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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
Q

What is mucosal associated lymphoid tissue in the GI tract called?

A

• GALT (Gut associated Lymphoid Tissue)

26
Q

Give three locations of GALT

A
  • Tonsils
    • Peyer’s patches
    • Appendix
27
Q

How can the recruitment of mast cells at the site of an infection in the GI tract cause damage?

A
  • Mast cells release histamine
    • Massive vasodliation and increase in capillarly permeability
    • Fluid loss and dehydration
28
Q

Give a condition where mast cell release of histamine (along with intrinsic toxins) causes massive fluid loss

A

• Cholera

29
Q

Give three conditions associated with GALT

A
  • Tonsilitis
    • Ilecaecal lymphatic tissue
    • Appendicitis
30
Q

Give two infections of the ileocaecal lymphatic tissue

A

• Mesenteric adenitis

Typhoid fever

31
Q

What is mesenteric adenitis and what is it caused by?

A

• Inflammation of mesenteric GALT tissue

Caused by adenovirus/coxsackie virus

32
Q

What are the main symptoms of mesenteric adenitis, and what can it be mistaken for?

A
  • Right iliac fossa pain in children

* Appendicitis

33
Q

What is typhoid fever?

A
  • Caused by Salmonella Typhi
    • Inflamed peyer’s patches in terminal ileum, can perforate and kill patients
    • Intestinal peyer’s patches haemorrhage
34
Q

Give three causes of appendicitis

A
  • Lymphoid hyperplasia at the appendix base
    • Faecolith obstruction
    • Worm obstruction
35
Q

Why is there a higher incidence of appendicitis during outbreaks of chicken pox?

A

• Lymphoid hyperplasia causes obstruction

36
Q

Give three causes of gut ischaemia

A
  • Arterial disease
    • Systemic hypotension

Intestinal venous thrombosis

37
Q

What does gut ischaemia lead to?

A

• Overwhelming sepsis and rapid death

38
Q

What does liver failure increase one’s susceptibility to?

A
  • Infections
    • Toxins
    • Drugs
    • Hormones
39
Q

What is an intrinsic affect of liver failure?

A
  • 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
Q

Give five major causes of hepatic liver failure

A 
• Viral hepatitis
	• Alcohol
	• Drugs
		○ Paracetamol, halothane 
	• Industrial solvents

Mushroom poisoning

41
Q

What is the main cause of liver failure in the UK?

A

• Alcohol

42
Q

What is cirrhosis?

A

• Hepatocellular necrosis followed by fibrosis

43
Q

What does liver cirrhosis lead to?

A

• Portal venous hypertension, leading to prosystemic shunting and therefore toxin shunting

44
Q

Give three conditions portosystemic shunting leads to

A
  • Oesophageal varicies
    • Haemorrhoids
    • Caput medusa
45
Q

Give the main tributaries of the hepatic portal vein

A
  • Superior mesenteric vein
    • Splenic vein
    • Inferior mesenteric
46
Q

What are bile pigments?

A

• Produced as a result of the break down of haemoglobin (bilirubin)

47
Q

What is the lifecycle of bilirubin?

A

• Conjugated in the liver and secreted in the bild ot be excreted in the faeces

48
Q

What occurs if bilirubin cannot be excreted?

A

• Accumulated in the tissues, causing jaundice

49
Q

Give one hormone the liver breaks down

A

• Insulin

50
Q

What is the most abundant plasma protein?

A

• Albumin

51
Q

What is albumin essential for?

A

• Maintaining oncotic pressure for the distribution of body fluids

52
Q

Name 7 coagulation factors produced by the liver

A
  • I – Fibrinogen
    • II – Prothrombin
    • V
    • VII
    • IX
    • X
    • XI
    • Protein C + S
    • Antithrombin
53
Q

What is thrombopoietin?

A

• A glycoprotein hormone that regulates the production of platelets by the bone marrow

54
Q

How does the liver generate aminoacids?

A

• Transamination

Semester 3 - Gastrointestinal (28 decks)

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