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Biochemistry > GI Tract > Flashcards

GI Tract Flashcards

1
Q

What might cause inflammation of the GI react?

A

Gastritis, pancreatitis, inflammatory bowel disease

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2
Q

What causes perforation of the GI tract?

A

Peptic ulcer, tumours

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3
Q

What causes neoplasia?

A

Colorectal tumours, gastric carcinomas

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4
Q

What causes obstruction in the GI tract?

A

Tumours, gall stones, hernia

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5
Q

What causes malabsorption in the GI tract?

A

Coeliac disease, chronic pancreatitis

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6
Q

What causes infarction of the GI tract?

A

Atheroma, thrombosis

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7
Q

What causes structural abnormalities

A

Diverticular disease of the colon

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8
Q

What is colicey pain?

A

Waves of pain caused by obstruction in GI tract

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9
Q

What is coffee group vomiting?

A

Coming of partly digested blood

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10
Q

What is black and Tarr-ey faeces called?

A

Malina

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11
Q

Are CT scans or ultrasounds used for diagnostic examination of the GI tract?

A

Both

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12
Q

What is a laparoscopy?

A

Key hole surgery to look inside abdomen

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13
Q

What can a FBC tell you in GI investigation?

A

Raised wbc = infection

Low haemoglobin =bleeding

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14
Q

What can urea and electrolytes tell you in GI investigation?

A

Vomiting and diarrhoea often lead to dehydration and electrolyte deficiency

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15
Q

What is the function of the pancreas?

A

To release enzymes and digestive juices into the small intestine to further breakdown food.

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16
Q

What does pancreatitis present with?

A

Sever abdominal pain, tenderness and vomiting

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17
Q

What are the major risks for pancreatitis?

A

Gall stones and alcohol abuse

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18
Q

What two tests would you do for suspected pancreatitis?

A

Serum amylase and serum lipase

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19
Q

Which is a more sensitive test amylase or lipase?

A

Lipase is more sensitive and remains elevated for longer

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20
Q

Levels of what amount are almost diagnostic of acute pancreatitis?

A

Levels >10 X the upper limit of the reference range (ULRR)

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21
Q

In what other conditions could you get raised serum amylase and serum lipase?

A

Biliary tract disease
Intestinal infarction
Perforated peptic ulcer

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22
Q

How do you treat acute pancreatitis?

A

Treat underlying cause - remove gall stones

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23
Q

What are the 3 most common sites for GI tumours?

A

Colorectal
Gastric
Oesophageal

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24
Q

What are presenting features for upper GI cancers?

A

Nausea, vomiting, anorexia, bleeding, deranged liver function test due to metastasis

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25
Q

Presenting features for colorectal cancer

A

Bleeding- fresh blood per rectum or anaemia due to chronic bleeding
Altered bowel habit
Deranged liver function due to metastasis

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26
Q

If a patient comes in with microcytic hypochromic anaemia what must you dismiss?

A

GI bleeding

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27
Q

What is the FOB test?

A

Faecal Occult Blood test - 3 stools on separate days

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28
Q

What is normal GI blood loss in healthy adults?

A
29
Q

What is involved in the uk bowel cancer screening programme?

A

2 FOB tests per year for 65-69 year olds

30
Q

What is selective malabsorption?

A

Deficiency of single enzyme or factor essential for the absorption of a specific nutrient

31
Q

Generalised malabsorption

A

Deficiency of multiple digestive enzymes or reduction in absorptive surface of intestine

32
Q

What type of malabsorption is fat malabsorption? What causes it?

A

Selective. Can result due to malabsorption of vitamins a, d and e
Can be due to bile salt deficiency
Can be due to liver disease or disease effecting the terminal ileum

33
Q

What do bile salts do?

A

Allows emulsification of fat so they can be digested by lipase a

34
Q

How dos selective malabsorption of disaccharides occur?

A

If there is a deficiency of enzymes present in the brush border of small intestinal mucosa- can’t break disaccharide into monosaccharide

35
Q

How do you get acquired malabsorption of disaccharides?

A

Gastroenteritis

36
Q

What happens if you have disaccharides in interstitial contents?

A

Osmotic form of diarrhoea

37
Q

What causes pernicious anaemia?

A

Malabsorption of Vit b12 due to autoimmune disease that attacks gastric parietal cells

38
Q

What are the clinical features of pernicious anaemia? Blood film

A

Megaloblastic anaemia and multinucleated granulocytes

39
Q

How is vitb12 normally absorbed?

A

Intrinsic factors created by parietal cells binds to Vit b12

Intrinsic factor - Vit b12 complex is recognised by intrinsic factor receptors in terminal ilium (Vit b12 is absorbed)

40
Q

Give 2 examples of generalised malabsorption

A

Coeliac disease- autoimmune reaction to gluten in diet.

Chronic pancreatitis

41
Q

What occurs from chronic pancreatitis

A

Loss of pancreatic exocrine secretions- lipase, amylase and trypsin- in extreme cases loss on pancreatic secretions resulting in diabetes

42
Q

How does interstinal ischaemia occur?

A

Atheroma of the mesenteric arteries

43
Q

How would you test for coeliac disease?

A

Anti- tissue transglutaminase or antiendomysial antibodies

44
Q

How would you test for pancreatic insufficiency?

A

Faecal elastase - measures elastase that is produced by the pancreas

45
Q

How do you test for pernicious anaemia?

A

Measure vitamin b12 or intrinsic factor or gastric parietal cell antibodies

46
Q

What is the result of hyperbilirubinaemia?

A

Jaundice

47
Q

What is the cause of pre-hepatic bilirubinaemia?

A

Can be caused by haemolysis or it can be congenital?

48
Q

What causes heptocellular (intra-hepatic) hyperbilirubinaemia ?

A

Hepatitis, toxins, space occupying lesions,

49
Q

What causes cholestatic (stasis of bile) ?

A

Can be extra hepatic due to stone or carcinoma at the head of the pancreas
Can also be intra-hepatic

50
Q

Why does haemolysis cause ore-hepatic jaundice?

A

Bilirubin is a breakdown product of haemoglobin- excess breakdown overwhelms the livers ability to deal with bilirubin

51
Q

How can congenital defects cause pre-hepatic jaundice?

A

Congenital defects in the transport system that carries bilirubin into the liver cells

52
Q

What are the 5 main liver function tests?

A

1) total bilirubin
2) gamma GT
3) Transaminases (ALT and AST)
4) Alkaline Phosphatase
5) Albumin

53
Q

What is bilirubin conjugated in the liver with?

A

Glucuronides

54
Q

What happens excess pre hepatic Unconjugated bilirubin?

A

It is insoluble in water and cannot be excreted

55
Q

What happens excess conjugated bilirubin?

A

It is soluble in water and is excreted in urine

56
Q

What does alanine Transaminase (ALT) and asparate Transaminase (AST) measure?

A

The level of heptocellular injury

57
Q

What is alkaline phosphatase (ALP) and what is a raised level associated with?

A

It is produced in bile canaliculi. Raised levels is associated with cholestasis

58
Q

What also produces ALP?

A

Osteoblasts and placenta

59
Q

What is GGT?

A

An enzyme that functions as a transporter molecule and is important for helping the liver metabolise drugs and other toxins

60
Q

If ALP and GGT is high what does this rule out?

A

Bone disease

61
Q

What is high GGT associated with?

A

Cholestatic or heptocellular disease or alcohol abuse

62
Q

What is albumin and what does it do?

A

Albumin is made in the liver and is required to stop fluid from leaking out of blood vessels

63
Q

What are LOW levels of albumin associated with?

A

Low levels due to reduced synthesis in chronic liver failure. But albumin can also be low as part of the acute phase response

64
Q

What effect does breastmilk have on bilirubin?

A

It inhibits conjugating enzymes

65
Q

What causes neonatal jaundice?

A

Large breakdown during neonatal period,

Immaturity of bilirubin uptake and conjugation

66
Q

What might the effect of rhesus incompatibility have on a baby?

A

Prolonged jaundice

67
Q

What is biliary atreria?

A

Bile duct not properly formed and baby unable to excrete bilirubin

68
Q

What is kernicterus?

A

Unconjugated bilirubin crosses the blood brain barrier and is deposited at basal ganglia of brain- causes abnormal muscle tone, lethargy and cerebral palsey.

69
Q

How does phototherapy cure jaundice?

A

Isomerisation of bilirubin as t passes through skin capillaries

Biochemistry (8 decks)

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