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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
What inherited colorectal carcinoma is associated with desmoid tumours and thyoroid carcinoma?
FAP
26
How is the gastroileal reflex stimulated and what does it do?
Gastric distension Opens the ileocaecal valve
27
What nerves control the ileocaecal valve?
Vagus nerve Sympathetic nerves Enteric neurones
28
What does the large intestine absorb?
H2O, Na+, Cl- Short chain fatty acids
29
What does the large intestine secrete?
K+ HCO3-
30
Why does the large intestine secrete HCO3-?
Neutralises acid produced by bacterial fermentation
31
Is a carcinoma cancerous?
Yes
32
Where is diverticular disease most likley to occur in the colon?
Sigmoid
33
What causes diverticular disease?
Low fibre intake
34
What is diverticular disease?
Mucosal herniation through muscle coat
35
What are the clinical features of diverticulitis?
LIF pain/tenderness Septic Altered bowel habit
36
What are some of the complications of diverticular disease?
Pericolic abscess Perforation Haemorrhage Fistula Stricture
37
A patient comes in and is diagnosed with diverticulitis. How are you going to treat them?
If they require antibiotics - oral Hartmann's procedure Primary resection Drainage
38
If a patient comes in with bloody diarrhoea, abdominal cramps, dehydration, weight loss, anaemia and sepsis...what do they have?
Acute colitis
39
How is acute/chronic colitis diagnosed?
X-ray Sigmoidoscopy + biopsy Stool cultures Barium enema
40
What is the treatment of an acute episode of UC or Crohn's disease?
IV fluids IV steroids - once infective/ischaemic colitis is ruled out GI rest
41
Occlusion of what artery often causes iscaehmic colitis?
Inferior mesenteric artery
42
Where does colonic angiodysplasia commonly occur?
Right side of the colon
43
How is colonic angiodysplasia diagnosed?
Angiography Colonoscopy
44
What is the treatment of colonic angiodysplasia?
Embolisation Endoscopic ablation Surgical resection
45
What are the causes of a large bowel obstruction?
Colorectal cancer Benign stricture Volvulus
46
What is the treatment of a sigmoid volvulus?
Surgical resection
47
What is a pseudo-obstruction?
No real mechanical obstruction Often seen in the elderly Hypoxia
48
What is the appendix?
Convergence of three taeniae
49
What are the clinical signs of appendicitis?
Mild pyrexia (never high temp initially) Mild tachycardia Localised pain in RIF Guarding Rebound
50
What is Rosving's sign for appendicitis?
Pressing on the left causes pain on the right
51
What investigations would you do to confirm a small bowel obstruction?
Urinalysis Bloods Gases AXR Contrast CT of abdomen Gastrografin studies
52
What is the treatment of a small bowel obstruction?
ABC Analgesia Fluids with potassium They aare usually hypokalaemic and alkalotic Catheterise NG tube Antithromboembolism measures
53
If the small bowel gets infarcted, what happens? If the large bowel gets infarcted what happens?
Dies Lives (marginal artery)
54
Where does Meckel's diverticulum occur?
60cm from the IC valve
55
What nerves are sensory nerves?
Visceral afferent nerve fibres
56
What do the visceral afferent nerve fibres in the rectum sense?
Fullness
57
What is the pelvic floor muscle?
Levator ani
58
Where does the sigmoid colon become the rectum?
Anterior to S3
59
Where does the rectum become the anal canal?
anterior to the tip of the coccyx
60
What are the names of the levator ani muscles from most inferior to most exterior?
Puborectalis Pubococcygeus Iliococcygeus
61
What muscle slingshots around the rectum? Is it skeletal or smooth?
Puborectalis Skeletal
62
Where do the sympathetic nerves that supply the anal canal come from?
T12-L2
63
Where do the parasympathetic fibres and visceral afferents come from that supply the anal canal?
S2, 3 and 4
64
Where does the somatic motor nerve that supplies the anal canal come from?
S2-4
65
Where does the nerve to the levator ani come from?
S3, 4
66
What nerve stimulates the contraction of the external anal sphincter?
Pudendal nerve
67
What nerve inhibits the contraction of the internal anal sphincter?
Parasympathetic nerves
68
Where does the pudendal nerve exit the pelvis?
Greater sciatic foramen
69
Where does the pudendal nerve enter the perineum?
Sciatic foramen
70
What nerve could be stretched during childbirth?
Pudendal
71
What is the pectinate line?
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
Above the pectinate what arterial supply, venous drainage, lymphatic drainage etc do the structures get?
Visceral
73
Below the pectinate line, what arterial supply, venous drainage, lymphatic drainage etc do the structures get?
Parietal
74
What is the lymphatic drainage below the pectinate line?
Superficial inguinal nodes
75
What is the lymphatic drainage above the pectinate line?
Inferior mesenteric nodes
76
What is the venous drainage system above the pectinate line?
Hepatic portal vein
77
What are rectal varices?
Dilation of collateral veins between portal and systemic venous systems Related to portal hypertension
78
What are haemorrhoids?
Prolapses of the rectal venous plexus Due to raised pressure e.g. chronic constipation. straining, pregnancy
79
What is an ischioanal abscess?
An infection within the ischioanal fossae (lie on the right and left of the anal canal)
80
What IBD presents with abdominal pain, diarrhoea, anorexia, malaise and fever?
Crohn's
81
What IBD presents with bloody diarrhoea, colicky abdominal pain and urgency?
UC
82
Should you use enteral nutrition in IBD?
Only helps in Crohn's (not UC)
83
What are patients told to do with their diet after having an episode of severe IBD?
Low fibre | Dairy should be closely monitored
84
What is the Rome IV criteria for IBS?
"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
What does FODMAP stand for?
``` Fermentable Oligo-saccharides - fructans Disaccharides - lactose Monosaccharides - fructoes And Polyols - sorbitol ```
86
What is the first test performed on a person suspected to have coeliac disease?
tTGA test
87
What must happen in order to confirm that a person has coeliac disease?
Biopsy
88
A positive tTGA test confirms what?
Coeliac disease
89
How many units can an adult male and female get of Gluten Free Food?
Male - 18 Female - 14

GI (22 decks)

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