
Pathobionts

169
Q

what is artificial nutrition support?

A

Provision of enteral or parenteral nutrients to treat or prevent malnutrition

170
Q

how does obstruction of a muscular tube present?

A

Colicky pain, fluctuates in severity, move to try and get comfortable

Prolonged obstruction can cause distension - > constant stretching pain -> when colicky pain becomes constant you worry about ischemia

171
Q

most NETs are __

A

Asymptomatic

172
Q

How do you treat a perforated ulcer?

A

Laparoscopic omental patch

Radical surgery - vagotomy, gastrectomy

Conservative treatment - Taylors approach

173
Q

State 2 cancers of GI tract resulting from connective tissue

A

Leiomyoma & liposarcomas

174
Q

state 3 roles of gut microbiota

A

Provide nutrients
Digest compounds
Defence against opportunistic pathogens
Contribute to intestinal architecture

175
Q

What is the mechanism of PPIs in treating PUD?

Give an example

A

Irreversible inhibitors of H+/K+ ATPase in gastric parietal cells. They are weak bases and accumulate in the acid environment

Omeprazole, lansoprazole

176
Q

What causes non-erosive chronic active gastritis?

A

H Pylori infection of antrum of stomach.

177
Q

__ is excessive thirst or excessive drinking

A

polydipsia

178
Q

What is a side effect of H2 receptor blockers in treating PUD?

A

Confusion, dizziness

Cimetidine (but not other H2 antagonists) inhibits cytochrome P450 and may retard the metabolism and potentiate the effects of a range of drugs

179
Q

Other than through m-cells, what other way do bacteria invade the GI epithelium?

A

Dendritic cells open up tight-junctions and collect bacteria from outside epithelium.

Bacteria then transported to mesenteric lymph nodes.

180
Q

zollinger-ellison syndrome is a clinical feature of which NET?

A

gastrinoma

181
Q

What hormonal changes occur after bariatric surgery?

A
  1. Ghrelin reduces - reduction of appetite
  2. GLP1 and GLP2 increased - insulin release stimulated, glucagon release inhibited
  3. PYY increased - increase in satiety
182
Q

State 2 cancers of GI tract resulting from epithelial cells

A

Squamous cell carcinoma & adenocarcinoma

183
Q

What 3 triggers control thirst?

A

Body fluid osmolality
Blood volume reduction
Blood pressure reduction

184
Q

A patient taking naproxen is diagnosed with PUD. There is no active bleeding and he is Helicobacter pylori negative.

What treatment would you initiate and what is the mechanism?

A

1st line - treat underlying cause plus PPI (4-8 weeks, e.g 20mg omeprazole)

Mechanism - Irreversible inhibitors of H+/K+ ATPase in gastric parietal cells. Reduce acid production. Allows ulcer to heal
Naproxen - stop if possible

185
Q

Describe the mechanism for vibrio cholerae invasion and damage

A

Bacteria releases enterotoxin in SI which enters enterocyte

Increased adenylate cyclase activity -> increased cAMP -> salt excretion causing water excretion -> diarrhea

186
Q

What type of drug is diclofenac?

A

NSAID

187
Q

What happens when plasma ADH is low? What is this called?

A

Large volume of urine is excreted

Diuresis

188
Q

which people should be considered for nutrition support?

A
  1. malnourished
    - BMI <18.5
    - unintentional weight loss > 10% past 3-6 months
    - BMI <20 + unintentional weight loss > 5% in past 3-6 months
  2. At risk of malnutrition
    - Eaten little or nothing for >5 days or likely to
    - Have poor absorptive capacity and or high nutrient losses and/or increased nutritional needs from causes such as catabolism
189
Q

Intra abdominal collection may occur following surgery if patient is not lavaged properly Some signs include:

A

Abdominal pain, soft and tender - with guarding
Very high CRP
High WCC, fever

confirmed by CT

190
Q

what are the symptoms of GERD?

A

HEARTBURN
Regurgitation
Dysphagia
Can be associated with asthma

191
Q

State 3 reasons why H.pylori is so virulent

A
  1. urease :
    Converts uric acid to ammonia - neutralises stomach acid
    - Ammonia chloride formation - gastric injury
  2. VacA exotoxin - gastric mucosal injury
  3. Secretory enzymes e.g protease, lipase - gastric mucosal injury
192
Q

What is calculous cholecystitis?

A

Gallstone impaction in cystic duct -> inflammation and gallbladder wall thickening

193
Q

describe 2 locations where you can experience dysphagia

A

UES or LES

194
Q

what features suggest strangulation in bowel obstruction?

A

Change in pain from colicky to continuous
Tachycardia, pyrexia, peritonism
Bowel sounds absent or reduced
Leucocytosis, increased CRP

195
Q

How do you assess the severity of acute pancreatitis?

A

Glasgow criteria

- specific criteria in notes/online

196
Q

how do you treat scleroderma?

A

Exclude organic obstruction

Improve peristalsis using prokinetics (cisapride)

197
Q

treatment for achalasia?

A

Pneumatic dilatation

Surgery:
- Hellers Myotomy (cutting of esophageal sphincter muscle). Often combined with Dor fundoplication to prevent GERD development

  • Peroral endoscopic myotomy (POEM)
198
Q

Inflammation causes _ levels of albumin and this is associated with poor prognosis

A

low

199
Q

What is the criteria for short bowel syndrome?

A

2m or less from duodenojejunal flexure

200
Q

How do you diagnose and stage gastric adenocarcinomas?

A

Endoscopy + biopsy

Staging:

  • CT of the chest, abdomen & pelvis
  • PET-CT
  • Diagnostic laparoscopy - peritoneal & liver metastases
  • Endoscopic ultrasound - local invasion & node involvement
201
Q

Diagnosis and Treatment for cholera?

A

Diagnosis - bacterial culture of stool
Main = oral rehydration
Vaccines- dukoral

202
Q

state 2 differences in symptoms and signs in large bowel obstruction vs small

A

constipation is early rather than late sign in LBO

vomiting is late sign in LBO. initially bilious and progresses to faecal vomiting

203
Q

In an examination for bowel obstruction, you should always search for ___ ___ and abdominal scars. You should also determine if obstruction is single or strangulating.

A

inguinal hernia

204
Q

Ulcer perforations are usually of the __ and occur more commonly on the __ surface

A

Duodenum

Anterior

205
Q

What are the Non-GI causes of IDA in order of frequency?

A
  1. Menstruation
  2. Blood donation
  3. Haematuria (1% of iron deficiency anaemias)
  4. Epistaxis
206
Q

what is the first-line approach for enteral feeding?

A

NGT

If gastric feeding is impossible e.g. in gastric outlet obstruction - NDT/NJT used

207
Q

With IBD, ___ ___ can affect any part of the GI tract, but __ __ is limited to colon.

A

Crohn’s disease

Ulcerative

208
Q

State different causes of upper abdominal pain

A 
Cardiac 
GI 
MSK 
Diabetes
Dermatological
209
Q

How do Bcells and Tcells circulate once they are formed?

A

Peyers Patch -> lymphocyte proliferation in lymph node -> thoracic duct -> circulation -> entering peripheral immune system (skin, tonsils, BALT)
OR exit back into intestinal mucosa/lamina propria (HEVs express MAdCAM1 - an adhesion molecule, and lymphocytes express alpha4beta7 to enable this)

210
Q

constant RUQ pain. Bilirubin and LFTS are fine. Sweats and rigors present. most likely diagnosis?

A

cholecystitis

211
Q

Which abdominal organs usually cause colicky pain and which usually cause constant?

A

Constant - liver, spleen, kidney

Colicky - ureteric, biliary, bowel

212
Q

State 4 examples of organised GALT

A

Peyers patches - SI
Caecal patches - LI
Isolated lymphoid follicles
Mesenteric lymph nodes

213
Q

State 4 things to consider in a medical history for obesity

A
  1. Dietary and physical activity patterns
  2. psychosocial factors
  3. weight-gaining medications
  4. familial traits
214
Q

State 2 cancers of GI tract resulting from neuroendocrine tumours

A

NETs and GISTs

215
Q

n which type of IBD is there transmural inflammation (->fistulas), cobblestone mucosa, creeping fat and “string sign” on gross morphology with granulomas on microscopic morphology?

A

chrons disease

216
Q

Ecoli has __ pathotypes associated with diarrhoea. ____ causes bloody diarrhoea. ___ causes hemolytic uraemic syndrome.

A

6
EIEC
EHEC/STEC

217
Q

what is biliary colic?

A

Stone in gallbladder causing intermittent RUQ pain

218
Q

What are peyers patches composed of?

A

Naive Tcells and Bcells - development requires microbiota exposure

219
Q

what are the symptoms and signs of bowel ischemia?

A

Sudden onset crampy abdominal pain

Bloody, loose stool (currant jelly)

Fever, signs of septic shock

220
Q

what investigations can be ordered for dysphagia?

A

Bedside: ECG (are there signs of cardiac ischaemia?)

Blood tests: Full blood count (iron deficiency anaemia from chronic GI bleed?), urea and electrolytes (dehydration from poor oral intake?)

Imaging: CXR (if basal crepitations present )

Microbiology: if infective cause suspected

Special/invasive: urgent upper GI endoscopy if cancer suspected

221
Q

What are the two main groups of bowel obstruction?

A

paralytic ileus

mechanical

222
Q

What bloods are ordered for acute appendicitis and what do they show?

A

FBC - neutrophilic leukocytosis
Increased CRP
Urinalysis - possible mild pyuria/hematuria

223
Q

What cells are found within follicle associated epithelium? What are their function?

A

M (microfold) cells

Transfer IgA-bacteria complex into Peyers patches!!

224
Q

What can you use to measure improvement in nutrition?

A

Increase in lean body mass

Increase in mid-arm circumference

225
Q

What treatment is given in severe c.difficile infection where there is fulminant colitis (hypotension, fever, -> can cause ileus, toxic megacolon)

A

Antibiotic therapy, supportive care and close monitoring

Early surgical consultation

226
Q

What diagnostic test is used for gallstones?

A

ultrasound

227
Q

State 3 causes of esophageal perforation.

A
  1. Iatrogenic - MOST COMMON - usually at OGD
  2. Borehaave’s Syndrome
  3. Foreign body(can include acid/alkali ingestion), Malignant, Trauma(blunt force to thorax, penetrating injury), spontaneous
  4. Intraoperative causes such as hellers myotomy
228
Q

Effect of PYY release in terminal ileum and colon?

A

Stimulates POMC neurons

Inhibits NPY release

229
Q

what are the symptoms of biliary colic?

A

intermittent RUQ pain that may radiate to the shoulder blade.

Nausea, vomiting

Pain especially after eating (gallbladder contraction). Especially fatty foods (CCK release triggers gallbladder contraction)

230
Q

What imaging is carried out to diagnose bowel ischemia?

A

CT angiogram - can show vascular stenosis, pneumatosis intestinalis, thumbprint sign for ischaemic colitis

231
Q

treatment for GERD?

A

Lifestyle - no smoking, weight loss

PPIs

Surgical:

  • Dilatation of peptic strictures
  • Refractory GERD - Nissens fundoplication
232
Q

What are the symptoms in esophageal perforation?

A 
Pain 
Fever 
Dysphagia 
Subcutaneous emphysema
(blood in saliva and haematemesis if trauma)
233
Q

what are the 3 types of tumours associated with MEN1

A
  1. Pituitary tumours
  2. Pancreatic tumours
  3. Parathyroid tumours
234
Q

How does 5 ASA treat IBD?

A

Inhibition of pro-inflammatory cytokines (IL-1 and TNF-a )

235
Q

What are the causes of secondary polydipsia?

A
  1. Chronic medical conditions: Diabetes insipidus & mellitus, Kidney failure, Conn’s syndrome, Addison’s disease, Sickle cell anaemia
  2. Medications: Diuretics, Laxatives, Antidepressants
  3. Dehydration: Acute illness, Sweating, Fevers, Vomiting, Diarrhoea, Underhydration
236
Q

what are the symptoms and signs of GI perforation?

A

sudden severe abdominal pain with distention
Diffuse abdominal guarding, rigidity and rebound tenderness!!

(Pain aggravated by movement
Nausea, vomiting, absolute constipation
Fever, tachycardia, tachypnoea, hypotension
Decreased or absent bowel sounds (due to ileus))

237
Q

what are the two structures that need to be identified and divided during a laparoscopic cholecystectomy?

A

Cystic duct and cystic artery

238
Q

what is atrophic gastritis?

A

Antibodies attack parietal cells:

  • parietal cell atrophy
  • Decrease in acid and IF secretion(pernicious anemia risk)
  • Occurs in fundus
239
Q

How do you diagnose NETs?

A

Biochemical assessment

  • screen for gut hormones like insulin, somatostatin, PPY
  • screen for calcium PTH, prolactin, GH
  • 24 hr urinary 5-HIAA!!!

Imaging - somatostatin receptor scintigraphy, CT/MRI etc

240
Q

What does an endoscopy show in bowel ischaemia?

A

Oedema, cyanosis and ulceration of mucosa

241
Q

how do you treat a rotavirus infection?

A

Oral rehydration

Vaccine

242
Q

what is the cost of malnutrition in england per year?

A

£19.6 billion - 15% health budget

243
Q

what are the causes of bowel obstruction?

A

Causes in the lumen - faecal impaction, gallstone ‘ileus’

causes in the wall - Crohn’s disease, tumours, diverticulitis of colon

Causes outside the wall - strangulated hernia, volvulus, obstruction due to adhesions or bands

244
Q

__ hernias can cause dead bowel without proper obstruction

A

Richter’s

245
Q

How do you treat a campylobacter infection?

A

Not usually required

Can use azithromycin

246
Q

what are the different types of dysphagia you can get?

A

For solids or fluids. Intermittent or progressive. Precise or vague in appreciation.

247
Q

what is diffuse esophageal spasm?

A

Uncoordinated contractions of the esophagus with NORMAL LES pressure

248
Q

what screening tool is used for malnutrition? what 3 things does it consider?

A
  • MUST
  • BMI score, weight loss score, presence of acute disease
  • Score may result in referral to dietician for assessment
249
Q

what investigation do you carry out for suspected GERD?

A

OGD

  • +ve findings include peptic stricture, barretts, esophagitis
  • look to see if cancer is present or not.
250
Q

A patient is found to have microcytic aneamia. Patient states weight loss and loose stools, no palpable masses in rectum, rectal exam shows blood in stool. What is the most likely diagnosis? What investigations are required?

What will the lower GI MDT need to consider when deciding the treatment approach?

A

Colon cancer

Bedside: Urine dipstick (haematuria?)
Blood tests: Iron studies (needed to confirm iron deficiency as the cause of microcytic anaemia), anti-TTG (a screening test for coeliac disease)
Imaging: Unlikely to order any from the GP clinic.
Microbiology: None required.
Special/invasive: She qualifies for an urgent colonoscopy. If this is negative, an upper GI endoscopy will be organised

staging CT CAP

251
Q

What is a characteristic imaging finding in acute pancreatitis?

A

CT of abdomen shows pancreas surrounded by edema. Enlarged pancreas

252
Q

What oral fluid advice would you give to prevent further dehydration and electrolyte imbalance if these issues are present in a patient with a duodenal jejunostomy?

A

Restrict oral fluid intake - hypotonic fluids may drag Na+ into gut lumen
Give electrolyte mix to patient (glucose-saline solution)

253
Q

Passive return of gastroduodenal content to mouth is ____

A

reflux

254
Q

What is boerhaave’s syndrome?

A

Severe vomiting against a closed glottis. Causes sudden increase in esophageal pressure and transmural rupture of esophagus.

255
Q

What is the primary treatment for ulcers?

A

Triple therapy for H pylori

Then PPI or H2 blocker

256
Q

State and describe 2 vascular anomalies causing dysphagia

A

Dysphagia lusoria - vascular compression of the esophagus by an aberrant right subclavian artery

Double aortic arch

257
Q

What is the role of a pathologist in cancer?

A

Confirms diagnosis using biopsy
Provides histologic typing
Provides molecular typing
Provides tumor grade

258
Q

in an elderly patient on antibiotics with new onset diarrhea, what are the important investigations?

A
  1. stool sample to check for C.difficile

2. followed by AXR

259
Q

___ is responsible for both adaptive and innate immune responses. It can be non-organised such as ______ lymphocytes and ___ ___ lymphocytes or it can be organised.

A

GALT
Intra-epithelial (in intestines)
Lamina propria

260
Q

State 5 comorbidities associated with obesity

A 
Stroke, MI, Hypertension 
Diabetes 
Depression 
Sleep apnoea 
Bowel cancer 
Osteoarthritis 
Gout 
PVD
261
Q

State 4 things that decrease gastric acid secretion

A

Prostaglandins
Somatostatin
Secretin
GIP

262
Q

how do you treat gastric cancer?

A

Neoadjuvant chemotherapy

Tumor at oesophago-gastric junction = oesophago-gastrectomy

<5cm from OG junction = total gastrectomy

> 5cm = subtotal
Adjuvant chemotherapy

263
Q

describe how a sigmoid volvulus is managed conservatively

A

A sigmoidoscope is passed with the patient lying in the left lateral position.
flatus tube passed along the sigmoidoscope.

if that fails -> Flexible sigmoidoscopy
If that fails -> Exploratory Laparotomy & Sigmoid Colectomy with end colostomy (Hartmann’s Procedure)

264
Q

____ combines endoscopy and fluoroscopy. It is used for imaging and therapy of biliary disorders.

A

ERCP

265
Q

76-yr-old gentleman presents to GP complains of discomfort behind his sternum every time he eats, starts seconds after swallowing. He noticed this 3 months ago and it’s getting worse.
As a result, he has been eating less and less. His wife, who comes to the clinic with him, says he has lost a lot of weight, although he has not noticed.
He denies any other symptoms.
what would be your starting list of differential diagnoses?

A

Abdominal: Causes of dysphagia:

Upper dysphagia:

  • Structural causes: Pharyngeal cancer, pharyngeal pouch
  • Neurological causes: Parkinson’s, stroke, motor neuron disease

Lower dysphagia:

  • Structural causes: Inside (mural and luminal): oesophageal or gastric cancer, stricture, Schatzki ring. Outside (extrinsic compression): lung cancer
  • Neurological causes: Achalasia, diffuse oesophageal spasm

Cardiac: Post-prandial angina
Other: Globus sensation/anxiety

266
Q

State some complications of ulcers? (surgical indication)

A

Hemorrhage
Obstruction
Perforation

267
Q

What blood investigations are carried out in bowel obstruction and what do they show?

A

WCC/CRP - only elevated in strangulation/perforation
U&E electrolyte imbalance if vomiting
VBG - metabolic acidosis (lactate) if strangulation

268
Q

What causes gastric adenocarcinoma?

A

Major driver is chronic gastritis and things that cause it like:

  • H. pylori infection
  • Pernicious anaemia
  • Patients who have had a partial gastrectomy (leads to bile reflux to stomach)
  • epstein-Barr virus infection

Hereditary diffuse-type gastric adenocarcinoma (due to E-cadherin mutations)

269
Q

what causes NETs?

A

75% sporadic

25% associated with a genetic syndrome e.g. MEN1

270
Q

What conditions are associated with each region of the abdomen?

NB: always consider cardiac causes and lung causes in the foregut

A
  • picture in notes, can also look online
271
Q

State 4 causes of dysbiosis

A 
Infection, inflammation 
Diet 
Xenobiotics 
Hygiene 
Genetics
272
Q

what causes relaxation of the LES?

A

Inhibitory NCNA neurons of myenteric plexus of esophageal wall mediated by vagus nerve

273
Q

Give 2 differential diagnosis for GI perforation

A

MI, acute pancreatitis

274
Q

What complication can develop from BOTH atrophic and chronic gastritis?

A

gastric adenocarcinoma

275
Q

What is pseudomembranous colitis?

A

Characteristic yellow-white plaques that form on pseudomembranes of colonic mucosa

Often associated with c.difficile infection
When severe = fulminant colitis

Medicine MBBS year 2 (11 decks)

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