GIT Flashcards
Where is the most common place for gallstones?
Hartmann’s pouch:a diverticulum that can occur at the neck of the gall bladder
Where is the most common place for obstruction of bile ducts?
Common bile duct
What are laxatives contraindicated for?
Obstructive conditions
A 35-year-old man presents to the GP complaining of fatigue, polyuria and polydipsia for the last two months. The GP finds that the patient’s random blood glucose is 19 mmol/L and his HbA1c is 13%.
Select which of the following statements would make this patient MORE LIKELY to have type 2 rather than type diabetes mellitus.
Select one:
a. Waist circumference of 75 cm
b. Blood test positive for GAD antibodies
c. Strong family history of diabetes mellitus
d. BMI of 24.3
C ? (check again when results come out) ;
a/ Waist measurement M>102cm, F>88cm
b/ T1DM
c/ T2DM genetic link > T1DM
d/ BMI >30 is overweight
A patient is diagnosed with nonrotation (loss of the last 180 degrees of rotation). What is the relationship of the large intestine to the small intestine, as compared to normal development?
1. The cecum and appendix lies to the left of the small intestine
2. The relationship between the small and large remains unchanged with malrotation
3. The small intestine becomes secondarily retroperitoneal
4. The small intestine lies superficial to the colon
5.The transverse colon lies posterior to the duodenum
1
The pancreas develops from which embryonic bud(s)?
a) Foregut bud
b) Midgut bud
c) Hindgut bud
d) Both foregut and midgut buds
B Both foregut and midgut buds
Explanation: The pancreas develops from both the foregut and midgut buds during embryonic development. The ventral pancreatic bud arises from the foregut, while the dorsal pancreatic bud arises from the midgut.
Which are true of direct hernias?
1More common in females
2Passes medial to the inferior epigastric vessels
3It is commonly due to a patent processus vaginalis
4The hernia always passes through the deep inguinal ring
2 (MDs dont LIe)
- passes through superficial inguinal ring at hesselbach triangle through anterior abdominal wall`
INDIRECT hernias are
- commonly due to patent processus vaginalis
- passes through deep inguinal ring
An indirect inguinal hernia is said to follow the “embryological pathway” because the tissue herniates through the deep inguinal ring. The relational position of the indirect hernia tissue to the spermatic cord is:
- Anterior: the hernia is inside the processus vaginalis, while the testes are posterior to it
- Posterior: the testes is inside the processes vaginalis, while the hernia is posterior to it
- Medial: both the hernia and the testes lie within the processus vaginalis
- Lateral: the hernia and the testes lie within the processus vaginalis
- There is no way to predict the relational position of the hernia to the spermatic cord based on the information provided.
1
One of the key structures related to inguinal hernias is the processus vaginalis. The processus vaginalis is a pouch-like extension of the peritoneal cavity that accompanies the testes during their descent. In normal development, the processus vaginalis undergoes obliteration, closing off its connection to the peritoneal cavity. However, in some cases, the processus vaginalis may persist as a potential space or canal.
An indirect inguinal hernia occurs when there is a protrusion of abdominal contents (such as a portion of the intestine) through the deep inguinal ring, which is an opening in the transversalis fascia within the inguinal canal. This herniation typically follows the pathway of the processus vaginalis.
Now, let’s consider the relational position of the hernia tissue to the spermatic cord. The spermatic cord is a structure that consists of the vas deferens, testicular artery and veins, lymphatic vessels, and nerves, all enclosed within layers of fascia. The processus vaginalis runs anterior to the spermatic cord.
In the case of an indirect inguinal hernia, the hernia sac (the protrusion of peritoneum containing abdominal contents) travels through the deep inguinal ring and into the inguinal canal. The hernia sac remains anterior to the spermatic cord as it follows the pathway of the processus vaginalis. Therefore, the correct answer is that the hernia is inside the processus vaginalis, while the testes (part of the spermatic cord) are posterior to it.
Understanding the anatomical relationships in the embryological development of the inguinal canal and the position of structures helps in explaining the relational position of the hernia to the spermatic cord in the case of an indirect inguinal hernia.
During a routine check up, a 43 year old male is informed that radiographic examination has given strong evidence that he has a malignancy of his scrotum. Which of the following lymph nodes are the first lymph nodes that drain the affected area?
Internal iliac
External iliac
Superficial inguinal
Deep inguinal
Paraaortic
Superficial inguinal
A 20‐year‐old male was stabbed in the back lateral to the vertebral column, just below the right 12th rib. The point of the blade lodged in his right kidney. Which of the following was MOST LIKELY penetrated?
Greater sac of peritoneal cavity.
Lesser sac of peritoneal cavity.
Right subphrenic space of peritoneal cavity.
Costodiaphragmatic recess of right pleural cavity.
Bare area of liver.
Right subphrenic space of peritoneal cavity.
A 37‐year‐old male presents with a single entrance wound from a rifle shot over the epigastric region. Although you quickly repaired bleeding vessels and closed the hole in the anterior and posterior wall of the stomach, the patient continued to ooze blood and HCl into the peritoneal cavity. Where would you expect to note the largest and most immediate collection of fluid if blood was exiting posterior to the stomach and the patient was lying supine?
Omental bursa/lessor sac
Greater sac
Right paracolic gutter
Left paracolic gutter
Right posterior subphrenic space
Omental bursa/lesser sac
A 50 year old female patient presented to ED with a perforated gastric ulcer causing rupture of her splenic artery. If she is lying supine, where is the blood collecting?
Rectovesical pouch
Rectouterine pouch
Hepatorenal recess
A&C
B&C
All of the above
B&C
A 30‐year‐old man comes to see the GP with a complaint of severe epigastric pain for the last 3 days. The pain is burning in nature and does not radiate. He tells you that he has been taking NSAIDs recently for a knee injury. On further questioning, he also admits that he has been passing black, tarry and foul smelling stools for the last 2 days. He has no significant history of alcohol consumption. What is the MOST LIKELY diagnosis in this patient?
Acute pancreatitis
Peptic ulcer disease
Hepatitis
Cholecystitis
Gastric cancer
Peptic ulcer disease
A surgeon needs to access the left gastric artery at the location of its anastomosis with the right gastric artery and she asks you to find it. Using your embryological knowledge, you remember that this structure used to be located _____________ to the stomach and is in the __________________ so you are able to quickly identify its location.
ventral; falciform ligament
dorsal; gastrosplenic ligament
ventral; hepatogastric ligament
dorsal; hepatogastric ligament
dorsal; lesser omentum
dorsal; hepatogastric ligament
An 80‐year‐old lady was treated with NSAIDs for her arthritis. Subsequently she was observed to be pale and experienced giddiness and a syncopal attack. She gave a history of passing black tarry stools. An upper endoscopy (OGDS) revealed a large ulcer at the posterior wall of first part of duodenum with oozing of fresh arterial blood. Which blood vessel is the most likely source of the bleeding?
Short gastric artery
Splenic artery
Superior pancreaticoduodenal artery
Gastroduodenal artery
Left gastroepiploic artery
Gastroduodenal artery
Foregut part supplied by gastroduodenal a.
Midgut part supplied by inferior pancreaticoduodenal a.
When performing a liver resection during liver transplantation surgery, the surgeon needs to carefully review the anatomy of the segments of the liver. Within each liver segment is located all of the following EXCEPT:
Branch of the hepatic artery
Branch of the hepatic duct
Tributary of the portal vein
Deep lymphatic vessels
Tributary of the hepatic vein
Tributary of the hepatic vein
Portal triad: hepatic portal v. + proper hepatic a. + common bile duct and portal vein supply and drain each of the 8 liver segments
Which segment of the adult duodenum is MOST MOBILE, as determined by its relationship with the peritoneum?
All are immobile
Ascending part
Cap/superior part
Descending part
Transverse part
Cap/superior
The cap or superior part of the duodenum is considered the most mobile segment in relation to the peritoneum. The duodenum is a C-shaped structure located immediately beyond the stomach and is the first part of the small intestine. It is divided into four segments: the cap/superior part, the descending part, the transverse part, and the ascending part.
The cap/superior part of the duodenum is attached to the liver by the hepatoduodenal ligament, which contains the common bile duct, hepatic artery, and portal vein. However, the superior part of the duodenum is relatively mobile because it is not directly attached to the posterior abdominal wall by peritoneal reflections.
In contrast, the other segments of the duodenum (descending, transverse, and ascending parts) are retroperitoneal, meaning they lie against the posterior abdominal wall and are fixed in position. These segments are firmly attached to the peritoneum and are not as mobile as the cap/superior part.
The mobility of the cap/superior part of the duodenum allows it to move within the peritoneal cavity, adapting to changes in the size and shape of the neighboring structures such as the liver, gallbladder, and stomach. This mobility is important for proper digestion and to accommodate the passage of food from the stomach into the small intestine.
A 60‐year‐old male with abdominal pain has a CT that shows an aortic aneurysm at the level of the L3 lumbar vertebra. Which of the following is MOST LIKELY to be affected by ischaemia from an occluded branch of the aorta at this level?
Spleen.
Jejunum.
A kidney.
Ascending colon.
Sigmoid colon.
Sigmoid colon
L3 – IMA –> hindgut –> sigmoid
How does the pancreas respond to acidic chyme entering duodenum?
Release of secretin from ECL cells in the duodenum wall into bloodstream–> activate release of alkaline pancreatic juice from pancreatic ductal cells and liver to produce alkaline bile
How does the pancreas respond to entry of fatty, protein-rich chyme entering duodenum?
Release of CCK into bloodstream from ECL cells in the duodenum wall into the bloodstream –> reach pancreas and activate release of pancreatic enzymes by acinar cells (produced as zymogen granules) and release of bile from gallbladder to aid with digestion
Which of these pancreatic enzymes are secreted actively and inactively? Why are inactive enzymes secreted by the pancreas?
trypsin, chymotrypsin, carboxypeptidase and elastase
lipase, cholesterol esterase, phospholipase (fats), a-amylase (carbohydrates), ribonuclease, deoxyribonuclease (nucleic acids)
Inactive precursors secreted by acinar cells as zymogen granules: trypsin, chymotrypsin, carboxypeptidase and elastase
Active enzymes: lipase, cholesterol esterase, phospholipase (fats), a-amylase (carbohydrates), ribonuclease and deoxyribonuclease (nucleic acids)
To prevent autodigestion of the pancrease
What are the actions of CCK?
CCK is released into the bloodstream when fatty and protein rich chyme enters the duodenum
1. release of pancreatic enzymes from pancreatic acinar cells: including pancreatic lipase and cofactor colipase
2. contraction of gallbladder for the release of bile
3. relaxation of sphincter of Oddi/hepatopancreatic sphincter
4. inhibit stomach churning (slow down for fat to be digested)
5. constriction of pyloric sphincter to slow down emptying of stomach into duodenum
what is the urine and stool results for prehepatic hyperbilirubinemia? is it conjugated or unconjugated?
unconjugated.
Prehepatic hyperbilirubinemia: This type of hyperbilirubinemia is caused by increased hemolysis, which leads to an excess of unconjugated bilirubin in the blood. Unconjugated bilirubin is hydrophobic and cannot be excreted in urine, resulting in normal urine color. However, the increased bilirubin can still be transported to the gut, leading to increased urobilinogen conversion. Although urobilinogen is colorless, it gets converted to stercobilin, which gives stool its normal color.
urine and stool results for intrahepatic hyperbilirubinemia? is it conjugated or unconjugated?
Conjugated. Dark urine and normal stools
Intrahepatic hyperbilirubinemia: Intrahepatic hyperbilirubinemia occurs due to hepatocellular damage, where the liver is unable to efficiently transport conjugated bilirubin (CB) into the gut. This leads to the leakage of CB into the bloodstream, resulting in conjugated hyperbilirubinemia. Since CB is hydrophilic, it can be excreted in urine, causing dark urine. However, the conjugated bilirubin does not decrease stercobilin production, so stool color remains normal. Additionally, hepatocellular damage leads to the release of liver enzymes, resulting in elevated levels of AST and ALT. The liver’s overall function may also be impaired, leading to decreased albumin levels in the blood.
urine and stool results for posthepatic hyperbilirubinemia? is it conjugated or unconjugated?
Posthepatic hyperbilirubinemia: Posthepatic hyperbilirubinemia, also known as obstructive jaundice, occurs when there is a blockage in the bile ducts, resulting in the accumulation of conjugated bilirubin (CB) in the blood. CB is hydrophilic and can be excreted in urine, causing dark urine. However, the obstruction prevents CB from entering the intestine, where it would be converted to urobilinogen by bacteria. As a result, there is a decrease in stercobilin production, leading to pale stools. Obstruction of the bile ducts can also cause the release of biliary tree factors, such as alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT), which can be detected at elevated levels in the blood.
mode of transmission for hepatitis viruses?
A&E fecal (opp ends)
B–bodily fluids, Parenteral contact, across placenta
C–chronic infection, blood borne, Contact with infected blood: IV drug use/transfusions
Contaminated personal products
D–only with hep B Rare
Only in individuals infected with HBV
what antibiotics should be given for someone suffering from vibro cholerae?
tetracyclines, quinolones and azithromycin
Antibiotics for clostridium difficile?
oral metronidazole/vancomycin
Treatment for h.pylori?
Triple therapy first line: Esomeprazol, clarithromycin, amoxicillin
2nd line: quadruple therapy – PPI + bismuth + metronidazole + tetracycline
Antibiotics for salmonella enterica?
Ciprofloxacin, ceftratrione, azithrymycin
What do Red colonies with black centres on XLD agar indicate?
Salmonella enterica
Treatment of parasites:
Broad spectrum antihelminthic drugs albendazole (preferred due to better GIT absorption) and mebendazole (poor GIT absorption)
