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Physiology - Hayley > GI Physiology > Flashcards

GI Physiology Flashcards

1
Q

What are the three top conditions of the upper GI tract

A

Peptic ulcer disease, gasto-esophogeal reflux, gastric cancer

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2
Q

What are common presentations of gastroenterology pathology

A

Acute GI bleed, dysphagia, dyspepsia, abdominal pain, malabsorbtion

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3
Q

What is dysphagia

A

Dysfunction in swallowing

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4
Q

What is Dyspensia

A

dysfunction in stomach

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5
Q

What are the three main functions of mastication

A

Lubricate food with salive
Physically grinds up food to facillitate swallowing
Being chemical digestion

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6
Q

What are the two chemical digestive enzymes found in saliva

A

Salivary amylase and lingual lipase

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7
Q

What is deglutination

A

swallowing

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8
Q

What type of neural control is the muscle involved in swallowing innervated by

A

Muscles in back of oral cavity - Striated muscle under voluntary control, innervated by somatic motor neurons

Lower 2/3 of oesophagus - smooth muscle innervated by autonomic neurons

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9
Q

What phases of swallowing are voluntary and involuntary

A

Oral phase - voluntary
Pharyngeal phase/oesophageal phase - involuntary

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10
Q

Explain the oral phase of swallowing

A

Movement of food to the back of the mouth by the tounge, oropharyngeal receptors detect the food bolus and stimulate the next phase

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11
Q

Explain the pharyngeal phase of swallowing

A

Soft palate lifts up to block the nasopharynx
Vocal chords close off opening of the larynx
Epiglottis folds down to cover vocal chords protecting the airway
Upper oesophageal sphincter relaxes, peristaltic waves push food through pharynx

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12
Q

Explain the oesophageal phase of swallowing

A

Food bolus is moved towards the stomach by peristalsis contraction

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13
Q

Where is the swallowing centre located in the brain

A

Medulla

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14
Q

What cranial nerve is the vagal nerve innervated by

A

Carinal nerve 10 (X)

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15
Q

What nerve and what cranial nerves are primarily involved in swallowing

A

Nucleus ambiguous

Cranial nerves IX and X

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16
Q

Damage of what nerves can cause dysfunction of swallowing

A

V, IX,X

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17
Q

What is Achalasia

A

Occurs when the LOS fails to relax during swallowing so food cannot pass through to the stomach

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18
Q

What nerve is their dysfunction in during achalasia

A

Myenteric plexus

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19
Q

What are 4 treatments options for people with achalasia

A
  1. medication (Ca2+ channel blockers, nitrates, beta blockers)
  2. Mechanical dilation
  3. Chemical paralysis (botox)
  4. Surgical myotomy
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20
Q

What are common symptoms of GORD

A

heartburn, cough, sore throat

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21
Q

What part of the anatomy is dysfunction in GORD

A

LOS is opening inappropriately

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22
Q

What occurs to the epithelium in Barrett oesophogus

A

replacement of the oesophageal stratified squamous epithelium with columnar cells that are more similar to gastric mucosa

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23
Q

What is the effect of GORD on oesophageal structure

A

Can result in narrowing of the oesophagus, making it difficult to swallow

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24
Q

What is GORD most commonly treated with

A

Medications to reduce the secretion of HCl - histamine receptor blockers and proton pump inhibitors

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25
Q

What can be the consequence of pyloric obstruction

A

May result in persistent vomiting = malnutrition, loss of H+ ions = metabolic alkalosis

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26
Q

What can be the conseuqence of obstruction distal to the stomach

A

Anti-peristaltic reflux from the small intestine, intestinal juices flow back to stomach

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27
Q

What is the consequence of obstruction in the distal colon

A

constipation, which can eventually lead to vomiting, dehydration

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28
Q

What is esophagitis and which individuals are at high risk of getting it

A

Infection with candida (herpes simplex)

Common in immunosuppressed individuals

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29
Q

What sorts of cancers develop along different areas of the oesophagus

A

Squamous cancers in the middle and upper portions

Adenocarcinoma in lower third

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30
Q

What is gastritis, what can cause it

A

Inflammation of gastric mucosa

Caused by aspirin and alcohol

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31
Q

What can be a consequence of gastritis and why

A

Increased chance of ulcers due to increased permeability of the damaged mucosa susceptible to HCl damage

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32
Q

What would be the result of no HCl secretion

A

Pepsin wouldn’t be activated

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33
Q

What is pernicious anaemia

A

Loss of intrinsic factor resulting in impacted absorption of vitamin B12

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34
Q

Where are gastric ulcers most commonly found

A

Near the pyloric sphincter

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35
Q

What are mechanically ventilated patients highly susceptible to developing

A

Highly susceptible to gastric stress ulcers.
They are treated with medication however this increases their chances of having colonisation by gram negative bacteria, causing pneumonia

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36
Q

What is the negative effect of gastric pH lowering medication such as proton pump inhibitors

A

They lower the ability for the mucosa to barrier against gram negative bacteria

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37
Q

What is Gastronoma

A

Rare disease where patients present with gastric ulcers due to high rates of gastric acid secretion

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38
Q

What is Omeprazole

A

potent inhibitor of parietal cells H+/K+ pump

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39
Q

What is Gastroparesis

A

Delayed gastric emptying

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40
Q

Where is the vomiting centre located in the brain

A

Postrema on the lateral wall of the 4th ventricle

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41
Q

What types of nerves are innervating the lower part of the upper GI tract

A

Vagal and sympathetic nerves

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42
Q

What types of motility pattern facillitates vomiting

A

Anti peristalsis

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43
Q

What initiates the actual vomiting act

A

Distention of the duodenum

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44
Q

What is the difference between regurgitation and vomiting

A

Regurgitation occurs without effort

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45
Q

In someone with regurgitation syndrome, how soon after a meal will they regurgitate

A

Within minutes of eating

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46
Q

What is the treatment for regurgitation syndrome

A

Cognitive behaviour therapy

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47
Q

What is functional dyspepsia

A

Discomfort in the upper abdomben area with no sign of ulcers

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48
Q

What are the two main gases in the stomach

A

oxygen and nitrogen

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49
Q

What are the 5 top presentations of people with lower GI tract pathology

A

Diarrhoea
Iron defincy anaemia
Rectal bleeding
Constipation
Tenesmus (cramping when bowel is empty)

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50
Q

What 2 motility patterns are in the SI

A

Segmentation (churning)
Propulsion (propagated peristaltic contraction)

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51
Q

Which intestine has fed/fasting motility

A

Large Intestine

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52
Q

What 2 motility patterns are in the LI

A

Non-propulsive segmentation
Mass movements

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53
Q

What is Hirschsprung disease

A

congenital polygenic disorder resulting in loss of neurons from submucosal and myenteric plexus

Cant relax their sphincters

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54
Q

What spinchters are effected in Hirschsprung disease

A

The internal anal sphincter does not relax after rectal distention but the external sphincter functions normally

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55
Q

What is Hartnup disease

A

Autosomal recessive disorder associated with the small internal and renal tubule dysfunction absorption of neutral amino acids

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56
Q

What is Cystinuria

A

Autosomal recessive disorder associated with dysfunction in absorbing cationic amino acids

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57
Q

What is lysinuric protein intolerance and what does it cause

A

Rare autosomal recessive disorder defect in basolateral membrane transports resulting in malnutrition

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58
Q

What is ceoliac disease

A

Autoimmune condition leading to mucosal inflammation in the upper small bowel

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59
Q

What epithelial changes are seen in ceoliac disease

A

Elongated crypts in duodenum and jejunum

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60
Q

What food group is mostly affected by pancreatic failure

A

Fats

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61
Q

What is hemochromatosis and what can it cause

A

This is excess iron which can cause cirrhosis in the liver if it reaches toxic levels

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62
Q

What causes secretory dihorreoa and what changes are their in the mucosa as a result of this

A

Viruses or bacteria cause secretory

The mucosa becomes irritated - increased insertion of Cl- channels into luminal membrane resulting in increased secretions

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63
Q

What is osmotic diarrhoea

A

Unabsorbed dietary nutrients in the intestinal lumen create an osmotic drive of fluid into the lumen
(i.e lactose deficiency)

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64
Q

What is psychogenic diarrhoae

A

Caused by excessive stimulation of the PNS which excites both motility and excess secretions

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65
Q

What changes would you see in a biopsy of someone with IBS

A

None - there are no visible changes in the histology of IBS

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66
Q

What is Crohns disease, where does it occur, what triggers is

A

Type of IBD - can occur anywhere in the GI tract. Inflammation

usually environmental triggers

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67
Q

What is ulcerative colitis

A

Colon becomes inflammated and ulcerated = bloody diarrhoea

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68
Q

What is the effect of ulcerative colitis on motility of the colon

A

Mass movements occur much of the day instead of the usual 3-10 minutes

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69
Q

What is diverticula and diverticulitis

A

Diverticular are abnormal pouches in colonic wall
Diverticulitis is inflammation of these pouches

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70
Q

What is usually associated with diverticulitis

A

Low fibre diet

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71
Q

What causes haemorrhoids/piles

A

Congestion of the venous plexuses around the anal canal

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72
Q

What is rectal prolapse

A

When the rectum loses its attachment and comes out through the anus

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73
Q

Rectocele prolapse

A

A type of rectal prolapse where the rectum sags and bulges into the vagina

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74
Q

What is intussusception

A

Where one part of the bowel slides into another (like collapsible telescope)

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75
Q

What part of defecation is not possible for someone with spinal cord injuries

A

The voluntary portion of defecation is blocked (external anal sphincter)

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76
Q

How are people with spinal cord injuries still able to deficate

A

Because the spinal cord reflex is still intact, a small edema is often enough to excite action of this cord reflex and stimulate adequate defecation

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77
Q

What are the 3 main gases in the lower GI tract

A

CO2, methane and hydrogen

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78
Q

What is the main cause of gases in the lower GI tract

A

bacterial fermentation of unabsorbed carbohydrates

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79
Q

What cranial nerve innervates the taste buds at the back of the throat

A

X - vagus nerve

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80
Q

During the pharyngeal phase of swallowing what causes the closure of naso-pharynx

A

Soft palete elevates and palatopharyngeal folds appose and close the nasopharynx

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81
Q

What are the layers of the gut wall from inside to out

A

Mucosa
Submucosa
Circular muscle
Myenteric plexus

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82
Q

What is the major difference between SI and LI mucosa

A

SI has microvilli

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83
Q

What is xerostomia

A

Dry mouth

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84
Q

What cells secrete the following things
HCl
Gastrin
Pepsinogen

A

HCl - parietal cells
Gastin - G cells
Pepsin - Cheif Cells

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85
Q

What is the main ionic component of fasting gastric juices

A

NaCl

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86
Q

What occurs to parietal cells when they are stimulated

A

Change morphology so they are able to increase the amount of apical surface area they have and insert more H+/K+ pumps onto this surface

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87
Q

What is the cephalic phase of gastric secretions and what nerve is this primarily mediated by

A

The smell, taste, thought and swallowing of food initiates the cephallic what
Primarily mediated by vagus nerve

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88
Q

What stimulates G cells

A

Partially digested proteins

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89
Q

What stimulates the secretion of gastrin in the duodenum

A

Acid

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90
Q

What is the most potent neural stimulator and inhibitor in pancreatic duct HCO3- secretion

A

Secretin - stimulator
Substance P - inhibitor

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91
Q

What food group does bile digest

A

Fats

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92
Q

What is pepsin activated by

A

Pepsinogen

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93
Q

Pepsin, trypsin and peptidases all digest what food group

A

Proteins

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94
Q

Arrival of fatty acids in the duodenum stimulate I cells to secrete what

A

CCK (which then stimulates bile from the liver)

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95
Q

What accounts for most of bilirubin production

A

Old red blood cells

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96
Q

What the 4 indications for esophogeal monometry

A

Dysphagia
GORD
Rumination Syndrome
Pre-fundoplication assesment of swallow

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97
Q

What are 4 contraindications for oesophageal manometry

A

Oesophageal varices
Large pharyngeal pouches
Large oesophageal diverticulum
Unable to tolerate procedure

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98
Q

What is the patient preparation for oesophogeal monometry

A

Fasting from 12 midnight before test

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99
Q

What is the contractile deceleration point (CDP) on oesophageal manometry

A

Point at which the speed of the peristaltic wave front slows

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100
Q

Where in the oesophogus does that contractile deceleration point occur

A

distal third of the oesophogus

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101
Q

What is contractile deceleration point associated with

A

ampullary emptying

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102
Q

What is the distal latancy in oesophageal manometry

A

Time from the onset of the swallow to the contractile deceleration point

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103
Q

What is the normal and premature contraction values of distal latency in oesophageal manometry

A

> 4.5s = normal
<4.5s = premature contraction

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104
Q

What is the intergrated relaxation pressure in oesophageal manometry

A

The pressure during the 4 second period of maximal OGJ relaxation during a swallow

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105
Q

When does the integrated relaxation pressure begin

A

Onset of UOS relaxation

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106
Q

What does the distal contractile intergal measure in oesophageal manometry

A

Contractile vigor

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107
Q

What are the normal, weak, failed and hypercontractile values for distal contractile intergral in oesophageal manometry

A

> 450 - 800 = normal
<450 = Weak peristalsis
<100 = Failed peristalsis
800 = hypercontractile

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108
Q

What two values are needed in oesophageal manometry for there to be a failed swallow

A

DCI < 450
DL < 4.5s

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109
Q

What are the 3 essential tests done in oesophageal manometry

A

10 x single 5mls swallow
5 x single 5mls swallows
Salty water swallow - impedance test

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110
Q

What are the three provocative tests done in oesophageal manometry and what do they each assess

A

Multiple rapid swallows: 2mls water every 2s, 5 times. Assesses peristaltic reserve

Rapid drinking challenge: 200mls water consumed through straw. Assesses OGJ relaxation.

Solid swallows: bread and butter consumed in 8 minutes. Assesses the intergrity of swallows.

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111
Q

What classification is used to assess oesophageal manometry results

A

Chicago Classification 4.0 Hierarchical Classification Scheme

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112
Q

What measurements of IRP does there need to indicate pathology in oesophageal manometry

A

> 15mmHg supine
12mmHg upright

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113
Q

Is there are pathological IRP values with peristalsis, what condition does the patient have

A

GORD

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114
Q

If a patient has pathological IRP values with no peristalsis, what condition do they have

A

Achalsaia

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115
Q

Type 1 Achalasia

A

100% failed peristalsis without panesophageal pressurization

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116
Q

Type 2 Achalasia

A

100% failed peristalsis with > 20% panesophogeal pressurization

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117
Q

Type 3 Achalasia

A

> 20% premature contraction +/- paneosophogeal pressurization

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118
Q

What 3 characteristics in oesophageal manometry results farther increases the validity of patholoigcal findings

A

Raised IRP in both upright and supine positions
Incomplete LOS relaxation
Lack of deglutitive inhibition in esophogeal body during rapid drink test

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119
Q

When can Chicago classifications not be applied to oesophageal manometry results

A

Post balloon dilation
Post Hellers myotomy
Post fundoplication
Large paraesophageal hiatal hernia

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120
Q

What type of Achalsia is least common and least responsive to treatment

A

Type III

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121
Q

What is deglutive inhibtion

A

When a swallow abruptly inhibits any ongoing contraction in the esophagus

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122
Q

During solid swallow provocative testing what OGJ relaxation pressure is considered normal

A

<25mmHg

123
Q

What will be the abdominal pressure of someone with regurgitation syndrome

A

> 30mmHg

124
Q

What is the DeMeester score used for

A

Used to determine if someone has GORD using results from the 24 hours pH test.

125
Q

What values are used in the DeMester score test

A

Compares the amount of time acid remains in the oesophagus and the amount of reflux episodes

126
Q

What is a normal DeMeester scoire

A

<14.2

127
Q

What is symptom association probability (SAP) and what value does this need to be for a positive GORD indicator

A

Measures the strength of the relationship between reflux and symtoms

> 95% = postiive for GORD

128
Q

What does acid exposure time (AET) syptom correlation measure and what value is required for a positive GORD result

A

Correlation between acidic changes measured in the test and symptoms experienced

> 50% = postiive

129
Q

What is effect of liquid on impedance during 24hr pH and how does this look on a graph

A

Retrograde decrease in impedance (look like a bowel on a graph)

130
Q

What is the effect of air on the impedance in 24hr pH testing and what does this look like on a graph

A

Anterograde increase in impedance (looks like a flat mountain)

131
Q

What results must be seen on 24hr pH trace for an event to be considered an acidic reflux event

A

Must have a decrease in impedance >50% of baseline and pH <4

132
Q

What results must be seen on 24hr pH trace for an event to be considered an non-acidic reflux event

A

decreased impedance of >50% and decrease in pH > 4

133
Q

What does esophogeal impedance testing measure

A

The movement of substance through the oesophogus

134
Q

24hour pH monitoring can detect both acidic and non-acid reflux, true or false?

A

False - 24 hour pH testing can only detect acidic reflux

135
Q

What 4 characteristics is esophogeal impedance testing and 24hr pH testing combined able to measure

A

Content of the relfux
Direction of bolus
Height of reflux in oesophogus
pH characteristics

136
Q

Where is the catheter places in 24hours pH tests

A

5cm above the upper boarder of the OGJ

137
Q

What is the catheter calibrated to prior to 24hr pH testing

A

pH 4 and pH 7

138
Q

If a patient has normal acid exposure negative SAP what diagnosis do they have

A

functional heartburn

139
Q

If a patient off PPIs has normal acid exposire, positive SAP what diagnosis do they have

A

reflux hypersensitivty

140
Q

If a patient off PPIs has abnormal acid exposure and inconclusive SAP what diagnosis do they have

A

NERD

141
Q

If a patient, on PPIs, has abnormal acid exposure what diagnosis do they have

A

GERD

142
Q

What is the Lyon Consensus

A

International consensus for diagnosis for GERD

143
Q

What is Mean Nocturnal Baseline Impedance (MNBI)

A

Impedance-pH metric assessing mucosal integrity of the oesopgogus due to chronic acid reflux

144
Q

What value of MNBI is abnormal and what pathology does this suggest

A

<2292 ohms

Inflamed esophogeal muscosa

145
Q

What is post reflux swallow induced peristaltic wave (PSPW)

A

Anterograde progression of impedance decline within 30s of a reflux episode on a pH-impedance study

146
Q

What is supragastric belching

A

Phenomenom where air is rapidly drawn into the oesophogus and expelled without reaching the stomach

147
Q

The London Classification outlines classification for what disorders

A

Anorectal Function

148
Q

What does high resolution anorectal manometry measure

A

Anorectal muscle function

149
Q

What are 4 indications for anorectal manometry

A

Referred after organic pathology excluded
Constipation/evacuation disorders
Preoperative assessment
Assessment after obstetric injury

150
Q

What patient preparation is required for anaorectal manometry

A

Continues to take all meds, no fasting required

151
Q

What is the longitudinal recording length of anorectal manometry

A

6cm

152
Q

Where should the base of the rectal balloon be based in anorectal manometry

A

3-5cm above the upper border of the anal canal

153
Q

What is the maximum inflation of the balloon during anorectal testing

A

400mls

154
Q

How do you measure the rectal anal inhibitory reflex in balloon testing

A

ramp the baloon 1-5mls/second

155
Q

How do you test the rectal sensation during anorectal balloon testing

A

physically add 10mls/second

156
Q

What is the balloon expulsion test in anorectal testing

A

Balloon is filled with 50mls water and measuring the ability for the patients to expel the balloon in <1min

157
Q

What measurement in anorectal manometry can you use to measure the internal anal sphincter function and why

A

Resting pressure can be a good indicator of internal anal sphincter function.

This is because the anal sphincter accounts for 52-85% of resting pressure

158
Q

What should the rise in pressure be when patients are asked to voluntarily activate the external anal sphincter

A

Should see the pressure rise at least double and the patients should be able to squeeze for at least 20seconds

159
Q

What is type 1 defecatory dyssynergia

A

Sufficient rise in rectal pressure (>40mmHg) + paradoxical anal sphincter contraction

160
Q

What is type 2 defecatory dyssynergia

A

Insufficent rise in rectal pressure (<40mmHg) + paradoxial anal sphincter contraction

161
Q

What is type 3 defecatory dyssynergia

A

Insufficient rise in rectal pressure + insufficient anal sphincter relaxation

162
Q

What are the London Classifications for type 1, 2, 3, 4 anorectal disorders

A

I = disorders of the rectoanal inhibitory reflex
II = disorders of anal tone and contractility
III = disorders of rectoanal coordination
IV = disorders of rectal sensation

163
Q

Contraction of the abdominal rectus generates what and should result in what

A

Should generate rectal drive
Causing relaxation of anal sphincter muscles and stool evacuation

164
Q

What 3 conditions are investigated through hydrogen methane breath testing

A

Small Intestinal Bacterial Overgrowth (SIBO)
Fructose Malabsorbtion
Lactose malaborbtion

165
Q

What sort of respiration does bacteria in the colon primarily use

A

Anaerobic

166
Q

What dietary group is usually responsible for the production of hydrogen and methane gases

A

Carbohydrates and short chain fatty acids

167
Q

What does the bacteria in the small intestine absorb that leads it to release excess gas, and what gases does it release

A

SI bacteria absorb glucose creating hydrogen and methane

168
Q

In a hydrogen breath test, what measurement is truly positive for SIBO

A

> 20PPM spike in hydrogen is consistent with a truly positive SIBO test

169
Q

What are some indications for hydrogen methane breath testing

A

Fluctuance, bloating, diarrhea, abdominal pain, constipation

170
Q

What is the result of methane on the gut motility

A

Methane production slows intestinal transit

171
Q

What is the course of treatment for a positive SIBO test

A

Antibiotics for SI infection

172
Q

What will be the next course of action if a SIBO test comes back negative

A

Lactose and fructose malabsorption tests will be carried out

173
Q

What is the suggested treatment for those with a positive lactose and fructose malabsorption test, respectfully

A

Lactose - lactose free diet
Fructose - low FODMAP diet

174
Q

What are the two primary causes of SIBO

A

Anatomical abnormalities (recent surguries)

Small intestinal motility disorders

175
Q

What type conditions are commonly associated with fructose malabsorbtion

A

IBS and ceoliac disease

176
Q

What is the difference between lactose intolerance and lactose malabsorbtion

A

Intolerance is the symptoms that occur due to lactose malabsorbtion.

Malabsorbtion is the intestinal inability to digest or absorb lactose sugar

177
Q

What are the 5 patient preparations for hydrogen methane breath testing

A

Avoid antibiotics 4 weeks prior
No colonoscopy/full bowel cleaning prep
Withdrawn motility enhancing drugs or laxatives 1 week prior
Refrain eating complex carbs 24 hours before test
Fasting 12 hours prior

178
Q

What is the solution given to non diabetic patients having hydrogen methane breath testing for SIBO

A

70g glucose
300mls water

179
Q

What is the solution given to diabetic patients having hydrogen methane breath testing for SIBO

A

10g lactulose in 300mls water

180
Q

What is the solution given to non diabetic patients having hydrogen methane breath testing testing for fructose malabdorbtion

A

25g fructose in 300mls water

181
Q

What is the solution given to diabetic patients having hydrogen methane breath testing for lactose malabsorbtion

A

25g lactose in 300mls water

182
Q

How often is a breath sample taken during hydrogen methane breath testing for glucose/lactulose testing

A

Every 15mins for 90mins

183
Q

How often is a breath sample taken during hydrogen methane breath testing for fructose

A

every 30mins for 180 mins

184
Q

How often is a breath sample taken during hydrogen methane breath testing for lactose testing

A

every 60minutes for 180 minutes

185
Q

What would a double peak of hydrogen in a hydrogen methane breath test results indicate

A

Hydrogen is being produced in multiple parts of the SI

186
Q

What result for methane in the hydrogen methane breath testing would be indicative of a positive test for SIBO

A

> 10ppm baseline

187
Q

Why is high baseline methane not a indicator of SIBO

A

Usually all patients having a hydrogen methane breath test will have increased baseline methane, doesnt mean they have SIBO

188
Q

What would a flat line response to a hydrogen methane breath test indicate

A

Patient predominately produces hydrogen sulphide

189
Q

What are the 4 types of capsule endoscopies

A

Small bowel, UGI, Colon, Chrons

190
Q

What are some indications for capsule endoscopy

A

GI bleeding, iron deficiency, IBD

191
Q

What are 3 contraindications for capsule endoscopy

A

Swallowing disorders, small bowel obstruction, pregnancy

192
Q

How long is the recording period for the UGI capsule

A

1.5 hours

193
Q

What is the use of the patency capsule in capsule endoscopy

A

This is a capsule that disintegrated in the GI tract, and is given to patients before a capsule endoscopy if potential obstruction is suspected

194
Q

What is the recording period for Colon/Chrons capsule endoscopy

A

15 hours

195
Q

In what time period does the patency capsule need to be passed for it to indicate capsule endoscopy can go ahead

A

Must be passed or disintergrated in <30 hours

196
Q

At what point is a capsule considered a ‘retained capsule’ during capsule endoscopy

A

When it has been retained proximal to the intestinal narrowing for at least 2 weeks

197
Q

What is the major advice given to patients regarding further medical treatment after a capsule endoscopy

A

They should not be receiving any MRI scans for 14 days following the capsule, or if they are unsure if they have passed it or not

198
Q

Was wavelength decreases what happens to the amplitude of the wave and the frequency

A

Amplitude stays the same
Frequency increases

199
Q

What is radiological density of tissue determined by

A

Density of the tissue and the atomic number

Higher atomic number, more absorbtion

200
Q

What type of barium is used in barium x ray and why

A

Barium sulphate - it is not toxic because it is insoluble so never absorbed

201
Q

What preparation is required for patients in advance to barium xray

A

Fasting

202
Q

What does barium xray allow us to image

A

Barium spreads along the GI tract so you can see the length of it.
Videoflouroscopy is also used to image movement such as swallowing, bolus movement down the oesophagus or gastric emptying

203
Q

What is barium enema and what is it used for

A

This is when barium sulphate is injected into the rectum and the patient is asked to expel the paste during xray.

Used to analyse dysfunction in stool evacuation

204
Q

What is radiopaque marker test and what does it allow us to image

A

Patient is given capsules to swallow with metal bits in them. The progress off these moving down the GI tract is then analysed on xray

Looks at the rate of which components transit through the GI tract

205
Q

What is the relative energy and wavelength of gamma rays in comparrison to xrays

A

Gamma rays have higher energy and smaller wavelegnths

206
Q

What gamma ray matierial is commonly used in medical diagnostics

A

Technetium-99m

207
Q

What is radionuclide scintigraphy

A

Used to non-invasively monitor progress of a radioisotope marker through the intestinal tracks using scintillation or gamma camera

208
Q

What is the gold standard test for measuring colonoic transit

A

Radionuclide scintigraphy

209
Q

In radionuclide scintigraphy, what test is indium used for and why

A

Used for assessment of small intestinal and colonic motility because it has a longer half-life

210
Q

When do the indium capsules dissolve in radionuclide scintigraphy and what does this ensure

A

These dissolve in the distal small intestine to ensure the bolus is released close to the colon

211
Q

How is intraluminal movement expressed in radionuclide scinigraphy

A

Calculating the geometric centre of the isotope mass in discreetly defined regions of the colon

212
Q

What nervous system is responsible for regulation of gastric smooth muscle

A

Parasympathetic

213
Q

What are varicosities

A

Connections between smooth muscle cells

214
Q

What is the behaviour of multiunit smooth muscle cells when they receive synaptic input

A

When in a multi unit, they can either all contract, or they can also contract independently.

215
Q

What sort of smooth muscle makes up the smooth muscle of the stoamch

A

Visceral smooth muscle

216
Q

Where is the pacemaker region of the stomach

A

Antrum

217
Q

Where do slow waves in gastric motility arrise from

A

Antrum

218
Q

How many slow waves are there in the stomach per minute

A

~3

219
Q

What cells are the pacemaker cells in the stoamch

A

Interstital cells of Cajal (ICCs)

220
Q

What are slow waves initiated by

A

Spike potentials

221
Q

What ion is responsible for driving gastric contractions

A

Ca2+

222
Q

What is the duration of the spike potentials in gastic motility

A

100ms

223
Q

What is the results of lumen size when there are circular and longitudinal contractions in the stomach, respectfully

A

Circular contractions decrease lumen size
Longitudinal contractions decrease lumen legnth

224
Q

What motility underlies grinding activity of the stomach

A

Propulsive and retrograde contractions

225
Q

Accommodation of the stomach contributes to what

A

Intragastric pressure which is important for the sensory feedback to the stomach

226
Q

What part of the stomach is primarily involved in storing dietary food and liquids

A

Proximal region

227
Q

What part of the stomach is primarily involved in mixing the food with the secretions in the stomach

A

Distal region

228
Q

What types of waves are seen on EGG

A

Sine waves

229
Q

What filter is used in EGG

A

Low pass filter - this helps exclude artefact including the heart beat

230
Q

What is the filter band frequencies in EGG machine

A

0.5Hz - 0.16Hz

231
Q

What sampling frequency would be suffient for EGG machine

A

1Hz

232
Q

Do patients have to fast in preparation for EGG

A

Yes

233
Q

Where are the leads for an EGG being placed

A

Over the antrum

234
Q

What three conditions is EGG used to investigate

A

Functional dyspepsia
Nausea or vomiting
Gastroparesis

235
Q

What are the 6 possible clinical interpretations for EGG

A
  1. Normal
  2. Tachygastria
  3. Bradygastria
  4. Nonspecific rhythm pattern
  5. Lack of post prandial power increases
  6. Uninterpretable secondary to technical problem or motion artefact
236
Q

During tachygastria, what motility pattern is common and what does this result in for the state of the stomach

A

Retrograde depolarisation may propagate with tachycgastria due to the increased amplitude inducing contractions.

This can cause the stomach to become atonic (limp)

237
Q

What is a normal EGG result trace

A

frequency of waveforms remains constant (~3cpm) but amplitude increases with food ingestion

238
Q

What are 4 symptoms of oesophageal dysfunction

A

Ineffective transport of food from mouth to stomach
Dysphagia
Odynophagia (pain on swallowing)
Patients may descibre “food getting stuck”

239
Q

What is the first line of investigation when people complain of difficult swallowing

A

Gastroscopy to exclude any organic pathology

240
Q

What are the two main conditions associated with disorders of OGJ outflow

A

Achalasia and OGF outflow obstruction

241
Q

What are the 4 conditions associated with disorders of peristalsis

A

Hypercontraction, absent peristalsis, DOS, IOM

242
Q

What is the primary cause of achalasia believed to be

A

Selective loss of inhibitory neurons in the myenteric plexus of the distal eosophogus

243
Q

What do excitory and inhibitory neurons release in the oesophagus, respectfully

A

Excitory - Ach
Inhibitory - Vaso active intestinal peptide and NO

244
Q

What types of achalasia are receptive to Hellers myotomy treatment

A

Type 1 and Type 2

245
Q

Is peristalsis concerved in OGJ outflow obsturction

A

Yes

246
Q

What is the relative level of peristaltic waves and DI value in hyp0contractility of the OGJ

A

DI will be low (<450) and peristaltic waves will be low

247
Q

What is hypocontractility of the OGJ usually due to

A

Connective tissue disease

247
Q

What is hypocontractility of the OGJ usually the most common cause of

A

GORD

248
Q

Those with IOM, what HRiM test can sometimes trigger their eosophogus to work

A

Solid food test

249
Q

What is a feacal immunochemical test

A

Test to see if there is blood in the stool

249
Q

What is endoscopic retrograde cheolangiopancreatography

A

is an endoscopic and fluoroscopic procedure in which an endoscope is advanced into the second part of the duodenum, this allowing other tools to be passed into the biliary and pancreatic ducts

249
Q

What is the main cause assocaited with DOS

A

Opioid use

250
Q

What compound found in stool can distinguish between IBD and non-inflammatory bowel conditions such as IBS

A

Fecal Calprotein

250
Q

What is a ova, cysts and parasites test

A

To see if there are any parasites in the GI tract

250
Q

What are 3 indications for esophogeal gastro duodenoscropy (Upper endoscopy)

A

Persistant abdominal pain
GI bleed
Chronic symptoms of GORD

250
Q

What are 3 indications of colonoscopy

A

Lower GI bleeding
Surveillance of polyps
Chronic dihorrea

251
Q

What does the Barium Swallow test allow us to assess

A

Structural changes in the upper GI tract

251
Q

What is the aim of timed barium column study

A

Assess the oesophageal emptying in patients with suspected achalasia

251
Q

What is video-flouroscopy useful for assess

A

The oro-pharyngeal phase of swallow

251
Q

What does endo-anal ultrasound allow us to assess

A

Images the anal sphincters and its surrounding structures as well as the pelvic floor

252
Q

Antacids
- What do they treat
- How do they do it
- Side effects (2)
- When do they need to be withdrawn for 24hr pH testing

A

Treat mild dyspepsia/heartburn

Neutralise gastric acid and trigger mucosal lining in the stomach to releive burning sensation

Constipation and rebound hyperacidity when discontinued

Withdraw 48 hours before 24hr test

253
Q

Alginates
- What do they treat
- How do they do it
- When do they need to be withdrawn for 24hr pH testing

A

GORD

Creates a mechnical barrier that displaces the acid in the stomach into a pocket

Withdraw 48 hours before 24hr pH testing

254
Q

H2 receptor antagonist
- What do they treat
- How do they do it
- Side effects (3)
- When do they need to be withdrawn for 24hr pH testing

A

GORD, peptic ulcers

Inhibit secretion of gastric acid through competitive inhibition of Histamine H2 receptor on parietal cells

Diarrhoa, headache, dizziness

Withdraw 48 hours before 24hr test

255
Q

PPI’s
- What do they treat
- How do they do it
- Side effects (4)
- When do they need to be withdrawn for 24hr pH testing

A

GORD

Bind to H+/K+ATPase on parietal cells to inhibit secretion of HCl

Headache, abdominal pain, decreased bone density, pneumonia

Withdraw 10 days before 24hr pH study and 2 weeks before H.Pylori test

256
Q

Mucosal protective agents
- What do they treat
- How do they do it
- Side effects (1)
- When do they need to be withdrawn for 24hr pH testing

A

Ulcers

Basic aluminum salt that locally covers the ulcer site and protects it from future attack by acid

Constipation

Withdraw 10 days before 24hr test

257
Q

What are prokinetic agents used for

A

To enhance the motility by increasing frequency and/or the amplitude of contractions in the stomach

258
Q

What type of drug is metoclopramide

A

Prokinetic agent - dopamine receptor antagonist

259
Q

What type of drug is Motilium and what condition is it used to treat

A

Prokinetic agent - dopamine D2 recpetor antagonist.

Used to treat GORD

260
Q

What type of drug is prucalopride

A

5-HT4 agonist that facilitates GI smooth muscle contractility while suppressing the resistance to propulsion due to circular smooth muscle contraction

261
Q

What drug can be good for refractory constipation

A

Prualopride

262
Q

What precautions must we as CMPs take patients on Ca2+ channel blockers and Opioids when preparing them for GI testing

A

We cannot take these patients of these drugs without consulting their physician first

263
Q

What can be a negative implication of Ca2+ blockers in regards to GI pathology

A

Ca2+ channel blockers are thought to increase the risk of GORD by significantly reducing the tone of the LOS and increasing esophageal exposure to gastric acid

264
Q

What is the effect of Botox on the esophogeal spincheter

A

Reduces tone of sphincter muscles

265
Q

When should laxatives be withdrawn prior to hydrogen and methane breath testing

A

1 week

266
Q

What are bulk forming laxitives and an example of it

A

Organic polymers that absorb water and thus increase stool water content

E.g psyllium husk

267
Q

What is the mechanism of action of stool softers and and example of one

A

Surface active agents that facilitate water interacting with the stool in order to soften it

E.g arachis oil

268
Q

What is the mechanism of action of osmotic laxatives and an example of one

A

These are poorly absorbed ions or molecules that create an osmotic gradient within the intestinal lumen, drawing water into the lumen and making the stool soft.

E.g lactulose

269
Q

What is the mechanism of action for stimulant laxitives and an example

A

Increase peristalsis in the large bowel and fluid secretion in the distal small bowel

E.g bisacody

270
Q

When would the use of antidiarrheal medication be contraindicated

A

If it is accompanied with high fever, blood in stool, or when inhibition of peristalsis is dangerous for the patient

271
Q

What are some dietary modifications that can be used to treat dysphagia

A

Softer foods, avoid foods of hot/cold temperature, change consistency of food to maximise swallowing safely

272
Q

What are some behavioural modifications for people with dysphagia

A

Remove excess distractions when you can, refrain from speaking with eating, special cups/straws can be used, plates fitted with dividers

273
Q

What are some postural adjustments to treat dysphagia

A

Upright posture during eating and 1 hour post meal

274
Q

Effortful swallowing exercise

A

Gather the saliva in your mouth in the middle of your tongue. Keep your lips pressed together. Swallow all the saliva at once like you’re swallowing a grape or pill

275
Q

Dynamic shaker swallowing exercise

A

Lie on your back on a flat surface. Make sure your shoulders are against the surface and do not use a pillow. Lift your chin but keep shoulders down as if you’re trying to look at your feet. Lower your head to the surface, repeat.

276
Q

Jaw thrust swallowing exercise

A

push your lower jaw as far forward as possible, placing your lower teeth in front of your upper teeth. Hold. Repeat.

277
Q

Masko manoeuvure swallowing techniqie

A

stick your tongue out of your mouth. Bite down on your tongue to keep it in place. Swallow while holding your tongue between your teeth. Release your tongue. Repat.

278
Q

Mendelsohn Manoeuvure swallowing technique

A

locate the adam’s apple with three fingers. Swallow once, noticing the swallowing movement. Swallow again, and squeeze your throat muscles to hold your Adam’s apple at its highest point.

279
Q

Supraglottic manoevrure swallowing exercise

A

collect saliva in your mouth. Take a deep breath and hodl it. Swallow while holding your breath. Immediately after swallowing, cough.

280
Q

Hyoid lift manoeuvre

A

use straw to suck up small pieces of paper and transfer to a cup

281
Q

Pitch glides swallowing manouvure

A

Sing ‘ee’ starting a low tone and then slowly raise your tone to your highest pitch. Hold this pitch for 10-2-0 seconds.

282
Q

How are some ways you can activate sensory-motor feedback in dysphagia

A

Thermal simulation (cold)
Taste stimuli (sour)
Surface electrical stimulation of neck muscles

283
Q

What are some feeding stratagies for people with dysphagia

A

Tube feeding if insuffient nutrition

284
Q

2 surgical strategies for people with dysphagia

A

Botox injections, esophageal stents

285
Q

Lifestyle modifications for people with GORD

A

Keep head elevated
Try lose weight
Stop smoking
Avoid alcohol, coffee, mint
No eating 2 hours before bed

286
Q

Dietary stratagies for people with gastroparesis

A

Avoid fatty foods
Eat smaller meals, more frequently
Eat more liquid based foods

287
Q

Surgical treatments for gastroparesis

A

Botox injection
Endoscopic pyloric dilation
Gastric pacing

288
Q

What type of exercise is best for helping gastric motility

A

Light exercise - walking

289
Q

Dietary strategies for function dyspepsia

A

Herbal therapies (peppermint, caraway oil)
Pre/probiotics

290
Q

Psychological and behavioural therapies for function dyspepsia

A

Cognitive behavioural therapy
Hypnotherapy
Acupuncture

291
Q

Dietary and lifestyle changes for nausea/vomiting

A

Maintain hydration, bland foods, avoid fatty/spicy/sweet foods.

292
Q

Non-pharamalogical treatments for functional gastrointestinal diroders

A

e.g IBS - low FODMAP diet, herbal supplements, reduced environemtnal stress

293
Q

Non-pharmalogical treatments for inflammatory bowel disease

A

Rich vegetable diet, low FODMAP, physical activity, CBT

294
Q
A

Physiology - Hayley (9 decks)

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