week 2

Question 1

Achalasia

Answer 1

lower oesophageal sphincter does not relax in response to swallowing, causing dysphagia.
Treatment: disrupt LOS using rigiflex balloon dilatation or Heller’s myotomy; incision is made in external muscular wall

Question 2

scleroderma

Answer 2

connective tissue disorder, leading to bad reflux due to weak LOS and absent peristalsis. Severe oesophagitis

Question 3

nutcracker oesophagus

Answer 3

very high pressures

Question 4

distal oesophageal spasm

Answer 4

peristalsis of the distal oesophagus occurs too rapidly

Question 5

travel time for liquids from small intestine to caecum

Answer 5

30 minutes

Question 6

travel time for solids from small intestine to caecum

Answer 6

150 minutes for half of chyme to traverse the small bowel

Question 7

gastrocolic reflex

Answer 7

marked increase in colonic activity in response to a meal

Question 8

transit time from rectum to caecum

Answer 8

14 hours to 2 days.

Faster in men than in women leading to a higher faecal weight

Question 9

a spinal injury at which level of the spine will call bowel issues

Answer 9

T12 or above

Question 10

loperamide

Answer 10

gut selective opiate MU agonist that slows transit through the large intestine by decreasing the tone and activity of the myenteric plexus allowing time for increased water absorption

Question 11

Prucalopride

Answer 11

a gut selective 5HT4 receptor agonist which increases colonic and other gut motility and which is licensed for use in chronic constipation in the UK

Question 12

Linaclotide

Answer 12

minimally absorbed guanylate C receptor agonist that increase secretion of chloride and bicarb into the lumen. This increase intestinal fluid and speeds up colonic transit licensed in UK for treatment of IBS-constipation

Question 13

Hirschprung’s disease

Answer 13

Segments lack neurons so they become constricted meaning the normal bowel becomes distended with faeces, and there can be rectal collapse

Question 14

motilin

Answer 14

polypeptide hormone produced by M cells in the small intestine and secreted at 90 minute intervals during the inter-prandial period
Stimulates contraction of gastric fundus and enhances gastric emptying

Question 15

key hormones for bile secretion and production after ingestion of a meal

Answer 15

CCK (contraction of gall bladder with relaxation of sphincter) and secretin (bicarb in bile as well as overall bile production)

Question 16

direct bilirubin measures

Answer 16

conjugated

Question 17

indirect bilirubin measures

Answer 17

unconjugated

Question 18

which tissue takes up the most iron from tranferrin?

Answer 18

the bone marrow for production of RBCs