GI exam notes Flashcards
hepatocytes
liver endothelial cells
stomach layers
extra muscularis layer
enterocytes
SI: siimple columnar epithelium with a brush border
primary and secondary bile salts
primary: cholic
chendeoxycholic acid
secondary: deoxycolic and lithocholic acid
russels sign and murphy sign
murphy: cholecystitiis
russel: eating disorder
fractitoius disorder
fake symptoms for no seconday gain
malingering
fake symptoms for secondary gain e.g. benefits
brunnels glands
duodenum and neutralise chyme
ascities treatment
1: spironolactone
2: tips
3: transplant
treatment of itch
sodium bicarbonate
coeliac investugation
check IgA to make sure not deficient then TTG, if +ve then biopsy
arcodermatitis enteropathica
zinc malabsorption
endoscopic treatment of bleeds
heater probe coagulation
hemospray
clips
inject medication that causes vasoconstriction
crypt cells
large and small intestine
colonocytes
large intestine epithelium
secretes ions
major difference between segmentation and hasutra
segmentation: minutes
haustra: hours
causes of chronic gastritis
autoimmune
bacterial: H.pylori
chemical: NSAIDS alcohol
histology of coeiliac
flattened glands :no villi
acinar cells
cells of the pancreas
zymogens
pancreatic proteases
stored in inactive form, activated by proteases and stored in zymogen granules surrounded by protease inhibitors
tripsin
released from pancreas as tripsinogen and activated in duodenum by enteropeptidase so can now activate zymogens
cholangiocarcinoma
bile duct cancer
peyers patches
ileum of the SI
mucosal immune system parts
epithelium: CD8 T cells
lamina propria: CD4 t cell
main antibody of mucosal immunity
IgA
key features of PBC
t cell mediated
cholestatic LFTs
AMA
t: deoxycholic acid
autoimmune hepatitis
hepatomegaly
jaundice
must give prednisolone
PSC
liver transplant
ultrasound/ MRCP
UC
where does the parotid gland drain into mouth
2nd molar tooth
where does the submandibular gland drain into mouth
lingual caruncle
metoclopramide
inc gastric emptying via vagus nerve
cells and secretion of stomach
HCL: parietal
pepsinogen: chief
mucus: gastric pits
histamine: enterochromaffin
gastrin: G cells
somatostain: D cells
additional stomach secretions
intrinsic factor: B12 absorption
enterochromaffin: iron absorption
Ach: inc acid secretion
prostaglandin: dec acid secretion
faecal peritonitis
complication of diverticulus where the bowl perforates and faeces enter the peritoneum
normal portal system pressure
8mmHg
oesophagus blood supply
thoracic: inferior thyroid artery and vein, aorta and azygous
abdomen: left gastric artery, azygous vein
portal vein: left gastric vein
what causes a volvulus
pregnancy
severe constipation
portal triad
hepatic artery
hepatic portal vein
bile duct
cantor string sign
crohns
achalasia treatment
ca channel blocker
or b blocker
virchows node
supraclavicular bump
suggests gastric cancer
oxalate renal stones
present in crohns bc of malabsorption
pharyngeal pouch
regurg
cough
dysphagia
halitosis: bad breath
treatment of hepatic encelopathy
lactulose and rifampicin
meissners plexus
enteric nervous system in the submucosa
complications of coeliac
osteoporosis
lymphoma
wilsons disease complication
haemolytic anaemia
femoral hernia
high risk of strangulation
emergency repair
below and lateral to pubic tubercle
females
inguinal hernia
superior and medial to pubic tubercle
indirect inguinal hernia
kiddos
lateral to inferior of epigastric artery
inguinal ring
direct inguinal ring
hasselbach triangle
abdo wall
disappears when cough
pylonephritis symptoms
kidney inflammation
fever
rigors
back pain
hepatoduodenal ligament
hepatic artery
hepatic duct
hepatic portal vein
hepatogastric ligament
right and left gastric vein
renal colic
pain in back in waves
blood in urine
lynch syndrome
HNPCC
mismatch repair
FAP
100s of polyps
mutation in APC tumour supressor
present young
angiodysplasia of the colon
degenerative vascular malformation intermittent gi bleed (upper and lower) >60 aortic stensois Treatment: endoscopic ablation of the abnormal vessels
prognostic indicator of alcoholic liver disease
encelopathy albumin albumin ascities PT time
pancreatic prognostic indicator
Pa02 <8pKa Age >55 Neutrophil WBC >15 Calcium <2 Renal function Urea>16 Enzymes AST/ALT>200 LDH >600 Albumin <32 Sugar >10
3= sever, CRITICAL CARE
blood supply of the small intestine
gastroduodenal artery till bile duct then SMA and SMV
gastropancreatic and superior mesenteric nodes
nerve that supplies the rectum
s4
thumb printing at splenic flexure
ischaemic colitis
abdominal pain
rectal bleeding
metabolic acidosis
mesenteric ischaemia
signet rings on biopsy
stomach cancer
alphafeto protein
gastric cancer
adrenal gland position
suprarenal
ampulla of vater
union of the pancreatic and bile duct
zollinger ellison syndrome
gastrin secreting tumour that causes hypersecretion of acid leading to gastric ulcer disease
mallory hyaline bodies
alcoholic hepatitis
coeliac trunk: where it arises and divisions
T12
splenic artery
hepatic artery
left gastric artery
holes in diaphragm
T8: vena cava
T10: oesophagus
T12: aortic hiatus
cheek msucle that moves food during mastication
buccinator
onion skinning fibrosis and beading of bile ducts
PSC
caput medusae
medusa from umbilicus
portal hypertension
tinkling bowel sounds
bowel obstruction
role of gastrin cck somatostatin glucagon GLP1 GLIP
inc HCL inc bile, pancreatic protease and lipase dec HCL and inc HCO3 hunger hormone inc insulin
what gastroenteritis cause bleeding
e coli
shigella
salmonella
campylobacter
first line for ascities
ascitic tap/ paracentesis: aspirate ascities and see if SBP(>250 cells per mm2)
then spironolactone
serum results in haemochromatosis and wilsons and treatment
haemachromatosis: high iron: venesection
wilsons: low copper: pecillamine a copper chealting agent
granulomas and IBD
crohns:non caseating granulomas
hep B or hep C acute
hep B: jaundice, asia
hep c acute: asymptomatic
prolonged laxative use
melanosis coli
brown pigmentation of coli
asymptomtic
causes death to colonic mucosa so lots of macrophages
recurrent peptic ulcers
gastrinoma: test gastrin levels
neuroendocrine tumour
Peutz Jeghers syndrome
multiple polyps
brown pigements at hand feet face
inc risk of cancer
dominant
UC endoscopy screening
low risk: every 5 years
medium risk: 3 years
high risk: annual
inc in ethogenicity
bigger
hyatid disease
sheep farming
uncooked meat
cysts: mainly liver or lung
drain with albendazole
cannot identify bleeding cause
capsule endoscopy
resistant c diff
faecal transplant:
bacterial flora from a healthy donor is given b=via enema
gilberts syndrome
jaundice genetic pre hepatic jaundice if stressed/ fatigues or viral illness can get an isolated rise in bilirubin benign
pain at night and relieved by milk
duodenal ulcer
diagnosis of achalasia
oesophogeal manometry study
dysphagia:
1) solids and liquids from start?
2) is it difficult to initiate a swallowing movement?
3) odonophagia?
4) intermittent or constant and worsening?
5) does the neck gurgle/ bulge?
1) yes: achalasia/ motility problem
no: structure
2) yes: blaber palsy, esp if cough on doing so
3) ulcer, malignancy, virus
4) intermittent: oesophogeal spasm, constant/ worsening: malignant
5) pharyngeal pouch
treatment of achalasia
endoscopic balloon dilation
hellers cariomyotomy
acute and prophylactic management of gasto-oesophogeal varices`
acute: banding or sclreotherapy
prophylaxis: b blocker
carcnoid tumour
neuroendocrine tumour of enterochromaffin cells
haemochromotosis
bronzed diabetic
tired
slate grey pigemntation
anti mitochondrial
PBC
ANTI SM
autoimmune
TTG
coeliac
ANA
autoimmune
anti GBM
goodpastures
ANCA
vasculitis
cantor string om CXR
crohns
leadpipe colon
UC
achalasia pharmacological treatment
B-blocker
Ca channel antagonist
halitosis
bad breath
coffee bean xray
sigmoid volvulus
corkscrew xray
midgut volvulus
birdspeak oesophagus
achalasia
hepatic encelopathy treatment
rifampicin and lactulose
gene in lynch vc FAP
lynch:HNPCC
FAP: APC
beta oxidation/lipolysis
fatty acid conversion to acetyl co A
- fatty acid to acyl coA (2ATP)
-acyl CoA to creatinine to cross memb then back to acyl CoA
beta oxidised
lipogenesis
acetyl CoA to citrate (TCA) to cross memb then back to acetyl Co-A. activated to menalyl Co-A by acetyl CoA carboxylase. acetyl A and menayl coA a are precursors for fatty acid synthesis.
amylase and lipase levels in hyperglycaemia induced pancreatitis
reduced
calcium and peptic ulcer
hypercalcaemia
increase alpha-fetoprotein
hepatocellular carcinoma
apart from dec acid, other role of PGE2
inc mucus and bicarbonate secretion
treatment of budd chairi
1) angicoagulation
2) angioplasty + thrombolysis
3) TIPS
4) in rapid developing ascities liver transplant
ESR
monitors inflammation
scalloping on endoscopy
coeliac
HIV
diarrhoea in immunocompromised
isospara belli
crpytosporidium
palmar arythema
liver cirrhosis
pyoderma gangrenosum
erythema nodosum
Crohns and UC
tropical sprue
chronic diarrhoea weight loss vitamin b12 folate deficiency give b spec: tetracycline and folate supplement
what is the meckels diverticulum a remnant of?
vitello intestinal duct
coeliac disease grading
0=normal 1=increased lymphocytes 2= crypt hyperplasia 3=blunt villi 4=total villious atrophy and atrophic crypts
C13 breath test
eradication of H.pylori
gold standard for H.pylori
breath test
h.pylori antibody
IgG … chronic
hep C investigation
1) hep C antibody
2) hep C RNA and genotype
treatment of hep C
genotype 1: PEG interferon, protease inhibitor and ribavirin
anal fissure: symptoms and treatment
pain on defecation
bloody stools
laxatives and GTN cream
if does not resolve surgery
hypercalcaemia
lethargy
nausea
confusion
stones
proctitis syndrome
blood and tenesmus
ceftriaxome for goonorrhea
budd chairi symptoms and affected vessel
hepatomegaly
abdominal pain
ascities
hepatic vein affected`
complication of e.coli and how to diagnose it
haemolytic uremic syndrome :
- haemolytic uremia
- acute kidney injury
- low platelet
foecal occult blood
screening for colorectal cancer
detects blood not visible by eye
alpha fectoprotein
liver tumour
cancer antigen 19-9
pancreas
carcinoembryonic antigen
large intestine
ca 125
ovarian maligancy
ACEI levels
low: obstructive pulmonary disease, hypothyroidism
high: sarcoidosis, PBC, hyperthyroidism
AMA
PBC
ANA
autoimmune:
- hepatitis
- rheumatoid
ANCA
vasculitis
PSC
IBD
autoimmune
ct of bowel obstruction
transition point of collapsed(black filled with air)/ distented bowel
management of painful hernia
surgery: suggests strangulation
paralytic ileus
disruption of the normal propulsive activity of the GI tract due to peristalsis failure
risk factors: recent surgery, inflammation
treatment: drip and suck
ogilvies syndrome
acute dilation of the bowel in the absence of any bowel obstruction in the acutely unwell
haemorrhoids
enlarged vascular cushion in the lower rectum/anal canal
painless bleeding
not mixed with stool usually bright red on paper
colonoscopy if red flags >55
treatment: grade 1: topical corticosteroid
grade 2: rubber band ligation
grade 3: rubber band ligation
grade 4: surgical haemorrhoidectomy
rectal prolapse
protruding pass from anus especially during defecation
mucus and blood are common
poor anal tone
anal prolapse
tear in the anus while passing a constipated stool
multiple fissures think crohns
fistula in ano
opening in the peri-anal skin
most commonly due to ano-rectal abscess
can be due to: crohns, carcinoma or TB
hod you test for wilsons
serum ceruloplasmin
ESR
inflammmation
causes of AF
chest infections
valve disease
alcoholism
MI
