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Semester 3 - me > GI Group And Lecs > Flashcards

GI Group And Lecs Flashcards

0
Q

How long is the oesophagus and where does it begin and end?

A

25cm, begins at the cricoid cartilage and ends at the cardiac notch

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1
Q

What type of epithelium is in the oesophagus?

A

Stratified squamous

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2
Q

Where is it important to measure for a nasogastric tube and how long is it?

A

From the incisors to the oesophagogastric junction, 38-40cm

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3
Q

Explain 2 changes you’d see in Barrett’s oesophagus

A

Goblet cells
Simple columnar
Both in the oesophagus

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4
Q

What can Barrett’s oesophagus lead to?

A

Adenocarcinoma

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5
Q

Name some causes of dysphagia

A

Narrowing in food pathway eg tumour
Benign narrowing, fibrous ring
Achalasia - the failure to relax the lower oesophageal spinchter

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6
Q

What are oesophageal varricies?

A

These are dilated mucosal veins in the oesophagus that can lead to torrential bleeding
Due to portal hypertension as instead of the hepatic portal vein blood drains into the left gastric which leads to the oesophagus

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7
Q

What are haemorrhoids?

A

Haemorrhoids are actual normal swellings which help maintain continence, they swell to stop faeces leaking.
They can distend beyond normal limits and can cause symptoms and are called internal/external based on the Denate line

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8
Q

What are the symptoms of swollen haemorrhoids?

A

Bleeding, itching, pain

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9
Q

Define diverticula

A

This is when there are small mucosal herniations which protrude through the intestines through small openings such as vasa recta.
They are. Im in in the sigmoid colon as there is a high pressure here

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10
Q

What are the symptoms of the small intestines blocking?

A

Pain
Vomitting
Abdominal distention

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11
Q

What is a Meckels diverticulum?

A

This is a vestigial remnant of the vitellointestinal duct forming a diverticulum which presents as appendicitis like or a volvulus
It follows the rule of 2s, 2 feet away from cecum, 2 inches long, 2% population

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12
Q

What would the removal of the small intestines result in?

A

Watery and fatty stools

Crohn’s, coeliac disease and malabsorption may lead to this being removed

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13
Q

What secretions does the major duodenal papilla recieve?

A

Gall bladder and pancreas

Bile, enzymes and neutralising juices

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14
Q

Where are peptic ulcers common?

A

Duodenum (first part)
Lesser curve of the stomach
Can perforate

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15
Q

Why can’t you see the upper part of the oesophagus very well with endoscopy?

A

Because peristalsis brings it down

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16
Q

What do 30% of Down syndrome patients present with in terms of GI?

A

Duodenal atresia

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17
Q

What are peyers patches and where are they found?

A

These are large lymph node aggregations found in the lamina propria of the small intestine
Oesophagus, appendix.

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18
Q

What is the history of the oesophagus?

A

Stratified squamous
First 1/3 is somatic
Smooth muscle

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19
Q

What is the history of the stomach?

A 
Simple columnar 
Rugae 
Goblet cells
Strong pylorus 
Mucosal spinchter
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20
Q

What is the history of the small intestine?

A 
Simple columnar
Brush border of microvilli
Pilicae circulares 
Inner and outer smooth muscle 
Common bile duct
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21
Q

What is the history of the large intestine?

A

3 layers of teniae coli
Ilio-coecal valve
Mucous secreting glands

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22
Q

What is the history of the anus?

A

Denate line
Below is stratified squamous, sebaceous and sweat glands
Above is simple columnar

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23
Q

What teeth are responsible for cutting?

A

Incisors

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24
What teeth are responsible for crushing?
Molars
25
What is saliva in relation to plasma?
Hypotonic
26
What is the volume of saliva determined by?
Acinar secretions
27
What is the composition of saliva determined by?
Ductal cells
28
What are the properties of stimulated saliva?
High volume, less hypertonic, more alkaline, lots of enzymes
29
What are the properties of resting saliva?
Hypertonic, low volume, neutral, fewer enzymes
30
What is the sympathetic control of saliva?
Superior central ganglion
31
What is the parasympathetic control of saliva?
Glossopharyngeal | Olic ganglion
32
What is dysphagia investigated by?
``` CT MRI Video fluoroscopy Ogd Manometry ```
33
What are the triggers of IBD?
``` Antibiotics Stress Diet Infection Smoking ```
34
What are the environmental causes of Crohn's?
Nsaids Smoking Early Appendicecromy
35
What are the genetic predispositions of Crohn's?
Card15 IBD1 NOD2
36
What Histological changes would you see in Crohn's?
Granulomas | Lymphoid hyperplasia
37
What Histological features would you see with uc?
Goblet cell depletion | Crypt abscesses
38
What tests would you use for uc and Crohn's?
ANCA for uc | ANSA for Crohn's
39
What are interstitial crypts?
These are glands which line the epithelia which sit at the base of the villi and have a role in turnover in gut base They have an ability to absorb as they move up
40
What is the function of the unstirred layer and the enzymes being in it?
To stop digestion of the wall itself | Enzymes in it and allows slow diffusion for food to be broken down
41
What is the gastro colic reflex
This reflex is stretching after a meal following peristalsis which can include mass movement
42
How is vitamin b12 absorped?
Carbalamine is taken in via the diet and absorbed by intrinsic factor. Carbalamine is responsible for the absorption of vitamin b12 so if there is a deficiency in instrinsic factor then this can lead to pernicious anaemia and you need carbalamine injected for the rest of your life
43
How is a lack of intrinsic factor thought to be caused?
Autoimmune gastritis and destruction of parietal cells and therefore a lack of intrinsic factor
44
What are the symptoms of pernicious anaemia?
Tachycardia, low grade fever, glossitis, cognitive impairment, paraesthesia, unsteady gait
45
What are kupffer cells?
Specialised macrophages which reside in the wall of hepatic sinusoids Promote homeostasis Release inflammatory mediators
46
What is mesenteric adenitis?
This is confused with appendicitis | Inflammatory response where mesenteric lymph nodes in right lower quadrant become inflammed and produce similar pain
47
What is dyspepsia?
Upper abdominal pain, heart burn, acid reflux, nausea and vomitting
48
Define GORD
Disorder in which there is an ineffective lower oesophogeal spinchter which causes stomach contents to empty into the oesphagus
49
What does h pylori do and use to adapt to stomach conditions?
Uses flagellum and chemotaxins to adhere to and colonise cell wall. Produces urease which is converted to ammonia and neutralises the stomach so it can colonise it
50
How do you treat h pylori?
PPI Metreonidazole, PPI, amoxicillin, clarithromycin H2 antagonist
51
Why is PPI more effective than h2 antagonist
Because PPI blocks proton pump and therefore blocks gastrin, Ach and histamine whereas h2 only blocks histamine
52
What does the interstitial phase of stomach release in response to a low ph in the stomach?
Somatostatin which inhibits gastrin Cck Gastrin inhibitory hormone
53
What slows gastric emptying?
Low ph, hypertonicity, fatty acids
54
What is the Glasgow coma scale a measure of?
Conscious level
55
What can an abdominal stab wound lead to?
Shock -> peritonitis | Blood loss
56
Why is a femoral hernia more likely to be incarcinated than an inguinal?
Because femoral canal is tighter
57
What symptoms does a bowel obstruction lead to?
Nausea, vomitting, peroration, abdo pain, necrosis if strangulated, colicky pain, electrolyte imbalance
58
What does secretin stimulate?
Bicarbonate rich pancreatic secretions
59
What does cck stimulate?
Enzyme rich pancreatic secretions
60
Define a globulis
Sensation of a lump in your throat
61
Define odynophagia
Painful swallowing | Mainly due to a tumour, candidiasis or PU
62
Why is swallowing food easier than Iiquid?
Due to chance of aspiration.
63
What can cerebral accidents lead to in terms of swallowing?
Lack of control of tongue, laynx and pharynx
64
What does parasympathetic stimulation of salivary glands do?
Acts upon the acinar cells for primary secretion and the ductal cells for HCO3- secretion Muscurinic receptors Extra blood flow
65
Describe achalasia
This is where there is a destruction of part of the enteric nervous system along the oesophagus which leads to a narrowing, lack of peristalsis, failure of LOS to relax and affects both solids and liquids
66
Name some causes of a narrowed oesophagus
Enlarged aorta Fibrous rings Tumour Lesions
67
What should be checked after a head injury in terms of swallowing?
Brain stem function due to a high risk of aspiration | This is absent in brain death
68
Explain what happens during swallowing (vol and involuntary phases)
Masstication, formation of a bolus, stimulates swallowing Voluntary phase where you move it into the pharynx Involuntary phase where pressure receptors in the palate and anterior pharynx lead to an inhibition of respiration, raising of larynx, glottis closing and opens oesophogeal spinchter
69
Explain what happens in the oesophogeal phase of swallowing
Upper third of oesophagus is voluntary, bottom 2/3 are smooth Rapid peristalsic wave Transit time to stomach is 10 seconds LOS opens
70
What are common GI presentations?
Abdo pain, abdo distention, dysphagia, dyspepsia, diarrhoea, constipation, anorexia
71
What is dyspepsia?
Abdominal pain, heart burn, bloating
72
What are the causes of dyspepsia?
GORD Ulcer Malignancy Functional - 3 months of pain with no cause
73
What would you do for dyspepsia?
Empirical acid suppression Investigate h pylori Upper endoscopy
74
What is abdominal pain?
Pain in the abdomen, very common and multiple causes
75
How do you classify abdominal pain?
Where it is Which embryological region Intra or extra peritoneal
76
Name some examples of foregut pain
Gall stones Pancreatitis Ulcers
77
Name some midgut examples of pain
Colicky pain - every 2/3 mins in small, 10/15 in large Obstruction Appendicitis
78
What are the symptoms of small bowel obstruction?
Pain, vomitting, distention | X ray shows distended loops and circular folds
79
Name some examples of hindgut pain
Volvulus | Obstruction
80
What are some causes of anorexia
``` Anxiety Depression Cancer Endocrine Pregnancy Anger ```
81
With what percentage of unintentional weight loss should you investigate?
>5%
82
Name some causes of food poisoning
``` Cholecystits Gastroenteritis Appendicitis Viral hepatitis Infection Pain Blockage ```
83
What are some causes of constipation?
``` Diet Disease Dehydration Medication Immobility Functional ```
84
What are the different classifications of diarrhoea and give an example
``` Secretory - infection Osmotic - lactose intolerant Abnormal motility - IBS Malabsorption - steatorrhoea Exudate - cancer ```
85
What is dysphagia?
A difficulty swallowing
86
What is odynophagia?
Painful swallowing
87
What are the causes of dysphagia?
Neuro | Anatomical
88
Why do you bleed from the upper GI?
Oesophogeal varricies Tumour Tear in oesophagus Erosive oesophogitis
89
Why do you bleed from the lower GI?
``` Angiodysplasia Diverticulum disease Crohn's Carcinoma Haemorrhoids ```
90
Why do you get abdominal distention?
``` Fluid Fat Faeces Foetus Flatus ```
91
Why do you get fluid Ascites?
Liver failure Portal hypertension Cancer
92
Define flatus
Swallowing of air leading to gas in the bowel
93
What should you look for during a GI practical?
Hand signs Jaundice Spider naevi Organomegally
94
What prophylactic antibiotics can you use for dirty surgery?
Metrionadazole kills anaerobic bacteria | Gentamicin
95
How is Norovirus spread?
Faecal oral route
96
What is the incubation period for Norovirus?
1-2 days
97
What are signs of dehydration?
``` Mucous membranes Sunken eyes Skin turgor Shock Little urine Tachypnoea and tachycardia ```
98
What is travellers diarrhoea caused by?
ETEC
99
How does ETEC cause travellers diarrhoea?
Adhesins, allow enterotoxins to stimulate liquid release from cells
100
Name some small intestine tumours
Lymphoid Carcinoid Carcinoma
101
What do hot flushes and watery diarrhoea indicate?
Carcinoid tumour
102
What are the most common male tumours?
Prostate, lung, colorectal, bladder, non Hodgkin's lymphoma
103
What are the common female cancers?
Breast, lung, colorectal, uterus and ovarian
104
How can GI cancers metastasise?
Invasion Lymph Haemo Peritoneal dissemination
105
What are the causes of large bowel obstructions?
60% malignancies 20% diverticular disease 5% volvulus
106
What are the symptoms of pancreatic cancer?
``` Pale stools Dark urine Jaundice Weight loss Back pain ```
107
What is endoscopic retrograde cholangiopancreatography?
Using forceps to remove gallstones in an endoscopy but there is a risk of infection,perforation, pancreatitis, haemmorage

Semester 3 - me (8 decks)

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