Week 3 Flashcards
1
Q
What diseases can present with oral manifestations?
A
Anaemia
Diabetes
Haematinic deficiencies
Adverse reactions to drugs
2
Q
What is the ‘Torsus Madibularis’ ?
A
A bony growth in the mandible which is just a developmental feature - it can develop in normal individuals but is often *mistaken for something more serious!
3
Q
What is ‘Angular Cheilitis’ ?
A
Cracking at the skin at the corner of the lips
- Causes include;
Anaemia, Candidiasis, Haematinic deficiencies
4
Q
What is meant by recurrent ‘Aptithous Stomatitis’ ?
A
Mouth ulcers
5
Q
What does herpetiform involve?
A
Multiple ulcers all over the mouth
6
Q
What are the possible oral manifestations of Crohn’s Disease?
A
Swollen lips Oral ulceration Angular Cheilitis Cobblestone mucosa Mucosal Tags
7
Q
What is a possible oral manifestation of type 2 diabetes?
A
Thrush (acute pseudomembranous candidiasis)
8
Q
What drug used to treat angina can cause mouth ulcers?
A
Nicorandil - a potassium channel activator
9
Q
Lichen Planes is an idiopathic inflammatory disease. What parts of the body can it affect?
A
Skin Nails Scalp Genitals Oesophagus
10
Q
How does Lichen Planus appear in the mouth?
A
Small white lumps or striations which can’t be removed by scraping like thrush can be
11
Q
How does Lichen Planus appear on the skin?
A
Raised purple lesions
12
Q
If lichen planus is symptomatic, what class of drugs are used to treat it?
A
Topical corticosteroids
13
Q
What is mucous membrane pemphigoid?
A
- Autoimmune disorders
- Involve blistering lesions on mucous membranes
- Blisters in the mouth can form ulcers
- Blisters in the eyes can heal with scarring and causeless of sight
14
Q
What is Sjogren’s Syndrome? List some signs/symptoms?
A
A chronic inflammatory autoimmune disorder
- Dry cough
- Dry eyes
- Dry mouth
- Dysphagia
- Fatigue
- Joint paint
15
Q
How does ‘hairy leukoplakia’ present and what disease is it associated with?
A
Shaggy white patches on the side of the tongue
- HIV
16
Q
How does Kaposi’s Sarcoma present in the mouth?
A
Dark red lesions
17
Q
List some risk factors for oral cancers
A
Smoking Alcohol Poor diet Candida Syphilis
18
Q
Which areas in the mouth are the high risk sites for oral cancers to present?
A
Floor of the mouth
Lateral borders of the tongue
Ventral tongue
19
Q
List some of the warning signs/ symptoms for oral cancer
A
Red/white lesions Ulcers (persistent without known cause) Lip/ face numbness Dysphagia Voice changes
20
Q
What scoring system is used for measuring dental caries?
A
DMF index
21
Q
What does BPE stand for?
A
Basic Periodontal Examination
22
Q
What diseases can endoscopy look for?
A
Coeliac disease Crohn's disease Ulcerative Colitis Tumours Ulcers Oesophagitis/ Gastritis
23
Q
What vascular abnormalities can be detected by an endoscopy?
A
Varices
Angiodysplasia
Ectatic blood vessels
24
Q
List three types of bleeding and how they can be managed
A
VARICEAL - Sclerotherapy - Banding - Histocryl glue ARTERIAL BLEEDING - Adrenaline - Heater probe coagulaiton - Clips ANGIODYSPLASIA - Argon plasma coagulation - Radio-frequency ablation
25
How are strictures treated?
Dilatation/ Stenting
26
What is polypectomy?
Removal of a polyp (type of tumour removal)
27
What is endoscopic mucosal resection?
A type of tumour removal
28
Where is a PEG tube for nutrition inserted and withdrawn from?
Inserted in to the abdomen and pulled out of the mouth
29
What parts of the GI tract wall arise from the endoderm layer?
Epithelium (mucosa)
| Ducts and glands
30
What parts of the GI tract arise from the visceral mesoderm?
Lamina Propria
Muscuaris mucosa
Musculares externa
Submucosa
31
Which mesentery (ventral or dorsal) are the lesser omentum, lesser curvature of the stomach and falciform ligament associated with?
VENTRAL MESENTERY
32
Which mesentery (ventral or dorsal) are the greater omentum and greater curvature of the stomach associated with?
DORSAL MESENTERY
33
At which weeks in development do the circular and longitudinal muscle layers of the GI tract wall develop?
CIRCULAR - WEEK 5
| LONGITUDINAL - WEEK 8
34
Which area in development does the liver bud grow into?
Mesoderm of the septum transversum
35
What is meant by the condition 'annular pancreas'?
A ring of pancreatic tissue encircles then duodenum
36
At what week does the spleen develop?
WEEK 5
37
Early in development the midgut communicates with the yolk sac. Later this communication narrows into which structure?
The vitelline duct
38
At which week does the appendix develop?
WEEK 8
39
What is Meckel's Diverticulum?
Remnant of the vitelline duct due to failure of complete regression
40
What is the vitelline ligament?
A fibrous remain of the connection with the yolk sac
41
What is a vitelline fistula?
The connection to the umbilicus and the outside world persists, meaning there is open communication
42
What is a vitelline cyst?
A closed capsule along the vitelline ligament connection
43
What is a urorectal fistula?
A congenital defect which results in the passage of urine through the rectum
44
What is the lining of the nasal cavity and nasopharynx?
Respiratory epithelium
45
Which papillae occupy a lot of the dorsal surface of the tongue but don't have tastebuds?
Filiform Papillae
46
State the 4 major layers of the digestive tract from the lumen out
```
MUCOSA
- Epithelium
- Lamina Propria
- Muscularis Mucosae
SUBMUCOSA
- Loose connective tissue
- Glands
MUSCULARIS EXTERNA
- Circular and longitudinal muscle layers
SEROSA/ADVENTITIA
- Connective tissue
```
47
What transition of epithelium occurs at the gastro-oesophageal junction?
Stratified squamous epithelium (oesophagus) to columnar epithelium (stomach)
48
What 4 areas make up a gastric gland and what is the cell type in each?
GASTRIC PITS (mucous cells)
ISTHMUS (parietal cells)
NECK (mucous cells)
BASE (chief cells, parietal cells and enteroendocrine cells)
49
What do chief cells secrete?
Digestive enzymes
50
What do parietal cells secrete?
HCL acid
51
What is unique about the muscular is external in the stomach?
It has an additional muscle layer to aid with the churning function of the stomach
52
Which cells of the small intestine epithelium are the principle absorptive cells?
Enterocytes
53
Which cells of the small intestine epithelium are the mucin producing cells?
Goblet cells
54
Which cells of the small intestine epithelium are the hormone (gastrin/CCK/VIP) producing cells?
Enteroendocrine cells
55
Which cells in the small intestine are the defensive cells?
Paneth cells
56
What is the function of 'Brunner's Glands' within the submucosa of the duodenum?
Produce mucous to neutralise chyme
57
Which part of the small intestine has many villi?
Jejunum
58
Which part of the small intestine has Peyer's Patches?
Ileum
59
What are the two main cell types of the large intestine?
Absorptive cells
| Goblet cells
60
What are the three muscular strips of the longitudinal muscle layer in the large intestine called?
Teniae Coli
61
What is the function of the 'myenteric plexus' and where can it be found?
Controls gut motility
| - found in the muscular externa
62
What is the function of the 'submucosal plexus' and where can it be found?
regulates secretions
| - found in the submucosa
63
What is reflux oesophagitis?
Inflammation of the oesophagus due to reflux of gastric contents
64
List causes of reflux oesophagitis
Hiatus hernia
Defective sphincter
Abnormal oesophageal motility
Increased intra-abdominal pressure e.g pregnancy
65
What microscopic changes occur due to reflux oesophagitis?
Basal zone epithelial expansion
| Lengthening of papillae
66
What is Barrett's Oesophagus
Replacement of stratified squamous epithelium with metaplastic columnar epithelium
67
What is a common cause of Barrett's?
GORD - reflux of acid/ bile
68
What cell type increase in allergic oesophagitis?
Eospinophils increase
69
With which drugs is allergic oesophagitis treated?
Steroids
Chromoglycate
Montelukast
70
What are benign oesophageal tumours called?
Squamous Papillomas
71
What are malignant oesophageal tumours called?
Squamous cell carcinomas
| Adenocarcinomas
72
Describe the pathogenesis to adenocarcinoma
Chronic inflammation - Barrett's Oesophagus - Low grade dysplasia - High grade dysplasia - Adenocarcinoma
73
What is a Mallory-Weiss Tear?
A tear in the lower oesophagus due to persistent vomiting and retching
74
What are oesophageal varies?
Abnormally enlarged veins in the oesophageal wall
75
What is the most common type of oral cancers?
Squamous cell carcinomas
76
What are possible causes of acute gastritis?
```
Chemicals
Severe burns
Shock
Trauma
Head injury
```
77
What are the 'ABC' causes of chronic gastritis and which is the most common?
Autoimmune (Least common)
Bacterial (Most common)
Chemical
78
What effects does autoimmune chronic gastritis have?
Atrophy
| Intestinal metaplasia
79
What is the culprit in bacterial chronic gastritis?
H.pylori
80
What does H.pylori increase risk of?
Gastric and duodenal ulcers
| Gastric carcinomas and lymphomas
81
What substances can cause chemical chronic gastritis?
Bile reflux
Alcohol
NSAIDs
82
What are benign gastric tumours referred to as?
Polyps
83
There are two subtypes of gastric adenocarcinomas; intestinal type and diffuse type. Which has better prognosis?
Intestinal type
84
Which type of gastric adenocarcinoma involves signet ring cells and expands, infiltrating the stomach wall
Diffuse type
85
List causes of GORD
```
Hiatus hernia
Incompetent lower oesophageal sphincter
Loss of oesophageal peristaltic function
Abdominal obesity
Smoking
Alcohol
Drugs
```
86
What are the signs/ symptoms of GORD?
```
Heart burn (retrosternal)
'Acid brash' - Acid/bile regurgitation
'Water brash' - Increased saliva secretion
Dysphagia
Odynophagia
Weight loss
Hoarse voice
Chronic cough (worse in the mornings)
Nocturnal asthma
```
87
Which is more likely to be a sign of cancer;
| Dysphagia/ Odynophagia?
Dysphagia
88
What investigations are done for GORD?
Endoscopy
Barium swallow
24hour oesophageal pH monitoring and manometry
Nuclear studies
89
What are the three possible drug groups used for GORD?
Antacids
H2 antagonists
Proton Pump Inhibitors
90
What is the name of the surgery which is a possibility for serious GORD?
Nissen Fundoplication surgery
91
What is meant by the term 'Gastroparesis'?
Delayed gastric emptying despite no physical obstruction, food remains in the stomach for an abnormal amount of time
92
What are the symptoms of gastroparesis?
```
Feeling of fullness
Nausea
Vomiting
Weight Loss
Upper Abdominal Pain
```
93
What is the most common cause of gastroparesis?
Diabetes
94
How is gastroparesis managed?
Liquid/ soppy diet
Promotility agents
Gastric pacemaker
95
What is achalasia?
When the lower oesophageal sphincter fails to relax due to degeneration of the myenteric plexus, causing dysphagia, regurgitation and weight loss - the oesophagus becomes stuffed with food
96
What are the investigations and treatments of achalasia?
CXR
Barium Swallow
- Treated with endoscopic balloon dilatation and proton pump inhibitors
97
What happens in vomiting?
Abdominal muscles and the diaphragm contract for forceful expulsion of stomach contents
98
Which process is in reverse in retching?
Peristalsis
99
Is the chemoreceptor trigger zone (CTZ) located inside or outside of the BBB
Outside the BBB
100
What is vomiting often preceded by?
Profuse salivation
Sweating
Increased heart rate
Nausea
101
What does the vomiting centre in the medulla receive input from?
The tractus solitarius
102
What are the consequences of severe vomiting?
```
Dehydration
Mallory-Weiss tear
Hypokalaemia
Hypocholaraemic metabolic alkalosis
Aspiration of vomitus
```
103
List the antiemetic drug classes
```
Dopamine antagonists
Prokinetic drugs
5HT3 receptor antagonists
H1 antihistamines
Anticholinergics
Adjuvant antiemetics
```
104
What is the 'triple drug regimen' used to treat chemotherapy induced nausea and vomiting (CINV)?
5HT3 receptor antagonists
Dexamethason
Aprepitant
105
What hormone produced by the placenta is associated with pregnancy associated nausea and vomiting?
Human Chorionic Gonadotropin
106
What is Hyperemesis Gravidarum?
Fluid and electrolyte disturbances and nutritional deficiencies which can develop from vomiting in pregnancy
107
What is the first line treatment of Hyperemesis Gravidarum?
Antihistamines
108
What part of the gut does epigastric pain originate from?
FOREGUT
109
What are the organic causes of dyspepsia?
Peptic ulcer disease
Gastric cancer
Drugs e.g NSAIDs
110
What is meant by a functional cause of dyspepsia? Give examples
Idiopathic dyspepsia in which there is no actual structural abnormality in the upper GI tract
- Abnormal reflexes
- Disrupted gut-immune interactions
- Visceral hypersensitivity
111
What are some of the signs of dyspepsia that can be found on examination?
Cachexia - muscle weakness and wasting
Masses
Abdominal distension - due to gastric outflow obstruction causing fluid to build up in the stomach
112
What are the two main important things to consider in the management of dyspepsia?
Eradication of H.pylori if present
| Acid inhibition treatment
113
Which ulcers are aggravated by eating and which are commonly relieved by eating?
Duodenal ulcers - aggravated by eating
| Gastric ulcers - relieved by eating
114
What are the most common causes of peptic ulcer disease?
H.PYLORI!!
NSAIDs
Gastric dysmotility/ outflow obstruction
115
What kind of organism is H.pylori?
Gram -ve microaerophilic flagellated bacillus
116
Which kind of ulcers does gastritis localised to the pyloric region of the stomach cause?
Duodenal Ulcers
117
Which kind of ulcers does gastritis localised in the body of the stomach cause?
Gastric Ulcers
118
What happens with duodenal ulcers?
G cells increase gastrin secretion and decrease somatostatin secretion.
- Gastrin stimulates parietal cell proliferation and causes HYPER-secretion of acid.
119
What happens with gastric ulcers?
Inflammation induces apoptosis of parietal cells which causes HYPO-secretion of acid
120
What is the word for hypo secretion of acid?
Hypochlorydria
121
Which drugs are used to decrease acid secretion?
Histamine antagonists
| Proton pump inhibitors
122
What tests are used to identify H.pylori?
Gastric biopsy
Urease breath test
Faecal antigen test
Serology for IgA antibodies
123
Which class of drugs are used for symptomatic relief of peptic ulcer disease?
Antacids
124
What does the 'triple therapy' for eradication of H.pylori involve?
PPI, amoxycillin and clarithromycin
125
List some of the causes of GI bleeding
Ulcers
Varices
Mallory-Weiss Tear
126
What is the '100 rule' used to assess?
The severity of the haemorrhage
127
What is the 'Rockall Risk Scoring System' used for?
Estimating the risk of adverse outcomes following a GI bleed
128
What is the 'Blatchford Bleeding Score' used for?
Assessing the likelihood of a patient requiring intervention due to a bleed. E.g blood transfusions
129
What can indicate a recent haemorrhage?
Active bleeding/ oozing
Vissible vessels
Clots
130
What treatment/management is used for a bleeding peptic ulcer?
```
Adrenaline injections
Heater probe coagulation
Combinations therapy^
Clips
Haemospray
```
131
What treatment/management is used for variceal bleeding?
ABCDE
Haemostasis
Coagulotherapy
