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Semester 3 > GI Session 5 > Flashcards

GI Session 5 Flashcards

1
Q

What are the causes of GORD?

A

LOS problems
Delayed gastric emptying –> raised intra-gastric pressure –> increased workload on LOS
Hiatus hernia
Obesity

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2
Q

What are the S/S of GORD?

A 
Heartburn
Cough +/- wheeze
Sore throat
Dysphagia
Odynophagia
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3
Q

What are the consequences of GORD?

A

Oesophagitis
Fibrous strictures –> regurgitation
Barrett’s oesophagus

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4
Q

What Tx can be used for GORD?

A 
Lifestyle modifications: smaller more frequent meals, wait 3 hrs after eating to sleep
Antacids
H2 antagonists
PPIs
Surgery
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5
Q

What surgical technique can be used to Tx externae cases of GORD?

A

Wrap fundus around oesophagus

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6
Q

Give an example of a PPI which is slightly more effective than H2 antagonists.

A

Omeprazole

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7
Q

How are H2 antagonists available to pts?

A

Low does over the counter

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8
Q

What is acute gastritis?

A

Localised/general transient mucosal inflammatory process

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9
Q

What causes acute gastritis?

A

Heavy NSAID use
Excessive alcohol intake
Chemotherapy
Bile reflux in reverse peristalsis of duodenum

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10
Q

How does chemotherapy lead to acute gastritis?

A

Targets rapidly regenerating cells so acts on defence cells in stomach

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11
Q

What are the S/S of acute gastritis?

A

Usually asymptomatic
Pain
N+V
Bleeding

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12
Q

When can acute gastritis be fatal?

A

If generalised gastritis leads to extensive bleeding

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13
Q

What is visible on histology in acute gastritis?

A

Inflammatory cell invasion

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14
Q

What are the consequences of acute gastritis?

A

Stomach ulcer
Polyps
Neoplasm

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15
Q

What is the Tx for acute gastritis?

A

Antacids
H2 antagonists
PPIs
Change away from NSAID painkiller

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16
Q

Give two examples of H2 antagonists used to Tx acute gastritis.

A

Cimetidine

Ranitidine

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17
Q

What is chronic gastritis?

A

Localised/generalised persistent mucosal inflammatory process

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18
Q

What are the causes of chronic gastritis?

A 
H.pylori infection
Autoimmun production of antibodies to gastric parietal cells
Chronic alcohol abuse
NSAIDs
Bile reflux
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19
Q

What S/S are seen in chronic gastritis due to H.pylori?

A

Asymptomatic
Similar to acute gastritis
Sometimes due to complications

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20
Q

What are the S/S of chronic gastritis due to autoimmune disease?

A

S/S of aneamia, classically glossitis
Anorexia
Neurological problems e.g. abnormal gait, numbness, tingling

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21
Q

What are the consequences of chronic gastritis due to H.pylori?

A

Peptic ulcers
Adenocarcinoma
MALT lymphoma

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22
Q

What are consequences of autoimmune chronic gastritis?

A

Pernicious anaemia +/- neurological disturbance

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23
Q

What causes neurological disturbance in autoimmune chronic gastritis?

A

Lack of B12 from deficiency in intrinsic factor

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24
Q

What is the Tx for chronic gastritis?

A

Abx if H.pylori (PPI+clarithromycin+amoxicillin)
PPIs
H2 antagonists
Antacids

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25
Q

What is dyspepsia?

A

Umbrella term for upper GI symptoms

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26
Q

What is peptic ulcer disease?

A

Defect in gastric/duodenal mucosa which extends through muscularis mucosa

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27
Q

Where are peptic ulcers most commonly found?

A

First part of duodenum
Lesser curvature of stomach
Body of stomach

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28
Q

What are the causes of peptic ulcer disease?

A

Stomach acid not being removed by adequate mucosal bloodflow
H.pylori
NSAIDs
Massive physiological stress (massive burns/trauma)

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29
Q

What effect does smoking have on peptic ulcer disease?

A

Contributes to relapse but does not initiate disease

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30
Q

What are the S/S of peptic ulcer disease?

A 
Asymptomatic
Epigastric pain with burning/gnawing after meals
Bleeding
Anaemia
Early satiety
Weight loss
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31
Q

What are the consequences of peptic ulcer disease?

A

Posterior erosion into gastroduodenal artery –> massive haematemisis
Melaena
Perforation –> peritonitis +/- sepsis
Gastric outlet obstruction

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32
Q

What Tx can be used for peptic ulcer disease?

A

Abx, PPIs, H2 antagonists, antacids

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33
Q

What is functional dyspepsia?

A

Symptoms of peptic ulcer without physical evidence of organic disease

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34
Q

Why is functional dyspepsia a diagnosis of exclusion?

A

Blood tests -ve for anaemia

Endoscopy -ve

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35
Q

What Tx are used for functional dyspepsia?

A

PPIs

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36
Q

What aids the survival of H.pylori in the stomach?

A

Production of urease to create alkaline surroundings
Flagellum for motility in gastric mucosa
Flagellum for adherence to gastric epithelium

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37
Q

How does H.pylori damage the host?

A

Release cytokines –> direct epithelial injury
Production of toxic ammonia
Possible degradation of mucus layer
Promotion of inflammatory response –> self-injury

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38
Q

What is the result of H.pylori colonisation in the body of the stomach?

A

Atrophic effect –> gastric ulcer –> intestinal metaplasia

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39
Q

What is the effect of H.pylori colonisation in the antrum?

A

Increase gastrin

Increase parietal cell acid production

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40
Q

When are H.pylori found in the duodenum?

A

Only after metaplasia to gastric epithelium

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41
Q

What is the result of H.pylori colonisation of the duodenum?

A

Ulcer formation

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42
Q

What is Zollinger-Ellison syndrome?

A

Non-beta islet cell gastrin secreting tumour of the pancreas such may also be in duodenum/abdomen/lymph nodes/ectopic

43
Q

What is the pathogenesis of Zollinger-Ellison syndrome?

A

Proliferation of parietal cells –> increased acid production –> severe stomach and small bowel ulceration

44
Q

What are the S/S of Zollinger-Ellison syndrome?

A

Abdominal pain
Diarrhoea
Malabsorption

45
Q

What syndrome can Z-E form part of?

A

Autosomal dominant familial Multiple Endocrine Neoplasia Type 1 (MEN1)

46
Q

What Tx can be used for Z-E syndrome?

A

PPI and H2 antagonists before surgery/chemotherapy

Octneotide (mimics somatostatin)

47
Q

Describe the epidemiology of stomach cancer.

A

3rd most common cancer in the world
~7000 new cases per year in the UK
High rates in Chile, Japan and South America

48
Q

Why does stomach cancer usually present late?

A

Has to be quite large before it becomes symptomatic

49
Q

What are the risk factors for developing stomach cancer?

A

Male
H.pylori
High salt intake
Smoking

50
Q

What are the S/S of stomach cancer?

A 
Dysphasia
Loss of appetite
Malaena
Weightloss
N+V
Virchow's nodes
51
Q

What are Virchow’s nodes?

A

Palpable node in L supra clavicular fossa MCL

52
Q

What types of stomach cancer are seen?

A

Majority adenocarcinomas - intestinal/diffuse

Small numbersof lymphomas, carcinomas, stromal tumours

53
Q

How is stomach cancer diagnosed?

A

Bloods for tumour markers
Upper GI endoscopy +/- biopsy
CT scan

54
Q

What is the Tx for stomach cancer?

A

Endoscopic mucosal resection in very early detection

Surgery/chemo/radiotherapy

55
Q

How can diagnosis of GI pathology be made?

A 
Upper GI endoscopy
Urease breath test (measure exhaled radiolabelled carbon)
Erect CXR (space under diaphragm = perforation)
Blood test (anaemia)
56
Q

What is the function of the hepatic artery proper?

A

Supplies liver with arterial blood from coeliac trunk

57
Q

How is lymph drained from the liver?

A

Hepatic lymph nodes along vessels and ducts in the lesser omentum –> coeliac nodes

58
Q

What are the ligaments of the liver?

A

Falciform
L+R coronary
L+R triangular

59
Q

What is the function of the falciform ligament?

A

Attach anterior lover surface to anterior abdominal wall

60
Q

What does the free edge of the falciform ligament contain?

A

Ligamentum teres

61
Q

What is the ligamentum teres?

A

Remnant of the umbilical vein

62
Q

What is the function of the L+R coronary ligaments of the liver?

A

Attach superior surface to diaphragm

63
Q

What is the function of the L+R triangular ligaments of the liver?

A

Attach superior liver to diaphragm

64
Q

What innervates Glisson’s capsule?

A

Branches of lower intercostal nerves

65
Q

Does distension of Glisson’s capsule cause well localised or diffuse pain?

A

Sharp, well-localised

66
Q

What is the function of the hepatic portal vein?

A

Supply deoxygenated blood with nutrients from the small intestine to the liver parenchyma for gut-related functions

67
Q

What two ligaments that attach to the liver are found in the lesser omentum?

A

Hepatoduodenal

Hepatogastric

68
Q

On postero-inferior views of the liver is the caudate or quadrate lobe more superior?

A

Caudate

69
Q

Where is the caudate lobe of the liver located?

A

Between IVC and ligamentum venosum fossa

70
Q

What is the function of the porta hepatis?

A

Transmit all vessels, nerves, ducts in and out of the liver

71
Q

What are the four lobes of the liver?

A

L, caudate, quadrate, R

72
Q

What separates the L lobe from the caudate and quadrate lobes?

A

Umbilical (L sagittal) fissure

73
Q

What forms the R portal fissure?

A

Position of R hepatic vein

74
Q

What separates the R lobe form the caudate and quadrate loves of the liver?

A

R sagittal fissure

75
Q

Where is the quadrate lobe of the liver located?

A

Between gallbladder and ligamentum teres fossa

76
Q

What is found between the R+L coronary ligaments, L triangular ligament and IVC?

A

Bare area

77
Q

Which 3 hepatic veins drain into the IVC?

A

Right, intermediate and left

78
Q

What helps to hold the liver in place?

A

3 hepatic veins draining into IVC in groove of liver

79
Q

What is in the portal triad?

A

Portal vein
Hepatic artery
Bile passages

80
Q

How is the liver parenchyma innervated?

A

Hepatic plexus
Sympathetic coeliac plexus
Parasympathetic vagus nerve fibres

81
Q

What are the three hepatic recesses?

A

L+R subphrenic spaces
Sub hepatic space
Morrison’s pouch

82
Q

Where are the L+R subphrenic spaces?

A

Between diaphragm and lover either side of falciform ligament

83
Q

Where os the subhepatic space?

A

Between inferior surface of liver and transverse colon

84
Q

Where is Morrion’s pouch?

A

Between visceral surface and R kidney

85
Q

Why does fluid collect in Morrison’s pouch when bedridden?

A

Deepest part of peritoneal cavity when supine

86
Q

What is the result of infected fluid collection in the hepatic recesses?

A

Abscess

87
Q

Where is Hartmann’s pouch?

A

Neck of gallbladder

88
Q

What is Hartmann’s pouch?

A

Mucosal fold which is a common site of gallstone lodging

89
Q

What perforates the gallbladder when it is in the fossa in the liver?

A

Cystic veins

90
Q

What does the duodenum secrete to stimulate bile secretion?

A

CCK

91
Q

Give a brief structure of the biliary tree.

A

R+L hepatic ducts–> common hepatic duct + cystic duct –> common bile duct + pancreatic duct –> hepatopancreatic Ampulla of Vater controlled by Sphincter of Oddi

92
Q

What gives arterial supply to the gallbladder?

A

Common hepatic –> hepatic artery –> cystic artery

93
Q

What gives venous drainage to the gallbladder?

A

Cystic vein –> portal vein

94
Q

What gives neural supply to the gallbladder?

A 
Coeliac plexus (sympathetic and sensory fibres)
Vagus nerve (parasympathetic)
95
Q

What is the action of vagus nerve stimulation of the gallbladder?

A

Contraction and secretion of bile into cystic duct

96
Q

How is lymph drained from the gallbladder?

A

Cystic node in gallbladder neck –> hepatic lymph node –> coeliac node

97
Q

Describe the branches of the hepatic portal vein.

A

SMV+splenic vein –> hepatic portal vein –> R+L branches –> secondary branches to medial and lateral divisions –> tertiary branches to supply 7 out of 8 hepatic segments

98
Q

Are gallstones more common in males or females?

A

Females

99
Q

Where is the head of the pancreas located?

A

Curve of duodenum

100
Q

Where is the neck of the pancreas positioned?

A

Overlies SMA+V with anterior surface adjacent to Pylorus of stomach

101
Q

Where is the body of the pancreas located?

A

Left of SMVA+V in omental bursa

102
Q

Does the posterior surface of the pancreatic body have peritoneum?

A

No

103
Q

Where is the pancreatic tail positioned?

A

Anterior to L kidney between layers of splenorenal ligament

Semester 3 (50 decks)

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