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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
Q

What teeth are responsible for crushing?

A

Molars

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25
Q

What is saliva in relation to plasma?

A

Hypotonic

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26
Q

What is the volume of saliva determined by?

A

Acinar secretions

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27
Q

What is the composition of saliva determined by?

A

Ductal cells

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28
Q

What are the properties of stimulated saliva?

A

High volume, less hypertonic, more alkaline, lots of enzymes

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29
Q

What are the properties of resting saliva?

A

Hypertonic, low volume, neutral, fewer enzymes

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30
Q

What is the sympathetic control of saliva?

A

Superior central ganglion

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31
Q

What is the parasympathetic control of saliva?

A

Glossopharyngeal

Olic ganglion

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32
Q

What is dysphagia investigated by?

A 
CT
MRI 
Video fluoroscopy 
Ogd 
Manometry
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33
Q

What are the triggers of IBD?

A 
Antibiotics
Stress
Diet 
Infection 
Smoking
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34
Q

What are the environmental causes of Crohn’s?

A

Nsaids
Smoking
Early Appendicecromy

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35
Q

What are the genetic predispositions of Crohn’s?

A

Card15
IBD1
NOD2

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36
Q

What Histological changes would you see in Crohn’s?

A

Granulomas

Lymphoid hyperplasia

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37
Q

What Histological features would you see with uc?

A

Goblet cell depletion

Crypt abscesses

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38
Q

What tests would you use for uc and Crohn’s?

A

ANCA for uc

ANSA for Crohn’s

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39
Q

What are interstitial crypts?

A

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

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40
Q

What is the function of the unstirred layer and the enzymes being in it?

A

To stop digestion of the wall itself

Enzymes in it and allows slow diffusion for food to be broken down

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41
Q

What is the gastro colic reflex

A

This reflex is stretching after a meal following peristalsis which can include mass movement

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42
Q

How is vitamin b12 absorped?

A

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

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43
Q

How is a lack of intrinsic factor thought to be caused?

A

Autoimmune gastritis and destruction of parietal cells and therefore a lack of intrinsic factor

44
Q

What are the symptoms of pernicious anaemia?

A

Tachycardia, low grade fever, glossitis, cognitive impairment, paraesthesia, unsteady gait

45
Q

What are kupffer cells?

A

Specialised macrophages which reside in the wall of hepatic sinusoids
Promote homeostasis
Release inflammatory mediators

46
Q

What is mesenteric adenitis?

A

This is confused with appendicitis

Inflammatory response where mesenteric lymph nodes in right lower quadrant become inflammed and produce similar pain

47
Q

What is dyspepsia?

A

Upper abdominal pain, heart burn, acid reflux, nausea and vomitting

48
Q

Define GORD

A

Disorder in which there is an ineffective lower oesophogeal spinchter which causes stomach contents to empty into the oesphagus

49
Q

What does h pylori do and use to adapt to stomach conditions?

A

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
Q

How do you treat h pylori?

A

PPI
Metreonidazole, PPI, amoxicillin, clarithromycin
H2 antagonist

51
Q

Why is PPI more effective than h2 antagonist

A

Because PPI blocks proton pump and therefore blocks gastrin, Ach and histamine whereas h2 only blocks histamine

52
Q

What does the interstitial phase of stomach release in response to a low ph in the stomach?

A

Somatostatin which inhibits gastrin
Cck
Gastrin inhibitory hormone

53
Q

What slows gastric emptying?

A

Low ph, hypertonicity, fatty acids

54
Q

What is the Glasgow coma scale a measure of?

A

Conscious level

55
Q

What can an abdominal stab wound lead to?

A

Shock -> peritonitis

Blood loss

56
Q

Why is a femoral hernia more likely to be incarcinated than an inguinal?

A

Because femoral canal is tighter

57
Q

What symptoms does a bowel obstruction lead to?

A

Nausea, vomitting, peroration, abdo pain, necrosis if strangulated, colicky pain, electrolyte imbalance

58
Q

What does secretin stimulate?

A

Bicarbonate rich pancreatic secretions

59
Q

What does cck stimulate?

A

Enzyme rich pancreatic secretions

60
Q

Define a globulis

A

Sensation of a lump in your throat

61
Q

Define odynophagia

A

Painful swallowing

Mainly due to a tumour, candidiasis or PU

62
Q

Why is swallowing food easier than Iiquid?

A

Due to chance of aspiration.

63
Q

What can cerebral accidents lead to in terms of swallowing?

A

Lack of control of tongue, laynx and pharynx

64
Q

What does parasympathetic stimulation of salivary glands do?

A

Acts upon the acinar cells for primary secretion and the ductal cells for HCO3- secretion
Muscurinic receptors
Extra blood flow

65
Q

Describe achalasia

A

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
Q

Name some causes of a narrowed oesophagus

A

Enlarged aorta
Fibrous rings
Tumour
Lesions

67
Q

What should be checked after a head injury in terms of swallowing?

A

Brain stem function due to a high risk of aspiration

This is absent in brain death

68
Q

Explain what happens during swallowing (vol and involuntary phases)

A

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
Q

Explain what happens in the oesophogeal phase of swallowing

A

Upper third of oesophagus is voluntary, bottom 2/3 are smooth
Rapid peristalsic wave
Transit time to stomach is 10 seconds
LOS opens

70
Q

What are common GI presentations?

A

Abdo pain, abdo distention, dysphagia, dyspepsia, diarrhoea, constipation, anorexia

71
Q

What is dyspepsia?

A

Abdominal pain, heart burn, bloating

72
Q

What are the causes of dyspepsia?

A

GORD
Ulcer
Malignancy
Functional - 3 months of pain with no cause

73
Q

What would you do for dyspepsia?

A

Empirical acid suppression
Investigate h pylori
Upper endoscopy

74
Q

What is abdominal pain?

A

Pain in the abdomen, very common and multiple causes

75
Q

How do you classify abdominal pain?

A

Where it is
Which embryological region
Intra or extra peritoneal

76
Q

Name some examples of foregut pain

A

Gall stones
Pancreatitis
Ulcers

77
Q

Name some midgut examples of pain

A

Colicky pain - every 2/3 mins in small, 10/15 in large
Obstruction
Appendicitis

78
Q

What are the symptoms of small bowel obstruction?

A

Pain, vomitting, distention

X ray shows distended loops and circular folds

79
Q

Name some examples of hindgut pain

A

Volvulus

Obstruction

80
Q

What are some causes of anorexia

A 
Anxiety 
Depression 
Cancer
Endocrine 
Pregnancy 
Anger
81
Q

With what percentage of unintentional weight loss should you investigate?

A

> 5%

82
Q

Name some causes of food poisoning

A 
Cholecystits
Gastroenteritis
Appendicitis
Viral hepatitis 
Infection 
Pain
Blockage
83
Q

What are some causes of constipation?

A 
Diet 
Disease
Dehydration 
Medication 
Immobility 
Functional
84
Q

What are the different classifications of diarrhoea and give an example

A 
Secretory - infection
Osmotic - lactose intolerant 
Abnormal motility - IBS
Malabsorption - steatorrhoea 
Exudate - cancer
85
Q

What is dysphagia?

A

A difficulty swallowing

86
Q

What is odynophagia?

A

Painful swallowing

87
Q

What are the causes of dysphagia?

A

Neuro

Anatomical

88
Q

Why do you bleed from the upper GI?

A

Oesophogeal varricies
Tumour
Tear in oesophagus
Erosive oesophogitis

89
Q

Why do you bleed from the lower GI?

A 
Angiodysplasia 
Diverticulum disease
Crohn's 
Carcinoma 
Haemorrhoids
90
Q

Why do you get abdominal distention?

A 
Fluid
Fat
Faeces
Foetus 
Flatus
91
Q

Why do you get fluid Ascites?

A

Liver failure
Portal hypertension
Cancer

92
Q

Define flatus

A

Swallowing of air leading to gas in the bowel

93
Q

What should you look for during a GI practical?

A

Hand signs
Jaundice
Spider naevi
Organomegally

94
Q

What prophylactic antibiotics can you use for dirty surgery?

A

Metrionadazole kills anaerobic bacteria

Gentamicin

95
Q

How is Norovirus spread?

A

Faecal oral route

96
Q

What is the incubation period for Norovirus?

A

1-2 days

97
Q

What are signs of dehydration?

A 
Mucous membranes
Sunken eyes
Skin turgor 
Shock 
Little urine 
Tachypnoea  and tachycardia
98
Q

What is travellers diarrhoea caused by?

A

ETEC

99
Q

How does ETEC cause travellers diarrhoea?

A

Adhesins, allow enterotoxins to stimulate liquid release from cells

100
Q

Name some small intestine tumours

A

Lymphoid
Carcinoid
Carcinoma

101
Q

What do hot flushes and watery diarrhoea indicate?

A

Carcinoid tumour

102
Q

What are the most common male tumours?

A

Prostate, lung, colorectal, bladder, non Hodgkin’s lymphoma

103
Q

What are the common female cancers?

A

Breast, lung, colorectal, uterus and ovarian

104
Q

How can GI cancers metastasise?

A

Invasion
Lymph
Haemo
Peritoneal dissemination

105
Q

What are the causes of large bowel obstructions?

A

60% malignancies
20% diverticular disease
5% volvulus

106
Q

What are the symptoms of pancreatic cancer?

A 
Pale stools 
Dark urine 
Jaundice
Weight loss
Back pain
107
Q

What is endoscopic retrograde cholangiopancreatography?

A

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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