Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Random > Flashcards

Random Flashcards

1
Q

What should you suspect in someone with atrial fibrillation and abdominal pain?

A

Mesenteric thrombosis

- could have small bowel ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common cause of splenomegaly & other causes?

A
  • Malaria (most common)

- other: thrombocytopenia, sickle cell (need special measures in surgery when administering anasethtic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Aortic aneurysm

- typical patient

A

Male, fat, 60’s, back pain, had a collapse.

Intraperitoneal –> die
Retroperitoneal –> tamponade due to muscle + pressure

Treatment = clamp on aorta

BE careful when examining as may cause it to burst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of small bowel obstruction

A
  • adhesions (may be from previous surgery)
  • hernia
  • Caecal cancer
  • Partial blockage - still get some gas through
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does pain from perforation radiate to? What nerve is involved?

A

Shoulder tip pain

C4 phrenic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does an obstructed bowel sound like?

A

Initially some sounds then more, when dilates there are pinging sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a proctelectomy?

A

Removal of rectum and all/part of colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What causes pseudomembranous colitis?

  • most likely organism
  • treatment?
A

Usually follows course of broad spectrum antibiotics

Characteristic macro and microscopic appearance

Caused by c. difficile

Treated with vancomycin or metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is cyclosporin?

A

immunosuppressant - acts by inhibiting production and release of lymphokines therefore suppresses cell-mediated immune response.

Given prior to and as maintenance post transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is TIPS?

A

Procedure that uses imaging guidance to connect the portal vein to the hepatic vein in the liver.

A stent is placed to keep the connection open and allow it to bring blood draining from the bowel back to the heart while avoiding the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Terlipressin

A

Synthetic vasopressin analogue

Relative specificity for the splanchnic circulation where it causes vasoconstriction in these vessels with a reduction in portal pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Positive AMA - what condition is likely?

A

Primary biliary cholangitis

PBC - M rule
IgM
anti-mitochondrial antibodies, M2 subtype
Middle aged females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should you think if you see markedly elevated ALP?

A

Bile duct pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sulphasalazine

  • What is it made up of?
  • SE
A

Ccombination of sulphapyridine (a sulphonamide) and 5-ASA

many side-effects are due to the sulphapyridine moiety: rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mesalazine

A

A delayed release form of 5-ASA
sulphapyridine side-effects seen in patients taking sulphasalazine are avoided.

mesalazine is still however associated with side-effects such as GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

IBD - which one can methotrexate be used in?

A

Crohns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Visceral pain

A

innervated by autonomic NS (sympathetic branch)

T6-12 and L1-2 through splanchnic nerves

Dull ache, poorly localized, nausea

stretching/traction, distention, inflammation, ischaemia, spasm

Areas and where they are felt:
foregut - epigastric area
midgut - umbilical area
hindgut - suprapubic area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Parietal pain

A

Innervated by somatic NS

severe, well localized, persistent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Somatic pain

  • where does it originate in?
  • what dermatomes are involved?
  • what sensation may stimulate this pain?
  • how would you describe this pain?
A

Originates in parietal peritoneum

T5- L2 dermatomes

mechanical, chemical, thermal stimulation

sharp constant pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What stimulates gastric acid secretion?

A

Ach, Gastrin, histamine

21
Q

What inhibits gastric acid secretion?

A

Somatostatin, secretin, cholecystokinin

22
Q

Possible causes of pain in right hypochondriac region

A 
Biliary colic
ascending cholangitis
sub-phrenic abscess 
appendicitis
basal pneumonia
23
Q

Possible causes of pain in Epigastric region

A 
Pancreatitis
gastritis/duodenitis
AAA
perforated DU
MI
24
Q

Possible causes of pain in Left hypochondriac region

A

Ruptured spleen

25
Q

Main causes of obstruction

(1) small bowel
(2) large bowel

A

(1) small bowel
hernia, previous operations

(2) large bowel
tumors, twisting of caecum

26
Q

Treatment in obstruction

A

Patient – V. dehydrated, distended abdomen

Fluid resuscitation

NG tube; Nil-by-mouth

Analgesia

Antiemetics

Stop medication?

Surgery – remove obstruction

27
Q

Maldigestion

A

impaired breakdown of nutrients, lumenal phase

28
Q

Malabsorption

A

defective mucosal uptake and transport of adequately digested nutrients. Selective or global.
Malassimilation: encompasses both.

29
Q

Malassimilation

A

Encompasses both maldigestion and malabsorption

30
Q

Possible causes of issues with lumenal phase of absorption
1 - nutrient hydrolysis
2 - fat solubilization
3 - lumenal availability

A

Nutrient hydrolysis

  • Enzyme deficiency: pancreatic insufficiency

  • Enzyme inactivation: ZE syndrome

  • Inadequacy of mixing: rapid transit, surgical resection 


Fat Solubilization


  • Decreased bile salts: cholestasis, cirrhosis

  • Bile salt deconjugation: bacterial overgrowth
  • Bile salt loss: ileal disease or resection 


Lumenal availability


  • Bacterial consumption of nutrients (bacterial overgrowth): B12 deficiency

  • Decreased intrinsic factor (pernicious anemia): B12 deficiency
31
Q

Possible causes of issues with mucosal phase of absorption

A

Brush border hydrolysis: lactase deficiency (post gastroenteritis, alcohol, radiation)

Epithelial transport:

  • Reduced absorptive surface - resection
  • Damaged absorptive surface – coeliac disease, tropical sprue, Crohn’s disease, ischaemia
  • Infections – Giardia, SIBO

  • Infiltration – lymphoma, amyloid
32
Q

Possible causes of issues with post- mucosal phase of absorption

A

Post-absorptive processing – lymphatic obstruction (lymphangectasia, neoplastic, TB)

33
Q

Clinical features of malabsorption

A

Diarrhoea, Steatorrhoea (fat, bile salts)


Weight loss despite adequate intake

Bloating, distension, gas, cramps, borboygmi

Lethargy, malaise

Symptoms often mild non-specific

Diarrhoea and weight loss in normal diet!

Evidence of malnutrition

Skin

  • Angular cheilitis, glosssitis
  • Dermatitis herpetiformis
  • Oedema
34
Q

Symptoms of B12 deficiency

A

Neurologic (B12) deficiency

  • Peripheral neuropathy
  • Ataxia (posterior column)
  • Psychosis, dementia
35
Q

Microcytosis

A

iron deficiency - common in coeliac and suspect GI blood loss

36
Q

Macrocytosis

A

B12, folate deficiency

common in colecial, alcohol

37
Q

PARASYMPATHETIC NS

A

PARASYMPATHETIC NS
Cholinergic drugs cause spasms; diarrhoea.
Anticholinergic drugs: dry mouth; constipation.

38
Q

SYMPATHETIC NS

A

SYMPATHETIC NS
Dopaminergic drugs cause nausea, slow down transit
Dopamine antagonists cause prokinetic (stimulate peristalsis); anti-emetic

39
Q

Constipation treatments

A

Bulk-forming

  • Isphagul husk (fybogel, isogel)
  • Methylcellulose

Stimulant

  • Polyphenolics: bisacodyl, sodium picosulphate (Picolax)
  • Anthraquinones: senna, dantron

Faecal softeners

  • Arachis oil (From peanuts – ALLERGY?)
  • Liquid paraffin

Osmotic

  • Draw water into bowel and helps soften poo
  • Lactulose – synthetic dissacharide
  • Macrogols – polymers of ethylene glycol (Movicol)
  • Magnesium salts, phosphate salts
40
Q

Nausea and vomiting treatments

A

Phenothiazines
- Prochlorperazine 5-10mg, 8-hrly IM/IV

Dopamine antagonists

  • Metoclopramide 10mg 8-hrly oral/IV
  • Domperidone

Anti-histamines
- Cyclizine 50mg 8-hrly oral/IV

5HT3 antagonists
- Ondansetron/ granisetron

41
Q

Antacid +/- alignates

- SE

A

Aluminium hydroxide, magnesium carbonate, calcium carbonate

OTC – Rennies, Settlers, Tums
Combined with alginates – Peptac, Gaviscon

Indications: GORD,

MOA:

  • Neutralise gastric acid
  • Alginates – swell when mix with gastric juice, forming ball clot above gastric juice

Effective for mild symptoms – rarely achieve healing

SE: Mg → laxative; Al→ Constipating; Ca→ hyperCa,

42
Q

Gastric acid production

A

Gastric parietal cell produces protons and HCl through ATPase pump.

  • Histamine acts on H2 receptor (cAMP dependent pathway)
  • Acetylcholine acts on muscarinic M3 receptor
  • Gastrin acts on CCK2 receptor (Ca2+ dependent pathway)
  • H+K+ ATPase
43
Q

PPI inhibitors

  • Examples
  • mechanism
  • indications
  • dose
  • SE
A

Lansoprazole, pantoprazole, esomeprazole

MOA: Blocks final step in the H+ ion secretion by the H+/K+ ATPase 
enzyme system in gastric parietal cell 

- Most powerful acid suppressants

Indications 


  • GORD -1st line
  • Oesophagitis not responding to H2 antagonist

Administration 
– 20 mg once daily by mouth for 4 weeks 


SE 
– diarrhoea/GI upset but well tolerated long-term

44
Q

H2 receptor antagonists

  • Examples
  • mechanism
  • indications
  • dose
  • SE
A

Cimetidine, ranitidine, famotidine, nizatidine

MOA

  • reduced H2 receptor stimulation in gastric parietal cells
  • Decreased acid secretion, gastric volume and H+ concentrations

Heals mild oesophagitis in 70-80% patients with GORD

Indication: gastric, duodenal ulcers

Administration: 400mg 6hourly by mouth 4-8 weeks

SE:

  • Diarrhoea & GI upset, confusion
  • Cimetidine inhibits cytochrome P450 + has important interactions (warfarin, phenytoin, theophylline)
45
Q

Aminosalicylate drugs

  • Examples
  • mechanism
  • indications
  • dose
  • SE
A

Sulfasalazine, mesalazine, osalazine

MOA
- Unknown: 20 % absorbed but remainder goes to colon where colonic bacteria cleave the diazo bond to liberate 5-ASA molecule which remains in colon-> local anti-inflammatory effects

Indications

  • Flare-ups in UC & Crohn’s
  • Maintenance for UC
  • Sulfasalazine - rheumatoid arthritis

Administration
- Once daily by mouth (some given locally)

SE
- Sulfasalazine - more side effects than others 
– haematopoiesis depressed, photosensitivity, azoospermia, hypersensitvity

Monitoring and follow-up: FBC, LFTs

46
Q

Loperamide

  • Other similar examples
  • mechanism
  • indications
  • dose
  • SE
A

Other similar opioid drugs: codeine

MOA: Act on opioid receptors found in muscle lining of walls of intestines → reduces peristalsis increasing transit time allowing greater fluid absorption

Indication

  • Relief from short-term diarrhoea symptoms in adult/children up to 12 years
  • Relief from diarrhoea in adults with long-term diarrhoea
  • Treatment of short-term diarrhoea associated with IBS in adults

Administration: 2mg after each loose stool (max 16mg/d)

SE:

  • Dizziness, sleepiness, constipation, vomiting
  • Not to be used in toxic megacolon
47
Q

Codeine

  • Other similar examples
  • mechanism
  • indications
  • dose
  • SE
A

Other similar opioid drugs
Mild opioids: tramadol
Powerful: morphine

MOA

  • Opioid receptor agonsits
  • Reduced GI motility

Indications: acute diarrhoea

Administration: 30mg 3-4 times daily by mouth

SE: nausea, vomiting, dizziness, drowsiness, constipation

48
Q

Co-phenotrope

  • Other similar examples
  • mechanism
  • indications
  • dose
  • SE
A

Mixture of two drugs

  • Diphenoxylate hydrochloride 2.5 mg 

  • Atropine sulphate 25 μg
  • Lomotil is a 100:1 ratio of the two components

MOA

  • Diphenoxylate blocks nerve signals to intestinal 
muscles to increase transit time and reduce spasm 

  • Atropine is a muscarinic receptor antagonist

Indication: acute diarrhoea

Administration 
– 2 tablets every 6 hours until diarrhoea controlled

SE: dry mouth, constipation, drowsiness 


GI (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions