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GASTROINTESTINAL > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What diseases can present with oral manifestations?

A

Anaemia
Diabetes
Haematinic deficiencies
Adverse reactions to drugs

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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!

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3
Q

What is ‘Angular Cheilitis’ ?

A

Cracking at the skin at the corner of the lips
- Causes include;
Anaemia, Candidiasis, Haematinic deficiencies

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4
Q

What is meant by recurrent ‘Aptithous Stomatitis’ ?

A

Mouth ulcers

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5
Q

What does herpetiform involve?

A

Multiple ulcers all over the mouth

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6
Q

What are the possible oral manifestations of Crohn’s Disease?

A 
Swollen lips 
Oral ulceration 
Angular Cheilitis 
Cobblestone mucosa 
Mucosal Tags
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7
Q

What is a possible oral manifestation of type 2 diabetes?

A

Thrush (acute pseudomembranous candidiasis)

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8
Q

What drug used to treat angina can cause mouth ulcers?

A

Nicorandil - a potassium channel activator

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9
Q

Lichen Planes is an idiopathic inflammatory disease. What parts of the body can it affect?

A 
Skin 
Nails 
Scalp
Genitals 
Oesophagus
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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

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11
Q

How does Lichen Planus appear on the skin?

A

Raised purple lesions

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12
Q

If lichen planus is symptomatic, what class of drugs are used to treat it?

A

Topical corticosteroids

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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
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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
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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

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16
Q

How does Kaposi’s Sarcoma present in the mouth?

A

Dark red lesions

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17
Q

List some risk factors for oral cancers

A 
Smoking 
Alcohol 
Poor diet 
Candida 
Syphilis
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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

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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
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20
Q

What scoring system is used for measuring dental caries?

A

DMF index

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21
Q

What does BPE stand for?

A

Basic Periodontal Examination

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22
Q

What diseases can endoscopy look for?

A 
Coeliac disease 
Crohn's disease 
Ulcerative Colitis 
Tumours 
Ulcers 
Oesophagitis/ Gastritis
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23
Q

What vascular abnormalities can be detected by an endoscopy?

A

Varices
Angiodysplasia
Ectatic blood vessels

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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
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25
Q

How are strictures treated?

A

Dilatation/ Stenting

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26
Q

What is polypectomy?

A

Removal of a polyp (type of tumour removal)

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27
Q

What is endoscopic mucosal resection?

A

A type of tumour removal

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28
Q

Where is a PEG tube for nutrition inserted and withdrawn from?

A

Inserted in to the abdomen and pulled out of the mouth

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29
Q

What parts of the GI tract wall arise from the endoderm layer?

A

Epithelium (mucosa)

Ducts and glands

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30
Q

What parts of the GI tract arise from the visceral mesoderm?

A

Lamina Propria
Muscuaris mucosa
Musculares externa
Submucosa

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31
Q

Which mesentery (ventral or dorsal) are the lesser omentum, lesser curvature of the stomach and falciform ligament associated with?

A

VENTRAL MESENTERY

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32
Q

Which mesentery (ventral or dorsal) are the greater omentum and greater curvature of the stomach associated with?

A

DORSAL MESENTERY

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33
Q

At which weeks in development do the circular and longitudinal muscle layers of the GI tract wall develop?

A

CIRCULAR - WEEK 5

LONGITUDINAL - WEEK 8

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34
Q

Which area in development does the liver bud grow into?

A

Mesoderm of the septum transversum

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35
Q

What is meant by the condition ‘annular pancreas’?

A

A ring of pancreatic tissue encircles then duodenum

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36
Q

At what week does the spleen develop?

A

WEEK 5

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37
Q

Early in development the midgut communicates with the yolk sac. Later this communication narrows into which structure?

A

The vitelline duct

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38
Q

At which week does the appendix develop?

A

WEEK 8

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39
Q

What is Meckel’s Diverticulum?

A

Remnant of the vitelline duct due to failure of complete regression

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40
Q

What is the vitelline ligament?

A

A fibrous remain of the connection with the yolk sac

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41
Q

What is a vitelline fistula?

A

The connection to the umbilicus and the outside world persists, meaning there is open communication

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42
Q

What is a vitelline cyst?

A

A closed capsule along the vitelline ligament connection

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43
Q

What is a urorectal fistula?

A

A congenital defect which results in the passage of urine through the rectum

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44
Q

What is the lining of the nasal cavity and nasopharynx?

A

Respiratory epithelium

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45
Q

Which papillae occupy a lot of the dorsal surface of the tongue but don’t have tastebuds?

A

Filiform Papillae

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46
Q

State the 4 major layers of the digestive tract from the lumen out

A 
MUCOSA 
- Epithelium 
- Lamina Propria 
- Muscularis Mucosae
SUBMUCOSA 
- Loose connective tissue
- Glands 
MUSCULARIS EXTERNA 
- Circular and longitudinal muscle layers 
SEROSA/ADVENTITIA 
- Connective tissue
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47
Q

What transition of epithelium occurs at the gastro-oesophageal junction?

A

Stratified squamous epithelium (oesophagus) to columnar epithelium (stomach)

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48
Q

What 4 areas make up a gastric gland and what is the cell type in each?

A

GASTRIC PITS (mucous cells)
ISTHMUS (parietal cells)
NECK (mucous cells)
BASE (chief cells, parietal cells and enteroendocrine cells)

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49
Q

What do chief cells secrete?

A

Digestive enzymes

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50
Q

What do parietal cells secrete?

A

HCL acid

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51
Q

What is unique about the muscular is external in the stomach?

A

It has an additional muscle layer to aid with the churning function of the stomach

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52
Q

Which cells of the small intestine epithelium are the principle absorptive cells?

A

Enterocytes

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53
Q

Which cells of the small intestine epithelium are the mucin producing cells?

A

Goblet cells

54
Q

Which cells of the small intestine epithelium are the hormone (gastrin/CCK/VIP) producing cells?

A

Enteroendocrine cells

55
Q

Which cells in the small intestine are the defensive cells?

A

Paneth cells

56
Q

What is the function of ‘Brunner’s Glands’ within the submucosa of the duodenum?

A

Produce mucous to neutralise chyme

57
Q

Which part of the small intestine has many villi?

A

Jejunum

58
Q

Which part of the small intestine has Peyer’s Patches?

A

Ileum

59
Q

What are the two main cell types of the large intestine?

A

Absorptive cells

Goblet cells

60
Q

What are the three muscular strips of the longitudinal muscle layer in the large intestine called?

A

Teniae Coli

61
Q

What is the function of the ‘myenteric plexus’ and where can it be found?

A

Controls gut motility

- found in the muscular externa

62
Q

What is the function of the ‘submucosal plexus’ and where can it be found?

A

regulates secretions

- found in the submucosa

63
Q

What is reflux oesophagitis?

A

Inflammation of the oesophagus due to reflux of gastric contents

64
Q

List causes of reflux oesophagitis

A

Hiatus hernia
Defective sphincter
Abnormal oesophageal motility
Increased intra-abdominal pressure e.g pregnancy

65
Q

What microscopic changes occur due to reflux oesophagitis?

A

Basal zone epithelial expansion

Lengthening of papillae

66
Q

What is Barrett’s Oesophagus

A

Replacement of stratified squamous epithelium with metaplastic columnar epithelium

67
Q

What is a common cause of Barrett’s?

A

GORD - reflux of acid/ bile

68
Q

What cell type increase in allergic oesophagitis?

A

Eospinophils increase

69
Q

With which drugs is allergic oesophagitis treated?

A

Steroids
Chromoglycate
Montelukast

70
Q

What are benign oesophageal tumours called?

A

Squamous Papillomas

71
Q

What are malignant oesophageal tumours called?

A

Squamous cell carcinomas

Adenocarcinomas

72
Q

Describe the pathogenesis to adenocarcinoma

A

Chronic inflammation - Barrett’s Oesophagus - Low grade dysplasia - High grade dysplasia - Adenocarcinoma

73
Q

What is a Mallory-Weiss Tear?

A

A tear in the lower oesophagus due to persistent vomiting and retching

74
Q

What are oesophageal varies?

A

Abnormally enlarged veins in the oesophageal wall

75
Q

What is the most common type of oral cancers?

A

Squamous cell carcinomas

76
Q

What are possible causes of acute gastritis?

A 
Chemicals 
Severe burns 
Shock 
Trauma 
Head injury
77
Q

What are the ‘ABC’ causes of chronic gastritis and which is the most common?

A

Autoimmune (Least common)
Bacterial (Most common)
Chemical

78
Q

What effects does autoimmune chronic gastritis have?

A

Atrophy

Intestinal metaplasia

79
Q

What is the culprit in bacterial chronic gastritis?

A

H.pylori

80
Q

What does H.pylori increase risk of?

A

Gastric and duodenal ulcers

Gastric carcinomas and lymphomas

81
Q

What substances can cause chemical chronic gastritis?

A

Bile reflux
Alcohol
NSAIDs

82
Q

What are benign gastric tumours referred to as?

A

Polyps

83
Q

There are two subtypes of gastric adenocarcinomas; intestinal type and diffuse type. Which has better prognosis?

A

Intestinal type

84
Q

Which type of gastric adenocarcinoma involves signet ring cells and expands, infiltrating the stomach wall

A

Diffuse type

85
Q

List causes of GORD

A 
Hiatus hernia 
Incompetent lower oesophageal sphincter 
Loss of oesophageal peristaltic function 
Abdominal obesity 
Smoking 
Alcohol 
Drugs
86
Q

What are the signs/ symptoms of GORD?

A 
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
Q

Which is more likely to be a sign of cancer;

Dysphagia/ Odynophagia?

A

Dysphagia

88
Q

What investigations are done for GORD?

A

Endoscopy
Barium swallow
24hour oesophageal pH monitoring and manometry
Nuclear studies

89
Q

What are the three possible drug groups used for GORD?

A

Antacids
H2 antagonists
Proton Pump Inhibitors

90
Q

What is the name of the surgery which is a possibility for serious GORD?

A

Nissen Fundoplication surgery

91
Q

What is meant by the term ‘Gastroparesis’?

A

Delayed gastric emptying despite no physical obstruction, food remains in the stomach for an abnormal amount of time

92
Q

What are the symptoms of gastroparesis?

A 
Feeling of fullness 
Nausea 
Vomiting 
Weight Loss 
Upper Abdominal Pain
93
Q

What is the most common cause of gastroparesis?

A

Diabetes

94
Q

How is gastroparesis managed?

A

Liquid/ soppy diet
Promotility agents
Gastric pacemaker

95
Q

What is achalasia?

A

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
Q

What are the investigations and treatments of achalasia?

A

CXR
Barium Swallow
- Treated with endoscopic balloon dilatation and proton pump inhibitors

97
Q

What happens in vomiting?

A

Abdominal muscles and the diaphragm contract for forceful expulsion of stomach contents

98
Q

Which process is in reverse in retching?

A

Peristalsis

99
Q

Is the chemoreceptor trigger zone (CTZ) located inside or outside of the BBB

A

Outside the BBB

100
Q

What is vomiting often preceded by?

A

Profuse salivation
Sweating
Increased heart rate
Nausea

101
Q

What does the vomiting centre in the medulla receive input from?

A

The tractus solitarius

102
Q

What are the consequences of severe vomiting?

A 
Dehydration 
Mallory-Weiss tear 
Hypokalaemia 
Hypocholaraemic metabolic alkalosis 
Aspiration of vomitus
103
Q

List the antiemetic drug classes

A 
Dopamine antagonists 
Prokinetic drugs 
5HT3 receptor antagonists 
H1 antihistamines 
Anticholinergics
Adjuvant antiemetics
104
Q

What is the ‘triple drug regimen’ used to treat chemotherapy induced nausea and vomiting (CINV)?

A

5HT3 receptor antagonists
Dexamethason
Aprepitant

105
Q

What hormone produced by the placenta is associated with pregnancy associated nausea and vomiting?

A

Human Chorionic Gonadotropin

106
Q

What is Hyperemesis Gravidarum?

A

Fluid and electrolyte disturbances and nutritional deficiencies which can develop from vomiting in pregnancy

107
Q

What is the first line treatment of Hyperemesis Gravidarum?

A

Antihistamines

108
Q

What part of the gut does epigastric pain originate from?

A

FOREGUT

109
Q

What are the organic causes of dyspepsia?

A

Peptic ulcer disease
Gastric cancer
Drugs e.g NSAIDs

110
Q

What is meant by a functional cause of dyspepsia? Give examples

A

Idiopathic dyspepsia in which there is no actual structural abnormality in the upper GI tract

  • Abnormal reflexes
  • Disrupted gut-immune interactions
  • Visceral hypersensitivity
111
Q

What are some of the signs of dyspepsia that can be found on examination?

A

Cachexia - muscle weakness and wasting
Masses
Abdominal distension - due to gastric outflow obstruction causing fluid to build up in the stomach

112
Q

What are the two main important things to consider in the management of dyspepsia?

A

Eradication of H.pylori if present

Acid inhibition treatment

113
Q

Which ulcers are aggravated by eating and which are commonly relieved by eating?

A

Duodenal ulcers - aggravated by eating

Gastric ulcers - relieved by eating

114
Q

What are the most common causes of peptic ulcer disease?

A

H.PYLORI!!
NSAIDs
Gastric dysmotility/ outflow obstruction

115
Q

What kind of organism is H.pylori?

A

Gram -ve microaerophilic flagellated bacillus

116
Q

Which kind of ulcers does gastritis localised to the pyloric region of the stomach cause?

A

Duodenal Ulcers

117
Q

Which kind of ulcers does gastritis localised in the body of the stomach cause?

A

Gastric Ulcers

118
Q

What happens with duodenal ulcers?

A

G cells increase gastrin secretion and decrease somatostatin secretion.
- Gastrin stimulates parietal cell proliferation and causes HYPER-secretion of acid.

119
Q

What happens with gastric ulcers?

A

Inflammation induces apoptosis of parietal cells which causes HYPO-secretion of acid

120
Q

What is the word for hypo secretion of acid?

A

Hypochlorydria

121
Q

Which drugs are used to decrease acid secretion?

A

Histamine antagonists

Proton pump inhibitors

122
Q

What tests are used to identify H.pylori?

A

Gastric biopsy
Urease breath test
Faecal antigen test
Serology for IgA antibodies

123
Q

Which class of drugs are used for symptomatic relief of peptic ulcer disease?

A

Antacids

124
Q

What does the ‘triple therapy’ for eradication of H.pylori involve?

A

PPI, amoxycillin and clarithromycin

125
Q

List some of the causes of GI bleeding

A

Ulcers
Varices
Mallory-Weiss Tear

126
Q

What is the ‘100 rule’ used to assess?

A

The severity of the haemorrhage

127
Q

What is the ‘Rockall Risk Scoring System’ used for?

A

Estimating the risk of adverse outcomes following a GI bleed

128
Q

What is the ‘Blatchford Bleeding Score’ used for?

A

Assessing the likelihood of a patient requiring intervention due to a bleed. E.g blood transfusions

129
Q

What can indicate a recent haemorrhage?

A

Active bleeding/ oozing
Vissible vessels
Clots

130
Q

What treatment/management is used for a bleeding peptic ulcer?

A 
Adrenaline injections 
Heater probe coagulation 
Combinations therapy^ 
Clips 
Haemospray
131
Q

What treatment/management is used for variceal bleeding?

A

ABCDE
Haemostasis
Coagulotherapy

GASTROINTESTINAL (13 decks)

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