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GI > GI pharmacology > Flashcards

GI pharmacology Flashcards

1
Q

what do PPIs do

A

irreversible inhibition by covalent modification of the gastric gland, parietal cell H+/K+ atp ase

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2
Q

where is the h+/K+ ATPase present

A

on the apical canalicular membrane

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3
Q

what is the H+/K+ atpase

A

the final pathway by which gastrin, ach and histamine increase gastric acid production, therefore blocking the h/k ATPase is more effective than h2 antagonists which is a competitive antagonist of H2 receptor and only blocks the action of histamine

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4
Q

when are PPIs used

A

in the treatment of GU, DU and GORD

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5
Q

what are some of the side effect to PPIs

A

are thought to increase the risk of clostridium difficile if used for long term, may disguise gastric cancer, diarrhoea, headache, abdo pain ,nausea and fatigue

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6
Q

what does the PPI interact with that can affect the absorption of other drugs

A

P450

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7
Q

what does interaction with P450 do

A

decrease platelet activity of clopidogrel

increase the effect of phenytoin and warfarin

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8
Q

describe the 4 parts to the structure of the internal alimentary canal

A

most inner layer is the muscosa which is made up of epithelium, lamina propria, a thin layer of looseconnective tissue and the muscularis mucosa-thin layer of smooth muscle
submucosa-loose connective tissue
muscularis externa-circular muscle then longitudinal muscle
serosa or adventitia-outer layer of connective tissue

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9
Q

what structures are found in the stomach

A

gastric pits and at the bottom of the gastric pit are 1-7 gastric glands

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10
Q

what is contained within the isthmus of the gastric pit

A

mostly parietal cells

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11
Q

what mutation is present in the HNPCC gene

A

mutation in DNA mismatch repair gene

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12
Q

what cells are present in the neck of the gastric pit

A

mucous and stem

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13
Q

what cells are present in the base of the gastric pit

A

mostly chief a few parietal and neuroendocrine cells

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14
Q

where are parietal cells found

A

in the isthmus of the gastric pit

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15
Q

where are mucous and stem cells found

A

neck

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16
Q

where are chief cells a few parietal and neuroendocrine cells found

A

base of the gastric pit

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17
Q

what layer is increased to form the pyloric sphincter

A

the inner circular layer is increased to form the pyloric sphincter

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18
Q

what does the cardia have

A

deep gastric pits, that branch into loosely packed tortuous glands

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19
Q

what does the body of the stomach have

A

shallow pits

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20
Q

what does the pylorus have

A

deep gastric pits with branched coiled gastric glands at a higher density than in the cardia

21
Q

what des the small intestine contain

A

crypts of lieberkuhn

22
Q

what does the duodenum contain and what is so unique about their location

A

brunners glands in the submucosa, this is unusual as it is the only part of the GI tract with glands in the submucosa

23
Q

where are the plicae circularis located

A

in the mucosa and submucosa

24
Q

what is located in the mucosa and submucosa of the jejunum

A

plicae circularis

25
Q

what is contained within the ileum and where

A

lymphoid follicles called payers patches in the submucosa and often extending into the lamina propria

26
Q

what are enterocytes made of

A

tall columnar epithelium cells with a brush border

27
Q

what do goblet cells produce and what does this cause

A

goblet cells produce mucin and this protects the epithelium and lubricates the passagage of material

28
Q

what are the two types of cell in the large intestine

A

absorptive cells which remove salts and thereby water and goblet cells which serete mucus to lubricate the colon

29
Q

describe some features of the appendix

A

a blind ending hollow extension of the caecum
less crypts than in the colon
circular arrangement of lymphoid tissue in submucosa and often lamina propria
lymphoid tissue declines with age

30
Q

what is there between the rectum and anal canal

A

a distinct junction between the mucosa of the rectum and stratified squamous epithelium of anal canal
2-3 cm long canal is then continuous with stratified squamous epithelium of the surrounging skin

31
Q

where is auerbachs myenteric plexus

A

in between the longitudinal and circular muscle layer

32
Q

where is meissners submucosal plexus

A

in the submucosa

33
Q

name the 2 parts of the ENS

A

auerbachs myenteric plexus and meissners submucosal plexus

34
Q

what si the first line investiagation for biliary colic

A

ultrasound

35
Q

what is the first line investigation for diverticulitis

A

CT

36
Q

what is the first line investigation for pancreatitis

A

ultrasouns to exclue gallstones or biliary obstruction and then CT to evaluate complications eg necrosis

37
Q

what is first line investigation for appendicitis

A

ultrasound

38
Q

what is the first line investigation for a distended abdomen

A

depends what you think the cause is
fluid-ultra sound
bowel source-AXR

39
Q

what si the first line investigation for a distended abdomen thought to be caused by bowel

A

AXR

40
Q

first line investigation for distended abdomen caused by fluid

A

ultrasound

41
Q

if suspect perforation what investigation do you do

A

erect CXR

42
Q

what is the first line investigation for jaundice

A

ultrasound

43
Q

if a post hepatic cause of jaundice was identified on ultrasound what would be the next investigation

A

ERCP/MRCP

44
Q

if an intrahepatic cause of jaundice was found on ultrasound what investigation would you do next

A

CT

45
Q

if cirrhosis was seen on ultrasound what investigation would you do next

A

Biopsy (guided by ultrasound)

46
Q

when are fluoroscopic contrast studies used

A

if small bowel disease is suspected with strictures wall thickening, fistulation

47
Q

how does plummer vinson present

A

patient being investigated for anaemia and then complains of dysphagia

48
Q

what can long term oesophageal reflux cause that is benign

A

a stricture

GI (13 decks)

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