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Medicine 2 > G.I Disease/ Disorders > Flashcards

G.I Disease/ Disorders Flashcards

1
Q

How far must a Peptic ulcer penetrate to be considered an ulcer?

A

Muscularis mucosa

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2
Q

What is the criteria for Cirrhosis?

A

Nodules

Fibrosis

Diffuse

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3
Q

What are the non invasive diagnostics tests for H. Pylori?

A

C - Urea Breath test

Serological Test

Stool Antigen Test

Biopsy Urease Test

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4
Q

What enzyme does H. Pylori use to break down the urea from proteins?

A

Urease

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5
Q

What are the by products of the urea that is metabolised by the H. Pylori?

A

Ammonia

CO2

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6
Q

What is the treatment of H.Pylori infection?

A

Triple therapy:

- [Amoxycillin]
- [Clarithromyosin]
- [Metronidazole]

PPI

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7
Q

What is the major complication of jaundice in new borns?

A

Kernicterus

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8
Q

What are the major shunts that occur during portal hypertension?

A

Oesphageal varices

Hemorrhoids - due to superior anal vein

Caput Medusae

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9
Q

What is the condition in which the esophagus can’t relax resulting in dysphagia?

A

Achalasia

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10
Q

What is the disorder where there is increased contraction of the peristalsis waves during swallowing - resulting in pain whilst swallowing and sometimes dysphagia?

A

Nutcracker Esophagus

Jackhammer esophagus

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11
Q

What is the condition where the symptoms reflect a mechanical obstruction in the small intestine, yet there is not?

A

Chronic intestinal pseudo obstruction

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12
Q

What is the condition where there is no movement in the G.I following surgery?

A

Acute Post - operative illus

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13
Q

In cholestasis what are the two broad types?

A

Intra - hepatocellular

Obstructed biliary

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14
Q

What is the autoimmune Intra- hepatocellular type of cholestasis?

A

Primary biliary Cholestasis / Cirrhosis

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15
Q

What are the broad etiologies of portal hypertension?

A

Pre- hepatic

Intrahepatic

Post - hepatic

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16
Q

What is acute pancreatitis and what are possible causes?

A

Acute cause which will return to normal when the insult is removed.

Activation of zymogens which cause inflammation.

increased intracellular Ca2+ levels. - idiopathic

Gallstones - ampulla hypertension = increased Ca2+

Infection : mumps

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17
Q

What is chronic pancreatitis and what are possible causes?

A

Irreversible damage of both exocrine and endocrine

Continual activation of tryposiogen

alcohol biggest cause impairing Ca2+ regulations

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18
Q

What is the metabolite formed in alcoholic liver disease that leads to increased production of fatty acids, and how does it do this?

A

Acetadehyde.

for formation needs to increase NADH and there is a reduction in NAD.

NADH promotes fatty acid synthesis. reduced NAD reduces beta oxidation of fatty acids.

Acetadehyde is transformed into acetly CoA which enters TCA and can be transformed into fatty acids.

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19
Q

What is the name of the disease in which there is excessive iron?

A

Hemochromatosis

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20
Q

Why is excessive Fe2+ in the tissues dangerous?

A

Increased Free radical production which damages cellular structure.
- especially in the liver

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21
Q

In primary Hemochromatosis what is the gene responsible and what is the outcome of this defective gene?

A

High Fe Gene / HFE Gene

Reduced expression of Hepcidin - resulting in increased levels of absorption of iron.

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22
Q

What is the most common homozygous of this HFE gene?

A

C282Y

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23
Q

List some common complication of hemochromatosis

A

Cirrohosis

Diabetes type II
- damage to Beta cells

Absorption
- damage to exocrine of pancreas

Restrictive Cardiomyopahty

DEgenerative joint disease

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24
Q

What are the treatments for Hemochromatosis?

A

Phlebotomy

Deferoxamine - binds to iron making it easier to excrete

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25
Q

In Coeliac Disease, what is the 33 amino acid that triggers the irritation?

A

Alpha Gliadin

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26
Q

In the lamina Propria what occurs to the IgA Alpha Gliadin complex?

and what enzyme does this?

A

It is deaminated

Tissue Transglutaminase (tTG)

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27
Q

What histological changes will you see in Coeliac disease?

A

Reduced Villi Height

Villi Atrophy

Crypt hypertrophy

Reduced surface area

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28
Q

What serological markers are present for diagnosis of Coeliac disease and which is most specific to adults?

A

Anti - tissue TransGlutaminas

Anti - EMAs

Anti - tTG is more specific

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29
Q

What is the most common Coeliac related malignancy?

A

Enteropathy - Associated T cell lymphoma

EATL

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30
Q

What is the recurrent malabsorpative symptoms that comes about after a gluten free diet?

A

Refractory Coeliac Disease

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31
Q

What are the complications of Coelic Disease?

A

Infection

Osteoporosis

Refractory Coeliac Disease

Malignancy

32
Q

What is the most common differential diagnosis for Coeliac disease?

A

Giardiasis

Common parasitic infection in the G.I

33
Q

Zollinger ellison disease - what does it affect?

A

Benign tumour that stimulates G cells to release inappropriate levels of Gastrin

34
Q

What is the term when someone vomits blood?

A

Haematemesis

35
Q

Typical symptoms of Peptic ulcer?

A

Burning epigastric pain
- often a patient can directly point to the area of pain

Sometimes food makes it worse but the relationship here is not set

Weight loss - not wanting to eat

36
Q

What are the types of gallstones that one may develop?

A

Cholesterol

Pigmented - bilirubin

Mixed

37
Q

What 3 factors may lead to the formation of gallstones?

A

Increased cholesterol saturation - especially in the presence of increased eostrogen

Increased Secretion of bilirubin - haemolytic circumstances

Biliary stasis - long periods of starvation - no stimulation to contract the gall bladder

38
Q

Name 3 important complication that occur to the gall bladder due to a gallstone and what is the umbrella term they fall under?

A

Complication to Gallbladder

Biliary Colic - stone in neck and stuck. gall bladder contracts to remove = pain

Acute cholecyctitis - infection develops in the gall bladder due to stagnant movement of the bile - E.Coli being most common

Empyema

39
Q

What significant post hepatic obstructive jaundice may occur?

A
  1. Choledocholithiasis - bile - duct - stone - static

this can lead to lack of pancreatic secretion - lack of absorption.

it may also induce pancreatitis

  1. Pancreatic cancer - obstructing the hepato-pancreatic ampulla
40
Q

What is GORD?

Name a couple of symptoms

A

Gastric Oesphageal Reflex Disease

Retrograde passage of food from stomach to esophagus

Heartburn
Indigestion
Dyspepsia - Epigastric pain
Regurgitation

41
Q

What are the protective mechanisms of the lower esophageal sphincter to prevent GORD?

A

Internal Sphincter and External Sphincter

Intra abdominal Pressure

Angle of His/ Flap Valve

Secondary Peristalsis

42
Q

What are the two types of Hiatus Hernia?

A

Sliding: Oesphageal junction slides into the hiatus - 80% of cases

Rolling: Fundus of stomach protrudes through the hiatus

43
Q

What are the Red flag symptoms when treating someone with gastric reflux?

A

Unexplained weight loss

Dysphagia

Persistent vomiting

Evidence of GI blood loss

Upper abdominal Mass

44
Q

Outline some basic causes for dysphagia.

A

Structural:
intrinsic causes - obstruction
Extrinsic causes: Swollen lymph nodes

Functional:
Motility dysfunctions - achalsia
Neuromusclular disorders - bulbar palsy

45
Q

What are the complications of Reflux?

A

Oesphagitis&raquo_space; Columnar transformation - Barret’s oesphagus&raquo_space; Adenocarcinoma

46
Q

What does High resolution manometry show?

A

Pressures in the oesphagus. Aids int he diagnosis of:

  • motility disorders
  • spasms
47
Q

How do prokinetic drugs work and give an example?

A

Inreace ACh - promoting:

  • gastric emptying
  • increased tone in LOS

Doperidone
Metaclopramide

48
Q

How does Sucralfate work?

A

Binds to positive charged glycoproteins and acts as a buffer for 6-8 hours

49
Q

What is tachyphylaxis? and what is a drug that this commonly happens to?

A

A decrease in the response to a drug due to long term exposure/ use of it.
- H2 antagonists

50
Q

Cimetidine is what kind of drug and what are some side affects?

A

H2 antagonist

Gynaecomastia

binds to P450s in liver affecting:

  • warfarin
  • Phenytoin
51
Q

What is is Nissen Fundoplication?

A

Surgical intervention where the fundus is tied around the LOS to reduce reflux

52
Q

Patients with Coelic disease are most likely to express what gene?

A

HLA DQ2

53
Q

What enzyme breaks the alpha gliadin IgA complex?

A

Tissue Transglutaminase

54
Q

What is called when both the acid and mucous secretion is reduced to cell loss?

A

Atrophic Gastritis Hypochlorhydria

55
Q

What is called when the entire stomach is infected with H.Plyoria?

A

Pangastritis

56
Q

What is most commonly seen on histological slides of someone with coeliac?

A

Villi Atrophy

57
Q

What are the stages of alcoholic fatty liver disease?

A

Normal > Steatosis > Chronic Hepatitis > Cirrohisis > Hepatocellular Carinoma

58
Q

Is Gilberts disease autosomal dominant or recessive?

A

Recessive

59
Q

What is the skin complication that occurs in people with Coeliac disease?

A

Dermatitis Herptiformis

60
Q

What is the golden rule of iron deficiency anemia in Males and post menopausal women?

and in fertile females?

A

Iron Deficiency anemia is due to GI blood loss until proven otherwise.

Menstrual blood loss and or pregnant

61
Q

Whats the main treatment for Haemochromotosis?

A

Venedesction

62
Q

What is it called when unwanted hormones are released from tumours affecting the endocrine cells of the appendix?

A

Carcinoid syndrome

63
Q

When would you be most likely see Mallory bodies in the liver?

and what are they?

A

Alcoholic hepatitis

Damaged intermediate filaments within hepatocytes.

64
Q

What is a sliding hiatus hernia?

A

Sliding of the cardia up through the hiatus

65
Q

What is rolling hiatus hernia?

A

Movement of the fundus through the hiatus

66
Q

What is the disease in which where abnormal erythrocytes are produced where they can uptake iron but not Incorporated it into the haem?

A

Sideroblastic Anaemia

67
Q

What is the toxic molecule that builds up in cirrohisis and why?

A

Ammonia

As the pressure builds the flow through sinucoids reduces, making the liver less effective at filtering and carrying out metabolism.

68
Q

If esophageal cancer is suspected what investigation may be done?

A

Esophagogastroduodenoscopy with biopsy

69
Q

if a person has a reduction in Transferrin, or a chronic bleed, what could they develop and why and what would the RBCs look like?

A

Anaemia

Due to inability to absorb or transfer Iron into the RBCs.

the RBCs will appear pale and small. called Hypochromatic anamia

70
Q

What are the risk factors for oesphageal carinoma?

A

GORD

High BMI

Fatty foods

Smoking

Alcohol

71
Q

In pancreatitis where is the pain? and why does it radiate here?

A

Mid-epigastric that radiates to the back

  • radiates because the organ is retroperitoneal and as result induces inflammation in that areas as well as to the lesser sac
72
Q

Name 3 clinical findings that may be present in chronic pancreatits:

A

Elevated blood glucose

Jaundice

Malnutrition/ vitamin deficiency - increased INR

73
Q

How is Gairdia pathogenic?

A

It causes dysregulation to the brush border enzymes - resulting in lack of nutrient breakdown.
this induces diarrhoea.
it may also cause enterocyte death.

74
Q

What is a red flag for pancreatic cancer?

A

Painless jaundice

75
Q

Outline the parthenogenesis of Ascites?

A

Due to the liver disease there is increased dialtion of splanchic vessels - which itself may lead to part of the ascites.
in order to maintain blood pressure systemic blood vessels constrict and RAAS is activated - this triggers retention of water and Na2+ - which may further augment the syndrome.
this combined with lack of albumin production leads to leakyness

Medicine 2 (28 decks)

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