LObs Flashcards
Describe the peritoneum and its parts
The peritoneum is a continuous membrane which lines the abdominal cavity and covers the abdominal organs (abdominal viscera).
The parietal peritoneum lines the internal surface of the abdominopelvic wall.
It receives the same somatic nerve supply as the region of the abdominal wall that it lines; therefore, pain from the parietal peritoneum is well localised.
The Visceral peritoneum invaginates to cover the majority of the abdominal viscera.
Pain from the visceral peritoneum is poorly localised and the visceral peritoneum is only sensitive to stretch and chemical irritation.
Pain from the visceral peritoneum is referred to areas of skin (dermatomes) which are supplied by the same sensory ganglia and spinal cord segments as the nerve fibres innervating the viscera.
What is the peritoneal cavity?
The peritoneal cavity is a potential space between the parietal and visceral peritoneum. It normally contains only a small amount of lubricating fluid.
What is a Carcinoma?
Carcinoma is a type of cancer that starts in cells that make up the skin or the tissue lining organs, such as the liver or kidneys.
What does the ‘Adeno’ in Adenocarcinoma indicate?
That the carcinoma is derived from Glandular Mucosa
What is dysphagia?
Difficulty in swallowing
Draw the structure of the GI Tract histological layers:
- What is different in the layers of the oesophagus and lower part of the rectum?
They have adventitia instead of serosa, as they are located outside the peritoneal cavity
What is the structural difference between the oesophageal epithelium compared to that of the Small/Large intestine and stomach?
The oesophageal epithelium consists of squamous cells, as opposed to the columnar epithelium in the rest of the GI Tract
Cells with rounder shape and intercellular bridges are found toward the basal layer or surface of the squamous epithelium?
The basal layer, they flatter as they mature and rise toward the surface.
What is GORD?
Gastroesophageal reflux disease occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit.
Highly acidic (as low as pH 1) gastric contents damage unprotected squamous mucosa, leading to:
- Infiltration of the damaged surface epithelium by neutrophil polymorphs and eosinophils.
- Basal cell hyperplasia as epithelium proliferates to replace damaged cells
What is the main aetiological cause of GORD?
For more details, visit https://emedicine.medscape.com/article/176595-overview#a2
What are the four main complication of GORD?
Draw a diagram of a peptic ulcer and discuss its possible complications if present in the stomach or duodenum?
Give a definition of Barrett’s oesophagus:
What is metaplasia? And why does it occur secondary to GORD?
Metaplasia is the reversible replacement of the one mature type of epithelium by another in response to adverse circumstance. It is reversible if the stimulus is removed.
The mucus barrier of columnar epithelium protects against acid better than the squamous, hence the metaplasia.
What is dysplasia?
(Atypical NF can include nuclear enlargement, and pleomorphism - which is variation in shape and size of the nuclei)
How does carcinoma of the oesophagus present in patients?
What are the two types of adenocarcinoma in the oesophagus?
In what parts of the body/the world are squamous vs adeno carcinoma more common?
What are the principal features of the specialised gastric mucosa?
Parietal cells: Secrete gastric acid
Chief cells: Secrete pepsinogen which is activated by acid in the gastric lumen to form the active protease enzyme Pepsin.
What are the normal formed in the stomach, and what are some factors that might interfere with their function?
What are the two main irritants of the gastric mucosa that lead to gastritis?
H. Pylori and NSAIDs
Draw a diagram explaining how the stomach secretes acid:
Outline the definition and risk factors for GORD
What are the typical and atypical (alarming) symptoms of GORD, and what treatment would we proposed based on them?
NB: Like asthma, only has to be ONE atypical symptom to warrant acute treatment.
Draw a treatment flow chart for diagnosing/managing GORD and it’s related conditions
What are the five main complications of GORD?
What are the symptoms for Gastric and Duodenal Ulcers and how do they differ?
How does H. Pylori infection lead to ulceration?
- Locally raise the pH leading to increased Gastrin secretion
- Impair mucus production
- Directly cause inflammation of the epithelial lining
What is the montreal definition/classification of GORD?
Describe the differences between Somatic, Visceral and Neuropathic pain
Why is visceral pain badly localised?
Because multiple viscera converge on to the same spinal cord neurones (makes up less than 10% of total afferents)
What are the 5 and half different types of afferent neurones in the gut?
Outline the main differences between the character of visceral and non-visceral pain
Outline the exacerbating factors for oesophagitis, GORD and peptic ulcers
Give an outline definition of dyspepsia
How do CCBs affect GORD?
Cause relaxation of LES
What are common drugs that can cause peptic ulcers / GORD?
NSAIDs
CCBs
Nitrates
Theophyllines
Biphosphonates
Corticosteroids
What would you look for on a FBC result to make you think about a peptic ulcer?
Lower Hb through bleeding
What is the LA Classification of Reflux Oesophagitis?
What are the 3 (kind of 4) options for treatment of GORD?
Give an overview of Laperoscopic Nissen Fundoplication
How does the Prague classification of Barrett’s Oesophagus work?
Outline the surveillance management for Barrett’s Oesophagus, in terms of vigilance for dysplagia and/or malignancy
What are the main risk factors for Barrett’s Oesophagus
Outline the investigations for peptic ulcers, and what criteria should be met for which
Outline the treatment options and guidelines for peptic ulcers
What are the 4 principle complications of Peptic ulcers?
What is an endocrine cell?
Endocrine cells are characterized by the secretion of various hormones (signaling molecules) to the blood.
Draw an outline of parietal cell function (12 steps)
Outline the differences between Autocrine and Paracrine signalling
What is the neurological pathway for secretion of stomach acid, and how can it be antagonised?
What is the endocrine pathway for secretion of stomach acid, and how can it be antagonised?
What is the paracrine pathway for secretion of stomach acid, and how can it be antagonised?
How does a PPI ensure inhibition of all pathways of HCL secretion?
Omeprazole irreversibly blocks the H+/K+ ATPase pump function thereby inhibiting all three pathways
What is a hiatus hernia?
A hiatal hernia occurs when a portion of the stomach prolapses through the diaphragmatic esophageal hiatus.
