GI Formative Flashcards
Thirty years ago, a bilateral vagotomy (cutting of right and left vagus nerves) was
performed on a male patient undergoing surgery for gastric ulceration.
What would be the consequences for SALIVARY SECTRETION?
No effect on salivary secretion.
No vagal innervation of head and neck.
(Facial and glossopharyngeal control parasympathetic secretion of saliva)
Thirty years ago, a bilateral vagotomy (cutting of right and left vagus nerves) was
performed on a male patient undergoing surgery for gastric ulceration.
What would be the consequences for PARIETAL CELL HCL SECRETION?
Direct stimulation of parietal cell HCl secretion (ACh pathway) would be removed. Therefore reduced HCl output.
(Also, reduced activation via vagal stimulated histamine release from ECL cells and via vagus-mediated gastin release from G cells)
Thirty years ago, a bilateral vagotomy (cutting of right and left vagus nerves) was
performed on a male patient undergoing surgery for gastric ulceration.
What would be the consequences for G CELL GASTRIN SECRETION
Stimulation of gastrin secretion during cephalic phase of gastric acid secretion (sight,
smell, taste) would be removed.
However, distension/peptide-induced stimulation of
G-cell secretion would remain.
Thirty years ago, a bilateral vagotomy (cutting of right and left vagus nerves) was
performed on a male patient undergoing surgery for gastric ulceration.
What would be the consequences for GASTRIC MOTILITY
Gastric motility would be reduced but local enteric reflexes would maintain a degree
of motility.
Specifically, gastric emptying into the duodeum would be reduced
Thirty years ago, a bilateral vagotomy (cutting of right and left vagus nerves) was
performed on a male patient undergoing surgery for gastric ulceration.
What would be the consequences for DEFECATION
Defaecation reflex mediated via vagus, therefore vagotomy would limit ability to
defecate.
Particularly reflex contraction of rectum and control of internal and
external anal sphincter tone
List five relevant questions to ask in order to clarify RUQ pain:
history of gallstones
characteristics of pain
any previous episodes of
pain/jaundice
any episodes of pyrexia
foreign travel
IV drug abuse
sexual contact
blood transfusion or blood products
alcohol history
prescribed drug history
any tattoos
colour of urine
has there been a change of colour of urine?
is there a change in stool?
is there a relation between meals and pain?
If a jaundiced patient with gallstones has significantly raised alkaline phosphatase, but normal alanine and aspartate what kind of jaundice is present?
Post Hepatic
Conjugated Bilirubin
List three possible causes of obstructive jaundice:
Gallstone in CBD
Tumour in CBD
Stricture of CBD
Carcinoma in head of pancreas
Tumour of Ampulla of Vater
Tumour of CHD
What INITIAL imaging investigation would you arrange to investigate the biliary tree?
Ultrasound
Give four complications of gallstones:
Acute inflammation of gall bladder
Chronic inflammation of gall bladder
Perforation of gall bladder
Carcinoma of gall bladder
Pancreatitis
Jaundice
Secondary biliary cirrhosis
Biliary Colic
Small bowel obstruction
Mucocele
Empyema
Biliary Peritonitis
State three risk factors for developing gallstones
Fat
Female
Fertile
Fourty
Diabetes
Hyperlipidemia
Why does jaundice affect the clotting system?
Absence of bile in small bowel
Failure of absoroption of fat soluble vitamins (i.e. Vit K)
Vit K is required for clotting factor synthesis.
Give four differentials for haematemesis
Gastritis
Peptic Ulcer
Gastric carcinoma
Oesophageal varices
Oesophageal carcinoma
Mallory Weiss Tear
What investigation would a gastroenterologist perform to establish a diagnosis?
UPPER GI endoscopy
With biopsy of lesion
What is the process of development for Gastric Cancer?
Normal
Chronic Gastritis
Intestinal Metaplasia
Dysplasia
Carcinoma
