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GASTROINTESTINAL > Week 2 > Flashcards

Week 2 Flashcards

1
Q

List 4 functions of mucosal tissue

A

Reproduction
Sensory activities
Food absorption
Gas exchange

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2
Q

What is the dominant antibody in the gut?

A

IgA (usually IgG elsewhere)

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3
Q

Which antibody takes over if the patient can’t make IgA?

A

IgM

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4
Q

What are intra-epithelial lymphocytes (IELs)?

A

CD8 +ve T cells which lie within the epithelial lining of the gut

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5
Q

Describe what is meant by intestinal failure

A

Where gut is no longer able to supply the hydration and nutritional needs of the body

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6
Q

Describe the 3 types/ levels of intestinal failure

A

1 - self-limiting, short term postoperative (most common) -(days to weeks)
2- Prolonged, associated with sepsis and metabolic complications, often related to abdominal surgery with complications
3 - long-term but stable

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7
Q

How would you treat Type 1 intestinal failure

A
  • Fluids and electrolytes
  • Parenteral nutrition if unable to tolerate foods and fluids
  • Acid suppression (proton pump inhibitors/ ocreteotide)
  • Alpha hyrdocycholecalciferol (to presevre magnesium)
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8
Q

What is a risk associated with insertion of lines for parenteral nutrition?

A

Due to the close proximity to the lungs, there is a risk of pneumothorax

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9
Q

Is bowel lengthening as a treatment of Type 3 intestinal failure used in adults or children?

A

CHILDREN

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10
Q

Which other type of transplant is a small bowel transplant usually given in combination with?

A

Liver transplant

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11
Q

Which vessel supplies the small bowel?

A

The superior mesenteric artery

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12
Q

Describe the outcomes of the three types of infarct to the small bowel

A

Mucosal infarct - There will be regeneration and mucosal integrity will be restored
Mural infarct - Repair and regeneration - fibrous stricture
Transmural - Gangrene and death if not sorted

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13
Q

What is ‘Meckel’s Diverticulum’

A

A slight bulge in the small intestine due to incomplete regression of the vitello-intestinal duct (an embryological remnant)

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14
Q

Secondary small bowel tumours are more common than primary tumours. Where do these secondary tumours commonly metastasise from?

A

Ovaries
Colon
Stomach

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15
Q

What are the three types of primary tumour that can occur in the small bowel?

A

Lymphomas
Carcinoid tumours
Carcinomas

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16
Q

What are the symptoms of appendicitis

A

Epigastric pain initially, RIF pain later
Vomiting
Fever possible

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17
Q

List possible consequences of appendicitis

A

Rupture
Abscess
Sepsis
Peritonitis

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18
Q

Which genes is coeliac disease associated with?

A

HLADQ2/HLADQ8

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19
Q

What component of gluten is the toxic agent?

A

GLIADIN

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20
Q

What do serology tests to investigate for coeliac disease look for?

A

IgA (deficiency - 10X more likely to have coeliacs)
Anti-TTG
Anti-gliadin antibodies
Anti-endomesial antibodies

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21
Q

What can malabsorption of fats do to stool?

A

Cause STEATORRHOEA (fat in the stool)

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22
Q

List the negative possible effects of malabsorption

A 
Weight Loss 
Anaemia 
Abdominal Bloating 
Vitamin deficiencies 
Failure to thrive
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23
Q

What are ‘Peyer’s Patches’

A

The lymph nodes of the gut

24
Q

What is the function of M cells within payer’s patches?

A

They provide maximum surface area for antigen absorption

25
Q

What happens in the TH1 response to infection?

A

Macrophages and B cells are activated

26
Q

What happens in the TH2 response to infection and which Interleukins are responsible?

A
  • IgE production (IL 4)
  • Recruitment and activation of eosinophils (IL-5)
  • Recruitment of mast cells which produce histamine/ TNFa and MMCP (IL-3 and IL-9)
  • Epithelial repair and production of mucus (IL- 13)
27
Q

What are the two main receptors for the HIV virus?

A

CCR5 and CD4

28
Q

List disorders associated with primary immunodeficieny

A

SCID
CVID
XLA
Selective IgA deficiency

29
Q

Which mucosal disorder is associated with low IgG, IgA, IgM and IgE, causing recurrent sinopulmonary and GI infections?

A

CVID

30
Q

Which mucosal disorder is x-linked and involves agammaglobulinaemia (No B cells!)

A

XLA

31
Q

Which areas of the GI tract does Crohn’s disease most commonly affect?

A

terminal ileum and the proximal colon

32
Q

What does Crohn’s disease cause?

A

Inflammation and deep eroding fissures

33
Q

What is the important gene to Crohn’s disease?

A

NOD2

34
Q

What area of the GI tract does ulcerative colitis affect?

A

The rectum and the colon

35
Q

Would mucositis occurring post-chemotherapy be considered as acute or chronic intestinal failure?

A

Acute/ Short-term

36
Q

Would short-gut syndrome be considered as acute or chronic intestinal failure?

A

Chronic/ Long-term

37
Q

What length of bowel constitutes ‘Short-Bowel Syndrome’

A

Less than 200cm

38
Q

List some of causes and impacts of malnutrition

A

Causes;

  • Anorexia
  • Dysphagia
  • Infection
  • Malabsorption

Impacts;

  • Infections and sepsis
  • Poor wound healing
  • GI dysfunction
  • Weight loss
  • Reduced muscle strength and fatigue
  • Reduced respiratory muscle strength causes an increase in the risk of chest infections
39
Q

List some of the assessments for malnutrition

A 
Mid arm circumference 
Biochemical assessments for; 
- Albumin 
- Transferrin 
- Vitamins 
E.t.c
40
Q

What is meant by enteral tube feeding?

A

Delivery of feed via a tube into the stomach or duodenum or jejunum

41
Q

What are the indications of use for enteral tube feeding?

A

Upper GI obstruction
Unconscious patients
Swallowing disorder

42
Q

What is meant by parenteral nutrition?

A

Administration of nutrient solutions via a vein

43
Q

What are the indications for use of parenteral nutrition?

A 
Severe malabsorption e.g IBD 
Short bowel syndrome 
Motility disorders 
Severe malnutrition 
Intestinal fistulae
44
Q

What is ‘MUST’ a screening tool for?

A

Malnutrition risk

45
Q

List some specific diseases that can be associated with malabsorption

A

Coeliacs Disease
Crohn’s Disease
Whipple’s disease
e.t.c

46
Q

What is Tropical Sprue?

A

Colonisation of the intestines by an infective agent

47
Q

Where does B- oxidation occur?

A

In the mitochondrial matrix

48
Q

What are the products of B-oxidation?

A

1 Acetyl CoA
1 FADH2
1 NADH and H+
1 Fatty Acyl CoA

49
Q

Under what conditions would ketone bodies accumulate?

A

Starvation

50
Q

Where does fatty acid synthesis occur?

A

In the liver

51
Q

What substance is the major fatty acid synthesis precursor?

A

Malonyl CoA

52
Q

What substances upregulate Acetyl CoA and which downregulate it?

A 
Upregulate 
- Citrate 
- Insulin 
Downregulate 
- Glucagon
- Adrenaline 
- AMP 
- Pamitoyl CoA
53
Q

Where does the urea cycle occur?

A

In the liver

54
Q

What is the catalyst which sits at the centre of the glycogen polymer and acts as the starting point for the glycogen polymer to be extended?

A

Glycogenin

55
Q

Which interleukin is specifically involved in Crohn’s disease?

A

IL 12

56
Q

What is meant by mucous membrane pemphigoid?

A

A group of autoimmune disorders that involve blistering lesions affecting mucous membranes

GASTROINTESTINAL (13 decks)

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