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A2 ME3031 ALIMENTARY > Tutorials; Cases > Flashcards

Tutorials; Cases Flashcards

1
Q

IBD Mgmt Drugs Pyramid

A
  1. AMINOSALICYLATES: antiinflamm
    >MESALAZINE = remission and maintenance in UC
  2. CORTICOSTEROIDS = remission in both UC and CD, NOT MAINTENANCE
    >pred.

> budesonide (better sfx profile)
!taper off

  1. IMM SUPPR. = THIOPRINE = azathioprine = reduces cell proliferation
    CI in preg., hepatic impairment, elderlry

!bone marrow dysf., hepatic impairment, pancreatitis

  1. BIOLOGICS = monoclonal antibodies in IBD = block cytokine / white cell movement
    * target immune mediators

CI = severe infection, prego and breast feeding, latent TB, MS, live vaccines

  1. Sx
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2
Q

Significance of corticosteroid use in IBD

A

Only to induce remission in both UC and CD but not for LT maintenance d/t sfx

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3
Q

Bile Acid Sequestrants

A

Bind to bile acid = bile acid and bile lost in stool

  • for pruritis
  • LDL lowering

> CHOLESTYRAMINE

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4
Q

Bile Acid Drugs

A

Managing cholesterol gall stones 1º Biliary Cirrhosis

= reduce cholesterol formation in liver; prevent cholesterol saturation
> URSODEOXYCHOLIC ACID

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5
Q

What secretes Pepsinogen

A

Pepsinogen is secreted from peptic (or chief) cells in the oxyntic gland.

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6
Q

What do parietal cells secrete

A

HCl
in response to eating a meal. Acid secretion is highly regulated, with paracrine (histamine), neural (acetylcholine), and hormonal (gastrin) factors acting in concert to regulate parietal cell function

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7
Q

T/F = Fructose is absorbed passively across the colonic eptihelium

A

FALSE

Fructose is absorbed passively (via GLUT - 5) across small intestinal villus epithelium

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8
Q

T/F = Vagal stimulation results in stimulation of a profuse watery salivary secretion.

A

FALSE

The vagus nerve does not innervate the head or neck. The facial and glossopharyngeal nerves stimulate secretion of watery saliva.

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9
Q

Bile Salt Reabs

A

Reabs at Distal ileum via HEPATIC PORTAL

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10
Q

T/F = Cholecystokinin causes the sphincter of Oddi to relax.

A

TRUE

CCK causes gallbladder contraction leading to bile expulsion. Co-ordinated relaxation of the sphincter of Oddi is required to permit bile entry into the duodenal mucosa

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11
Q

T/F = Stomach distension leads to inhibition of gastrin secretion

A

F

Stomach distension leads to stimulation of gastrin secretion

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12
Q

In which condition is villous atrophy a characteristic finding upon intestinal biopsy?

A

COELIAC DISEASE

Although some other conditions can cause villous atrophy, coeliac disease is the most commonly associated with this. Malabsorption occurs as a consequence of autoimmune destruction of villi in coeliac disease, which typically presents as diarrhoea, steatorrhea, weight loss, and vitamin deficiency.

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13
Q

How would you expect transferrin and ferritin levels to be effected by iron deficiency?

A

High transferrin, low ferritin

In Iron deficiency, the liver increases production of transferrin in order to increase iron uptake and maintain iron homeostasis. In contrast, ferritin acts as an iron store, so levels increase when there are high amount of iron in the blood, and decrease in iron deficiency. A low ferritin is the more sensitive marker of iron deficiency and is the more commonly used test.

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14
Q

Which of the following drugs commonly cause constipation as a side-effect?

A

Opioids

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15
Q

Hepatitis bloods

A

HBsAg = indicates a current infection.

Anti HBc = indicates a previous infection.

Vaccination = only Anti HBs

Current infection = HBsAg “mops up” any antibody to hepatitis B surface antigen, so the test for HBsAg will appear negative.

Acute hepatitis B infection, Anti HBc will be IgM,
Vs
Chronic infection = antibody to hepatitis B core will be IgG.

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16
Q

How is crohn’s disease definitively diagnosed?

A

ENDOSCOPE

  • cobblestone
  • mucosal inflamm
  • skip lesions
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17
Q

What can be a side effect of use of proton pump inhibitors such as omeprazole?

A

Increased risk of C. Diff infection

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18
Q

Which auto antibodies are characteristic for primary biliary cholangitis?

A

antimitochondrial antibodies

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19
Q

Which of the following are signs of chronic liver disease?

A

spider naevi , palmar erythema , gynaecomastia, ascites

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20
Q

What concentration of neutrophils in an ascitic tap would indicate starting antibiotics for spontaneous bacterial peritonitis?

A

> 250 cells per mm3

21
Q

Essential mgmt of hepatic encephelopathy

A

Supportive care , Reversal of precipitating factors , Lactulose

All patients with hepatic encephalopathy should receive lactulose to reduce the nitrogenous load from the gut (the exact mechanism is unclear).

22
Q

What would you expect to see upon endoscopy in ulcerative colitis?

A

Loss of vascular marking
Crypt abscesses
continuous uniform involvement

23
Q

Which conditions have an association with coeliac disease?

A 
AuImm conditions such as:
Dermatitis Herpetiformis
Insulin dependent diabetes mellitus 
Autoimmune thyroiditis 
Primary biliary cholangitis
24
Q

Coeliac Disease complications

A

Small bowel lymphoma
Oesophageal carcinoma
Small bowel adenocarcinoma

25
Q

What is the treatment for dermatitis herpetiformis?

A

similar presentation to herpes but associated with coeliac disease

> DAPSONE
GF DIET

26
Q

Which stool test can be used to help diagnose inflammatory bowel disease?

A

Faecal calprotectin

27
Q

functional causes of vomiting?

A

Pregnancy, Migraine, Alcohol

28
Q

Definition of functional disorder

A

Functional disorders are those in which no clear structural or biochemical pathology can be demonstrated. In GI conditions they are characterised as disorders with:

No detectable pathology

Related to gut function

“Software faults”

Good long term prognosis

29
Q

organic causes of constipation?

A

Anal fissure, Colonic tumour , Diverticular disease

30
Q

Cases where PEG (Percutaneous endoscopic gastrostomy) tube appropriate

A

Motor neurone disease, oesophageal cancer , Prolonged period on ICU , Abdominal Malignancy

31
Q

Refeediing Syndrome

A

Patients at risk of refeeding syndrome need their electrolytes monitored closely (initially daily bloods), with electrolyte supplementation given as required.

Hypokalemia, Hypomagnesemia , Hypophosphatemia

32
Q

Which biochemical abnormalities may you expect to see in severe cases of anorexia nervosa?

A

Metabolic Alkalosis (loss of H+ in vomit) or diuretic abuse

Hyponatremia can result from diuretic abuse and pyschogenic polydipsia (occasionally seen in anorexia nervosa)

Hypokalemia

33
Q

Which anti-emetic should be avoided in bowel obstruction?

A

Metoclopramide should be avoided as it is a pro-kinetic agent and can result in increased colicky pain.

34
Q

What detail in a history should make you suspicious of raised intracranial pressure as a cause of vomiting?

A

Vomiting and nausea occur early in the morning

35
Q

NG Indications

A
  • Swallowing disorders
  • Head and Neck Cancers
  • Cystic Fibrosis
  • Anorexia Nervosa
36
Q

Nasojejunal indications

A
  • Delayed gastric emptying
  • Reflux causing an aspiration risk
  • Upper GI surgery
  • Pancreatitis
37
Q

The role of Gastrin

A

(g cells)

  1. regulates HKATP on parietal = acidic env.
  2. Enterochromatifain-like cells stimulation releasing HISTAMINE
  3. Stimulated by lumen peptides
38
Q

The role of Histamine

A

(from ISF), functions as a paracrine

  1. HKATP activity+
  2. released from ECL cells to act on parietal
39
Q

The role of ACh

A

Vagal nerve cholinergic receptors, neuronic control

  1. (+) HKATP on parietal cells (cephalic phase)
  2. Vagal reflex stimualted upon stomach distension = act on parietal cells
  3. ACh activates ECL (gastric)
40
Q

The role of prostaglandins

A

prevents cAMP formation and inhibitory to HKATP mechanism

41
Q

The role of Secretin

A

Released from (S cells)

  1. triggered by acid in duo. = bicarb secretion
42
Q

The role of Gastric inhibitory peptide

A

stiulated by fat and CHO in duodenum

= ⇩gastric secr. and parietal HCl

43
Q

Regarding the MMComplex

  • What initiates
  • When it occurs
  • Factors stopping it
A
  1. MOTILIN
  2. FASTING: stomach to distal ileum
  3. FOOD IN STOMACH stops MMC, starts segmentation
44
Q

Associations 1º Sclerosing Cholangitis

A

UC

Cholangiocarcinoma

45
Q

Associations 1º Biliary Cholangitis

A

Hepatocelular carcinoma

+ALP, ESR

46
Q

Pathognomic Signs of Ceoliac

A

GF = relief
vllous atrophy, crypt hypertrophy
anti-TTG

47
Q

Pathognomic signs of Small Bowel Obstruction

A

intermittent colick; relieved by vomit
frequent and larger volume vomit
focal tenderness

48
Q

Pathognomic Signs of LBO

A

continuous pain
intermittent vomit
diffuse tenderness

A2 ME3031 ALIMENTARY (7 decks)

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