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GASTROINTESTINAL > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What is the gastroileal reflex stimulated by and what does it involve?

A

Stimulated by gastric distension

Involves opening of the ileocaecal valve

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2
Q

What is absorbed and secreted by the large intestine?

A

Water, sodium and chloride ions are absorbed

Potassium, bicarbonate and mucus are secreted

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3
Q

Carbohydrates not absorbed in the S.I can be absorbed in the L.I but first must be converted. What does this involve?

A

Colonic flora ferment the carbohydrates to short-chain fatty acids which can then be absorbed

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4
Q

Is the internal anal sphincter under control of the brain or the spinal cord?

A

Spinal cord

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5
Q

What does RELAXATION of the skeletal muscle of the external anal sphincter cause?

A

Defecation

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6
Q

What does CONTRACTION of the skeletal muscle of the external anal sphincter cause?

A

Delays defecation

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7
Q

What are some of the roles of colonic bacteria within the bowel?

A

Increase intestinal immunity
Promote motility
Activate some drugs
Synthesis vitamin K2 and free fatty acids

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8
Q

What are the two main important drug classes used for IBD?

A

Steroids and immunosuppressants

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9
Q

What two conditions fall under IBD?

A

Crohn’s Disease and Ulcerative Colitis

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10
Q

What is a polyp?

A

A protrusion above an epithelial surface

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11
Q

What is an adenoma?

A

Benign tumours composed of epithelial cells

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12
Q

What is an adenocarcinoma?

A

A malignant epithelial tumour

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13
Q

Injecting what substance can prevent bleeding when removing a polyp?

A

Adrenaline

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14
Q

Why must all adenomas be removed?

A

They are dysplastic and are pre-malignant - it would only take a few more mutations for a cancer to develop and thus they need to be removed to prevent this from happening

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15
Q

Are left or right sided colorectal cancers more common?

A

Left- sided

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16
Q

Why can there be spread to the liver from a colorectal cancer?

A

The merging of the systemic with the portal venous system allows metastasis to be directed towards the liver

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17
Q

Name two types of inherited cancer syndromes

A

HNPCC (hereditary non polyposis coli)

FAP (familial adenomatous polyposis)

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18
Q

What are causes of diverticular disease?

A

Low fibre diet

Increased intraluminal pressure

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19
Q

What is diverticulitis?

A

Inflammation of the diverticulae

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20
Q

What are some of the complications of diverticular disease?

A 
Inflammation 
Rupture/ Perforation - peritonitis/ sepsis
Abscess 
Fistula 
Stricture 
Massive bleeding
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21
Q

What is the most common fistula that can occur from the large intestine? What can this cause?

A 
Colovesical fistula (bladder and L.I communicate) 
- Can cause recurrent UTI's and flatus (bubbles) in the urine
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22
Q

What is a fistula?

A

A pathological communication between two epithelial surfaces

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23
Q

What classification is used to stage acute diverticulitis?

A

Hinchey Classification

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24
Q

What is the name of the surgery used in the management of complex diverticulitis?

A

Hartmann’s procedure

25
Q

Who gets ischaemic colitis?

A

Elderly patients

Arteriopaths (patients with artery disease)

26
Q

What are some of the causes of rectal bleeding?

A

Haemorrhoids
Diverticular disease
Cancer
Large polyps

27
Q

What are some of the possible causes of large bowel obstruction?

A

Colorectal cancer
Hernias
Volvulus
Strictures

28
Q

What are the symptoms of large bowel obstruction?

A

Constipation
Distension
Pain
Vomiting

29
Q

What is a sigmoid volvulus?

A

When the sigmoid colon twists on its mesentery causing the lumen to be blocked off and the vasculature to be pinched off - can cause infarction and gangrene

30
Q

What is meant by a ‘pseudo obstruction’?

A

When there is no real mechanical/ physical obstruction - can be due to hypoxia/ biochemistry

31
Q

What are the histopathological clues of ischaemia?

A

Withering of crypts
Pink, smudgy lamina propria
Few chronic inflammatory cells

32
Q

What are the histopathological clues of antibiotic-induced pseudomembranous colitis?

A

Patchy yellow membrane exudates on the mucosal surfaces

33
Q

What are the histopathological clues of collagenous colitis?

A

Increased thickness of sub epithelial collagen

thickened basement membrane

34
Q

What are the histopathological clues of lymphocytic colitis?

A

Increased intraepithelial lymphocytes

No thickening of the basement membrane

35
Q

What two conditions come under the term ‘Microscopic Colitis’?

A

Collagenous Colitis and Lymphocytic Colitis

36
Q

What kind of history would be important in considering a diagnosis of radiation colitis?

A

History of prostate/cervical cancer, treated with radiotherapy

37
Q

What are two causes of irritable bowel syndrome?

A

Disorders of intestinal motility

Visceral hypersensitivity

38
Q

What can exaggerate the symptoms of IBS?

A

Stress
Menstruation
Gastroenteritis

39
Q

What investigations are done for IBS?

A 
FBC 
ESR/ plasma viscosity 
CRP 
Antibody testing for coeliac disease 
Lower GI tests if >50 years or there is a FH of colorectal cancer
40
Q

What classes of drugs can be used for the treatment of IBS?

A

Anti-diarrhoeals
Anti-spasmodics
Anti-depressants
Laxatives

41
Q

Which disease has a higher risk of malnourishment - Crohn’s or Ulcerative colitis?

A

Crohn’s

- As the disease can affect anywhere in the GI tract from the mouth to the anus

42
Q

A BMI of 30 - 35kg/m2 reduces life expectancy by how many years?
A BMI of >40kg/m2 reduces life expectancy by how many years?

A

2-4 years

10 years

43
Q

What are the alarm symptoms for dyspepsia which require urgent referral for endoscopy?

A 
Chronic GI bleeding 
Weight loss (unintentional) 
Persistent vomiting 
Dysphagia 
Iron deficiency anaemia 
Epigastric mass
Patient >50 years with persistent dyspepsia
44
Q

List 3 medications which can cause dyspepsia

A

NSAIDs
Aspirin
Corticosteroids

45
Q

What are the three types of jaundice?

A

Prehepatic
Intrahepatic
Posthepatic

46
Q

List some possibilities to include in the differential diagnosis of dysphagia

A 
Cancer 
Ulcers 
GORD 
Achalasia 
Oesophagitis 
Extrinsic pressure 
Oesophageal spasm 
Benign strictures and tumours
47
Q

What are the investigations for dysphagia?

A

History and examination

Endoscopy (OGD)

48
Q

Bacillus Serus can cause food poisoning. What food is it usually associated with?

A

Starchy foods - particularly poorly temperature controlled rice

49
Q

What is the most common organism to cause food poisoning?

A

Campylobacter

50
Q

Which organisms which cause food poisoning can cause bacteraemia in immunosuprressed patients?

A

Campylobacter and Salmonella

51
Q

What organism which can cause food poisoning do reptiles carry a lot of?

A

Salmonella Enteritidis

52
Q

What organism which is a cause of food poisoning can cause cell death of red blood cells and renal cells?

A

E.Coli 0157

53
Q

What substance does E.coli 0157 produce?

A

Verotoxins

54
Q

What can cause Haemolytic Ureamic Syndrome (HUS)?

A

E.Coli 0157

55
Q

What are the symptoms of HUS?

A 
Anaemia signs and symptoms 
Fever 
Vomiting and diarrhoea 
Abdominal pain 
Blod in stools
Low/ no urine output
56
Q

Why must antibiotics not be given to patients with suspected E.coli/ HUS?

A

As antibiotics can actually cause E.coli to produce more verotoxins, which worsens the condition

57
Q

Which virus is the most common cause of vomiting and diarrhoea in children under 3 years old?

A

Rotavirus

58
Q

Which virus involves sudden onset of explosive diarrhoea and vomiting, is highly infectious and causes large outbreaks?

A

Norovirus

GASTROINTESTINAL (13 decks)

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