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Semester 3 - Gastrointestinal > Session 7 - Liver, gallbladder and pancreas 2 > Flashcards

Session 7 - Liver, gallbladder and pancreas 2 Flashcards

1
Q

Outline 7 different “toxins” which we willfully put into our GI tract

A
  • Chemical
    • Bacteria
    • Viruses
    • Protozoa
    • Nematodes (Roundworms)
    • Cestodes (Tapeworms)
    • Trematodes (flukes)
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2
Q

What are the two overall defence mechanisms available to the GI tract to defend it from toxins

A

• Innate

Adaptive

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3
Q

What are the two parts of the innate immune system?

A
  • Physical

* Cellular

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4
Q

Describe 8 physical innate defences

A
  • Sight/smell
    • Memory
    • Saliva
    • Stomach acid
    • Small intestine secretions
    • Colonic mucus
    • Anaerobic environment
    • Peristalsis/Segmentation
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5
Q

How does sight/smell work as a physical innate defence?

A

• If food looks or smells bad you won’t eat it

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6
Q

How does memory work as a physical innate defence?

A

• If food tastes bad, you won’t eat it next time

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7
Q

Give three reasons saliva is an integral part of the physical innate defence of the GI tract?

A
  • pH 7.0
    • Contains lysozyme, lactoperoxidase, complement, IgA and polymorphs
    • Washes toxins down into the stomach
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8
Q

What is the clinical condition in which there is reduced salivary flow?

A

Xerostomia

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9
Q

Give two causes of xerostomia

A
  • Severe illness

* And/or dehydration

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10
Q

What does xerostomia cause?

A
  • Microbial overgrowth in the mouth and dental caries

* Parotitis

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11
Q

What organism causes parotitis?

A

• Staph aureus

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12
Q

How does stomach acid serve as a physical innate defence?

A

• Low pH kills the majority of bacteria and viruses

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13
Q

What condition can make the stomach a less effective defence?

A
  • Achlorhydria

* Makes more susceptible to shigellosis, cholera and salmonella infection

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14
Q

What can cause achlorhydria?

A
  • Pernicous anaemia
    • H2 antagonists

PPIs

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15
Q

What are people taking PPI’s more at risk of if they have achlorhydria if in hospital?

A

Clostridium difficile infection

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16
Q

Name three organisms resistant to stomach acid

A
  • Mycobacterium Tuberculosis is resistant to gastric acid (Acid and alcohol fast bacterium)
    • Enteroviruses - Hep A, Polio and Coxsackie are resistant to gastric acid
    • Helicobacter Pylori produces urease which acts on urea to produce a protective cloud of pneumonia
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17
Q

What four properties of small intestinal secretions allow it to repel GI invaders

A
  • Bile
    • Proteolytic enzymes
    • Lack of nutrients

Shedding of epithelial cells

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18
Q

How does the colonic mucus protect the GI system?

A

Separates epithelial wall from its contents

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19
Q

How does peristalsis/segmentation prevent GI disease?

A

• Normal intestinal transit time is 12-18 hours. If peristalsis slow, gut infections are prolonged.

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20
Q

Give five cellular innate defences of the GI tract

A 
• Neutrophils 
	• Macrophages 
		○ Kupfer cells in the liver
	• Natural killer cells
	• Tissue Mast Cells
	• Eosinophils 
		○ Parasitic infections
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21
Q

How does the hepatic portal system aid in GI defence

A

• All venous blood from the GI tract passes through the liver before returning to systemic circulation

Kupffer cells are specialised macrophages in the liver which clear debris and toxins

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22
Q

Outline three adaptive cellular defences of the GI tract

A
  • B lymphocytes
    • T lymphocytes
    • Lympatic tissue
23
Q

What do B lymphocytes do?

A

• Produce antibodies including IgA and IgE that are particularly effective against extracellular microbes

24
Q

What do T lymphocytes do?

A

• Directed against intracellular organisms

25
What is mucosal associated lymphoid tissue in the GI tract called?
• GALT (Gut associated Lymphoid Tissue)
26
Give three locations of GALT
* Tonsils * Peyer's patches * Appendix
27
How can the recruitment of mast cells at the site of an infection in the GI tract cause damage?
* Mast cells release histamine * Massive vasodliation and increase in capillarly permeability * Fluid loss and dehydration
28
Give a condition where mast cell release of histamine (along with intrinsic toxins) causes massive fluid loss
• Cholera
29
Give three conditions associated with GALT
* Tonsilitis * Ilecaecal lymphatic tissue * Appendicitis
30
Give two infections of the ileocaecal lymphatic tissue
• Mesenteric adenitis Typhoid fever
31
What is mesenteric adenitis and what is it caused by?
• Inflammation of mesenteric GALT tissue Caused by adenovirus/coxsackie virus
32
What are the main symptoms of mesenteric adenitis, and what can it be mistaken for?
* Right iliac fossa pain in children | * Appendicitis
33
What is typhoid fever?
* Caused by Salmonella Typhi * Inflamed peyer's patches in terminal ileum, can perforate and kill patients * Intestinal peyer's patches haemorrhage
34
Give three causes of appendicitis
* Lymphoid hyperplasia at the appendix base * Faecolith obstruction * Worm obstruction
35
Why is there a higher incidence of appendicitis during outbreaks of chicken pox?
• Lymphoid hyperplasia causes obstruction
36
Give three causes of gut ischaemia
* Arterial disease * Systemic hypotension Intestinal venous thrombosis
37
What does gut ischaemia lead to?
• Overwhelming sepsis and rapid death
38
What does liver failure increase one's susceptibility to?
* Infections * Toxins * Drugs * Hormones
39
What is an intrinsic affect of liver failure?
* Increased blood ammonia due to failure of the urea cycle * Ammonia produced by colonic bacteria and deamination of amino aids Can cause hepatic encephalopathy
40
Give five major causes of hepatic liver failure
``` • Viral hepatitis • Alcohol • Drugs ○ Paracetamol, halothane • Industrial solvents ``` Mushroom poisoning
41
What is the main cause of liver failure in the UK?
• Alcohol
42
What is cirrhosis?
• Hepatocellular necrosis followed by fibrosis
43
What does liver cirrhosis lead to?
• Portal venous hypertension, leading to prosystemic shunting and therefore toxin shunting
44
Give three conditions portosystemic shunting leads to
* Oesophageal varicies * Haemorrhoids * Caput medusa
45
Give the main tributaries of the hepatic portal vein
* Superior mesenteric vein * Splenic vein * Inferior mesenteric
46
What are bile pigments?
• Produced as a result of the break down of haemoglobin (bilirubin)
47
What is the lifecycle of bilirubin?
• Conjugated in the liver and secreted in the bild ot be excreted in the faeces
48
What occurs if bilirubin cannot be excreted?
• Accumulated in the tissues, causing jaundice
49
Give one hormone the liver breaks down
• Insulin
50
What is the most abundant plasma protein?
• Albumin
51
What is albumin essential for?
• Maintaining oncotic pressure for the distribution of body fluids
52
Name 7 coagulation factors produced by the liver
* I – Fibrinogen * II – Prothrombin * V * VII * IX * X * XI * Protein C + S * Antithrombin
53
What is thrombopoietin?
• A glycoprotein hormone that regulates the production of platelets by the bone marrow
54
How does the liver generate aminoacids?
• Transamination

Semester 3 - Gastrointestinal (28 decks)

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