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first year med > GI > Flashcards

GI Flashcards

1
Q

what is slow waves of depolarisation in smooth muscle driven by?

A

interstitial cells of Cajal (ICCs) = pacemaker cells located largely between the circular and longitudinal muscle layers

  • electrically coupled to each other and smooth muscle cells
  • some ICCs form a bridge between nerve endings (post-ganglionic) and smooth muscles
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2
Q

where do parasympathetic nerves synapse with enteric nervous system?

A

S2 - S4

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3
Q

where and what do sympathetic preganglionic nerves synapse with? (gen GI)

A

thoraco-lumbar region

synapse in prevertebral ganglia:

  • celiac
  • superior mesenteric
  • inferior mesenteric
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4
Q

name the 6 sphincters

A
  1. upper oesophageal (UOS)
  2. LOS
  3. pyloric
  4. Ileocaecal valve
  5. internal anal (smooth muscle)
  6. external anal (skeletal muscle)

minus sphincter oddi

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5
Q

describe the process of lipid catabolism

A

triglycerides from dietary and storage fat is broken down by lipases (lipolysis) into fatty acids and glycerols

fatty acids + CoA are oxidised in the cytoplasm to become acyl-CoA to become activated - requires 2 ATP

fatty acids are transferred from acyl-CoA to carnitine - fatty acyl-carnitine crosses membrane from cytoplasm to mitochondrial matrix

become fatty acyle-CoA

beta oxidation produces acetyl-CoA, FADH2, NADH + H+, fatty acyl-CoA

acetyl-CoA then enters TCA

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6
Q

describe ketosis in starvation and diabetes

A
  • oxaloacetate is consumed for gluconeogenesis
  • fatty acids are oxidised to provide energy
  • acetyl-CoA is converted to ketone bodies
  • high levels in blood
  • too much for extrahepatic tissue (heart, brain etc)
  • ketone bodies are moderate acids - accumulation leads to severe acidosis
    • impairs tissue function (particularly CNS)
    • smell of acetone on breath
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7
Q

what constricts the oesophagus in the thorax?

A
  • arch of the aorta

- left main bronchus

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8
Q

what are the 4 pairs of extrinsic muscles of the tongue and what are they supplied by?

A
  • palatoglossus **
  • styloglossus
  • hyoglossus
  • genioglossus

all supplied by CN XII (hypoglossal - motor)
EXCEPT PALATOGLOSSUS (CN X- vagus)

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9
Q

what are the opening and closing muscles of the jaw? what are they supplied by?

A

opening = lateral pterygoid

closing = masseter, temporalis, medial pterygoid

supplied by mandibular division of trigeminal nerve = CN V3

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10
Q

what nerve supplies the general sensation to the superior half of oral cavity?

A

CN V2

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11
Q

which nerve provides the sensory limb of the gag reflex?

A

glossopharyngeal (CN IX)

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12
Q

what is the upper oesophageal sphincter called?

A

cricopharyngeus

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13
Q

what is included in the foregut?

A

oesophagus to mid-duodenum

liver, gall bladder, spleen and half of pancreas

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14
Q

what is included in the hindgut?

A

distal third of transverse colon to proximal half of anal canal

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15
Q

where do sympathetic nerves for the abdominal wall leave the spinal cord?

A

between T5 + L2

** except adrenal gland - leaves at T10 - L1 and synapses DIRECTLY onto cells

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16
Q

what 4 antibiotics should be avoided for C. Diff prevention?

A

cephalosporins
clindamycin
ciprofloxacin
co-amoxiclav

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17
Q

which bacteria associated with gastroenteritis can cause bloody diarrhoea?

A

E. coli 0157
campylobacter
salmonella

c. diff - sometimes bloody

shigella

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18
Q

how is variceal bleeding treated?

A

terlipressin (vasoconstrictor) - contraindicated in ischaemic heart disease

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19
Q

how are haustra formed?

A

tonic contraction of the teniae coli

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20
Q

what are the teniae coli?

A

3 longitudinal bands of thickened smooth muscle - runs from caecum to distal end of sigmoid colon

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21
Q

where is most often the maximum point of tenderness in appendicitis?

A

McBurney’s point - 1/3 of the way between ASIS (boney hip bit) to umbilicus

–> where appendiceal orifice is (usually)

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22
Q

what is meant by sigmoid volvulus?

A

when the sigmoid colon twists round itself

v motile due to long mesentery (sigmoid mesocolon)

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23
Q

where does the inferior mesenteric artery branch from the abdominal aorta?

A

L3 ish

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24
Q

what are the branches of the SMA? (superior to inferior)

A 
inferior pancreaticoduodenal 
middle colic
right colic
ileocolic
appendicular
jejunal + ileal branches
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25
Q

what are the branches of the IMA?

A

left colic
sigmoid colic
superior rectal

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26
Q

what is the anastomosis between SMA + IMA called?what is the benefit of this?

A

marginal artery of Drummond

collateral prevent ischaemia/infarction

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27
Q

where do the veins of foregut, midgut and hindgut drain to?

A

hindgut -> IMV -> splenic
midgut -> SMV -> hepatic
foregut -> splenic -> hepatic

fore, mid, hind -> hepatic -> liver for first metabolism
clean blood -> IVC (retroperitoneal) -> RA

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28
Q

where are the 3 major portal systemic anastomoses?

A

distal end of oesophagus
skin around umbilicus
rectal / anal canal

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29
Q

what happens to the portal systemic anastomoses during portal hypertension?

A

blood is diverted through collateral veins back to systemic venous system

anastomoses now have large flow (usually small) - dilate, become varicose

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30
Q

describe the process of swallowing? what cranial nerves are involved?

A
  1. Close lips to prevent drooling (orbicularis oris + CN VII)
  2. tongue (CN XII) pushes bolus posteriorly towards oropharynx
  3. Sequentially contract pharyngeal constrictor muscle (CN X) to push bolus inferiorly towards oesophagus
  4. At same time inner longitudinal layer of pharyngeal muscles (CN IX + X) contracts to raise larynx, shortening pharynx and closing off laryngeal inlet to prevent aspiration
  5. Bolus reaches oesophagus
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31
Q

where does the celiac trunk arise?

A

T12

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32
Q

what does the celiac trunk bifurcate into?

A

splenic artery
hepatic artery
left gastric artery

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33
Q

what ribs protect the liver and spleen respectively?

A

liver 7-11

spleen 9-11

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34
Q

name the 4 lobes of the liver

A

right
left
caudate (top at back)
quadrate (bottom at back)

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35
Q

what is the lowest part of the peritoneal cavity when the patient is supine?

A

hepatorenal recess

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36
Q

what are the 3 main ligaments of the liver and what do they connect to?

A

coronary ligaments (top) - attach to diaphragm

falciform ligament (between left/right) - attach to anterior abdominal wall

ligamentum teres - remnant of embryological umbilical vein

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37
Q

what does the gallbladder do?

A

stores + concentrates bile

foregut organ
removal = cholecystectomy

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38
Q

where does the bile duct drain?

A

joins with main pancreatic duct to form ampulla of Vater
–> both then drain into the 2nd part of the duodenum through major duodenal papilla

smooth muscle sphincters:

  • bile duct sphincter
  • pancreatic duct sphincter
  • sphincter of Oddi (from ampulla of Vater)
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39
Q

what investigation is used to study the biliary tree and pancreas?

A

endoscopic retrograde cholangiopancreatography (ERCP)

–> pics of dye filled biliary tree

40
Q

what autonomic nerves supply the pancreas?

A

vagus - parasympathetic
abdominopelvic splanchic - sympathetic

forms plexus around celiac trunk + SMA

41
Q

what are lacteals?

A

specialised lymphatic vessels of small intestine

bile helps absorb into intestinal cells via lacteal

42
Q

what is indicated is AST/ALT is more elevated than ALP?

A

hepatocellular injury

43
Q

what is indicated is ALP is more elevated than AST/ALT?

A

obstruction

44
Q

what is indicated by an acute rise in GGT?

A

alcohol consumption

45
Q

why do patients with an obstructed biliary tree present with pale stools?

A

due to reduced levels of conjugated bilirubin entering GI tract which would colour the stool

conjugated bilirubin turns into bile and enters the small intestine (to be eliminated by stool)

46
Q

what is the difference between conjugated and unconjugated bilirubin?

A

unconjugated = not water soluble so not excreted by urine - normal colour

conjugated = water soluble so can be excreted in urine, dark (coke) coloured wee

unconjugated bilirubin is bound to serum albumin and transferred to the liver where it is conjugated (making it water-soluble) to glucuronate by glucuronyl transferase. Conjugated bilirubin is excreted into bile.

47
Q

what does shiga toxin do?

A

binds to receptors found on renal cells, RBC etc

inhibits protein synthesis –> causes cell death

48
Q

what type of cells line the normal sigmoid mucosa?

A

simple columnar

49
Q

what artery supplies the transverse colon?

A

middle colic artery

50
Q

what is charcot’s triad?

A

acute cholangitis

fever
jaundice
RUQ pain

51
Q

what 3 muscles make up the levator ani muscles? what type of muscle are they?

A

lateral to medial
iliococcygeus
pubococcygeus
puborectalis

skeletal muscle - under voluntary control

52
Q

at what point does the sigmoid colon become the rectum?

A

anterior to S3

53
Q

where does the rectum become the anal canal?

A

anterior to tip of coccyx

54
Q

the rectum, anal canal and anus are all located in the perineum

true or false

A

false !

rectum = pelvis

anal canal + anus = perineum

55
Q

what nerves supply the levator ani muscles?

A

superior = nerve to levator ani - S4

inferior = pudendal - S2, S3, S4

56
Q

what function does the puborectalis muscle play in faecal continence?

A

contraction of this muscle decreases the anorectal angle - acting like a sphincter
when rectal ampulla is relaxed + filled with faeces, voluntary contraction of this muscle with help maintain continence

  • part of levator ani muscle
  • marks transition point between rectum + anal canal
57
Q

characteristics + nerve supply of internal anal sphincter

A 
smooth muscle (involuntary)
superior 2/3rd of anal canal

contraction stimulated - sympathetic nerves
contraction INHIBITED - parasympathetic

contracted ALL the time - relaxes reflexive in response to distension of rectal ampulla

58
Q

characteristics + nerve supply of external anal sphincter

A 
skeletal muscle (voluntary)
inferior 2/3rds of anal canal

contraction stimulated - pudendal nerve
–> voluntarily contracted along with puborectalis in response to distension in rectal ampulla + internal sphincter relaxation

59
Q

where do the sympathetic fibres responsible for contraction of anal sphincter and inhibiting peristalsis come from?

A

T12-L2

60
Q

what is the pudendal nerve formed from? what does it supply?

A

formed from S2, 3 + 4

supplies external anal sphincter

branches to supply structures of perineum

61
Q

what does the pectinate line divide?

A

marks the junction between the part of the embryo which formed the

GI tract - endoderm
+
skin - ectoderm

arterial, venous, lymphatic + nerve supply differ above + below line

62
Q

what are the fossae called that lie each side of the anal canal?

A

ischioanal fossae

–> filled with fat + loose connective tissue

can communicate with each other

63
Q

what are haemorrhoids (piles)?

A

prolapses of rectal venous plexuses - raised pressure

can occur in chronic constipation

64
Q

which organs are intraperitoneal?

A 
stomach
1st part of duodenum
jejunum
ileum
transverse colon
sigmoid colon
65
Q

which organs are retroperitoneal?

A 
2nd, 3rd, 4th parts of duodenum
ascending colon
descending colon
pancreas
kidneys
ureters
aorta
IVC
66
Q

what are antimicrobials? what is antimicrobial resistance (AMR)?

A

all agents that act against microorganisms - bacteria, fungi, viruses, protozoa

AMR = when microbes are resistant to one or more antimicrobial agents to treat infection / as an antiseptic
–> multi-drug resistance (MDR)

67
Q

what are antibiotics?

A

drugs that kill or inhibits growth of microorganisms

68
Q

list some mechanisms of antimicrobial resistance

A

inactivation - add phosphate group on the antibiotic which will reduce its ability to bind to bacterial ribosomes

pumping out - increasing active efflux of drugs

modification - modifying drug target

impermeability - modifying cell wall protein (decreased influx)

69
Q

how can bacteria develop antimicrobial resistance?

A

chromosomal mutations - vertical transmission (innate)

most common = resistent genes/clusters via conjugation, transposition, transformation - horizontal (acquired)

70
Q

why is antimicrobial resistance increasing?

A

increasing resistance in community
complacency regarding ABs
increased use of broad spectrum ABs

–> antimicrobial stewardship to fix this

71
Q

common presentations of gonorrhoea + chlamydia

A 
GONORRHOEA
low abdo pain
diarrhoea
rectal bleeding
anal discharge
tenesmus
urethral/vaginal discharge

CHLAMYDIA
mostly asymptomatic, milder than gonorrhoea - similar symptoms
discomfort itch
anal discharge

72
Q

clinical feautes of HSV

A

pain
ulcers
painful defecation
bleeding, mucus

73
Q

what STI are anal warts a common presentation in?

A

HPV

74
Q

coffee bean sign on AXR

A

sigmoid volvulus

75
Q

what is Choledocholithiasis?

A

presence of gallstones in bile duct

76
Q

what are the borders of hesselbach’s triangle and what type of hernia is it associated with?

A

medial = rectus abdominus muscle

superior / lateral = inferior epigastic artery

inferiorly = inguinal ligament

direct inguinal hernias (reducible)

77
Q

advantages of buccal/sublingual drug administration

A

buccal/sublingual = under tongue - GTN

by-passes portal system + avoids first pass metabolism
avoids gastric acid

78
Q

most common liver tumour

A

haemangioma - benign

well demarcated circular on USS

79
Q

most likely liver tumour in younger patients

A

adenoma

focal nodular hyperplasia - central scar

80
Q

which nerve supplies the anterior 2/3rd of taste on the tongue?

A

CN V3 - mandibular branch of trigeminal nerve

81
Q

which nerve supplies the posterior 1/3rd of taste on the tongue?

A

CN VII - facial nerve (chorda tympani branch)

82
Q

what level is the caval hiatus?

A

T8 - contains IVC, phrenic nerve

83
Q

where does the oesophagus + aorta pass through the diaphragm respectively?

A

oesophageal hiatus = T10

aortic hiatus = T12

84
Q

where does the coeliac, SMA + IMA branch from the abdominal aorta respectively?

A

coeliac axis - T12

SMA - L1

IMA - L3

85
Q

autoimmune liver disease investigations + management

A

young/middle aged women

diagnosis = liver biopsy - piecemeal necrosis

+ anti-smooth muscle antibody (ASMA)

Mx = steroids (remission) + azathioprine

86
Q

alpha 1 anti-trypsin deficiency

A

liver failure in YOUNG

lung emphysema

87
Q

what can the presence of antinuclear antibodies (ANA) indicate?

A

autoimmune disease

88
Q

what are pseudocysts?

A

collections of pancreatic juice

–> can develop 4 weeks after acute pancreatitis

89
Q

what is a whipple procedure? when would it be done?

A

surgical operation to remove tumour of head of the pancreas that has NOT spread

removal of -
head of pancreas
pylorus - can be preserved (modified Whipple = PPPD)
duodenum
gallbladder
bile duct 
relevant lymph nodes
90
Q

courvoisiers law

A

palpable gall bladder + jaundice

–> cholangiocarcinoma / pancreatic cancer

91
Q

what class of drugs can cause gynaecomastia?

A

H2 receptor antagonists –> ranitidine

can cause drug-induced gynaecomastia

92
Q

what is the most common cause of liver failure in the UK (massively raised ALT) ?

A

paracetamol overdose

93
Q

flapping hands tremor

A

hepatic encephalopathy - increased ammonia

94
Q

what type of bacteria is C. Diff?

A

gram positive bacillus

95
Q

pathophysio of chronic pancreatitis

A

destruction of the islets of Langerhans cells

Excessive alcohol intake is the most common risk factor for the development of chronic pancreatitis, with this inflammation of the pancreas resulting in the destruction of the islets of Langerhans cells.

96
Q

what pathway is responsible for ketone development in states of insulin depletion?

A

lipolysis (fat breakdown)

-> develops ketone bodies which can be measured in urine plasma clinically in diabetic ketoacidosis / insulin deficiency

this pathway is regulated by insulin

97
Q

different types of vomit in intestinal obstruction

A

semi-digested food eaten a day or 2 ago (no bile) = gastric outlet obstruction

copious bile-stained fluid = upper small bowel obstruction

thicker brown, foul smelling (faeculant) = most distal

first year med (15 decks)

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