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GI > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What lies in the palacolic gutters?

A

Descending and ascending colon

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2
Q

What is the name of the fatty projections found on the colon?

A

Omental appendices

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3
Q

Where is McBurney’s point?

A

1/3 of the way between the right ASIS to the umbilicus

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4
Q

Name the abdominal branches of the aorta

A

Celiac trunk

Superior mesenteric

Renal

Gonadal

Inferior mesenteric

Common iliac arteries

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5
Q

Where does the celiac trunk come off of the aorta?

A

T12

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6
Q

Where do the renal arteries branch off of the aorta?

A

L1

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7
Q

Where do the gonadal arteries branch off of the aorta?

A

L2

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8
Q

Where does the superior mesenteric artery branch off of the aorta?

A

L1

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9
Q

Where does the inferior mesenteric artery branch off of the aorta?

A

L3

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10
Q

What is the anastomoses in the colon called?

A

Marginal Artery of Drummond

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11
Q

Where are the venous system anastomoses?

A

Distal end of the oesophagus

Skin around the umbilicus

Rectum/anal canal

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12
Q

If a patient has Caput Medusae, what is the underlying cause?

A

Portal hypertension

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13
Q

If a patient has oesophageal varices, what is the underlying cause?

A

Portal hypertension

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14
Q

What is a polyp?

A

Tumour/protrusion above an epithelial surface

Could be benign or malignant

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15
Q

What is a pedunculated ployp?

A

A polyp hanging on a stalk

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16
Q

What is a sessile polyp?

A

Hairy/flappy in appearence

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17
Q

‘All adenomas are dysplastic’

What does this mean?

A

All adenomas have abnormal cells

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18
Q

Should adenomas of the colon get removed?

A

Yes

They are all premalignant

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19
Q

Which is more common, left sided or right sided colorectal carcinoma?

A

Left sided

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20
Q

What is the difference between Heriditary Non-Polyposis Coli (HNPCC) and Familial Adenomatous Polyposis (FAP)

A

HNPCC < 100 polyps
Late onset
Defect in DNA mismatch repair

FAP > 100 polyps
Defect in tumour supression
Inherited mutation in FAP gene

BOTH ARE AUTOSOMAL DOMINANT

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21
Q

What inherited colorectal carcinoma predominantly presents right sided tumours?

A

HNPCC

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22
Q

What type of inherited colorectal carcinoma gives rise to mucinous tumours?

A

HNPCC

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23
Q

What type of inherited colorectal carcinoma can present as polyps found throughout the colon?

A

FAP

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24
Q

What type of inherited colorectal carcinoma can present as adenocarcinoma?

A

FAP

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25
Q

What inherited colorectal carcinoma is associated with desmoid tumours and thyoroid carcinoma?

A

FAP

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26
Q

How is the gastroileal reflex stimulated and what does it do?

A

Gastric distension

Opens the ileocaecal valve

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27
Q

What nerves control the ileocaecal valve?

A

Vagus nerve

Sympathetic nerves

Enteric neurones

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28
Q

What does the large intestine absorb?

A

H2O, Na+, Cl-

Short chain fatty acids

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29
Q

What does the large intestine secrete?

A

K+

HCO3-

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30
Q

Why does the large intestine secrete HCO3-?

A

Neutralises acid produced by bacterial fermentation

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31
Q

Is a carcinoma cancerous?

A

Yes

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32
Q

Where is diverticular disease most likley to occur in the colon?

A

Sigmoid

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33
Q

What causes diverticular disease?

A

Low fibre intake

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34
Q

What is diverticular disease?

A

Mucosal herniation through muscle coat

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35
Q

What are the clinical features of diverticulitis?

A

LIF pain/tenderness

Septic

Altered bowel habit

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36
Q

What are some of the complications of diverticular disease?

A

Pericolic abscess

Perforation

Haemorrhage

Fistula

Stricture

37
Q

A patient comes in and is diagnosed with diverticulitis. How are you going to treat them?

A

If they require antibiotics - oral

Hartmann’s procedure

Primary resection

Drainage

38
Q

If a patient comes in with bloody diarrhoea, abdominal cramps, dehydration, weight loss, anaemia and sepsis…what do they have?

A

Acute colitis

39
Q

How is acute/chronic colitis diagnosed?

A

X-ray

Sigmoidoscopy + biopsy

Stool cultures

Barium enema

40
Q

What is the treatment of an acute episode of UC or Crohn’s disease?

A

IV fluids

IV steroids - once infective/ischaemic colitis is ruled out

GI rest

41
Q

Occlusion of what artery often causes iscaehmic colitis?

A

Inferior mesenteric artery

42
Q

Where does colonic angiodysplasia commonly occur?

A

Right side of the colon

43
Q

How is colonic angiodysplasia diagnosed?

A

Angiography

Colonoscopy

44
Q

What is the treatment of colonic angiodysplasia?

A

Embolisation

Endoscopic ablation

Surgical resection

45
Q

What are the causes of a large bowel obstruction?

A

Colorectal cancer

Benign stricture

Volvulus

46
Q

What is the treatment of a sigmoid volvulus?

A

Surgical resection

47
Q

What is a pseudo-obstruction?

A

No real mechanical obstruction

Often seen in the elderly

Hypoxia

48
Q

What is the appendix?

A

Convergence of three taeniae

49
Q

What are the clinical signs of appendicitis?

A

Mild pyrexia (never high temp initially)

Mild tachycardia

Localised pain in RIF

Guarding

Rebound

50
Q

What is Rosving’s sign for appendicitis?

A

Pressing on the left causes pain on the right

51
Q

What investigations would you do to confirm a small bowel obstruction?

A

Urinalysis

Bloods

Gases

AXR

Contrast CT of abdomen

Gastrografin studies

52
Q

What is the treatment of a small bowel obstruction?

A

ABC

Analgesia

Fluids with potassium
They aare usually hypokalaemic and alkalotic

Catheterise

NG tube

Antithromboembolism measures

53
Q

If the small bowel gets infarcted, what happens?

If the large bowel gets infarcted what happens?

A

Dies

Lives (marginal artery)

54
Q

Where does Meckel’s diverticulum occur?

A

60cm from the IC valve

55
Q

What nerves are sensory nerves?

A

Visceral afferent nerve fibres

56
Q

What do the visceral afferent nerve fibres in the rectum sense?

A

Fullness

57
Q

What is the pelvic floor muscle?

A

Levator ani

58
Q

Where does the sigmoid colon become the rectum?

A

Anterior to S3

59
Q

Where does the rectum become the anal canal?

A

anterior to the tip of the coccyx

60
Q

What are the names of the levator ani muscles from most inferior to most exterior?

A

Puborectalis

Pubococcygeus

Iliococcygeus

61
Q

What muscle slingshots around the rectum? Is it skeletal or smooth?

A

Puborectalis

Skeletal

62
Q

Where do the sympathetic nerves that supply the anal canal come from?

A

T12-L2

63
Q

Where do the parasympathetic fibres and visceral afferents come from that supply the anal canal?

A

S2, 3 and 4

64
Q

Where does the somatic motor nerve that supplies the anal canal come from?

A

S2-4

65
Q

Where does the nerve to the levator ani come from?

A

S3, 4

66
Q

What nerve stimulates the contraction of the external anal sphincter?

A

Pudendal nerve

67
Q

What nerve inhibits the contraction of the internal anal sphincter?

A

Parasympathetic nerves

68
Q

Where does the pudendal nerve exit the pelvis?

A

Greater sciatic foramen

69
Q

Where does the pudendal nerve enter the perineum?

A

Sciatic foramen

70
Q

What nerve could be stretched during childbirth?

A

Pudendal

71
Q

What is the pectinate line?

A

It marks the junction between the part of the embryo which formed the GI tract (endoderm) and the part that formed the skin (ectoderm)

72
Q

Above the pectinate what arterial supply, venous drainage, lymphatic drainage etc do the structures get?

A

Visceral

73
Q

Below the pectinate line, what arterial supply, venous drainage, lymphatic drainage etc do the structures get?

A

Parietal

74
Q

What is the lymphatic drainage below the pectinate line?

A

Superficial inguinal nodes

75
Q

What is the lymphatic drainage above the pectinate line?

A

Inferior mesenteric nodes

76
Q

What is the venous drainage system above the pectinate line?

A

Hepatic portal vein

77
Q

What are rectal varices?

A

Dilation of collateral veins between portal and systemic venous systems

Related to portal hypertension

78
Q

What are haemorrhoids?

A

Prolapses of the rectal venous plexus

Due to raised pressure e.g. chronic constipation. straining, pregnancy

79
Q

What is an ischioanal abscess?

A

An infection within the ischioanal fossae (lie on the right and left of the anal canal)

80
Q

What IBD presents with abdominal pain, diarrhoea, anorexia, malaise and fever?

A

Crohn’s

81
Q

What IBD presents with bloody diarrhoea, colicky abdominal pain and urgency?

A

UC

82
Q

Should you use enteral nutrition in IBD?

A

Only helps in Crohn’s (not UC)

83
Q

What are patients told to do with their diet after having an episode of severe IBD?

A

Low fibre

Dairy should be closely monitored

84
Q

What is the Rome IV criteria for IBS?

A

“Recurrent abdominal pain on average at leats 1 day a week in the last 3 months associated with two or more of the following:

Related to defication

Associated with a change in frequency of stool

Associated with a change in consistency of stool

Symptoms must have started at least 6 months ago”

85
Q

What does FODMAP stand for?

A 
Fermentable
Oligo-saccharides - fructans
Disaccharides - lactose
Monosaccharides - fructoes
And
Polyols - sorbitol
86
Q

What is the first test performed on a person suspected to have coeliac disease?

A

tTGA test

87
Q

What must happen in order to confirm that a person has coeliac disease?

A

Biopsy

88
Q

A positive tTGA test confirms what?

A

Coeliac disease

89
Q

How many units can an adult male and female get of Gluten Free Food?

A

Male - 18

Female - 14

GI (22 decks)

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