1. GIT intro

Question 0

What is the distance from the incisor teeth to the Oesophago-gastric junction?

Answer 0

38-40cm

Question 1

How long is the oesophagus?

Answer 1

25cm

Question 2

What is Barrett’s Oesophagus?

Answer 2

An adaptive feature replacing normal stratified squamous epithelia of oesophagus with metaplastic columnar epithelia (with goblet cells) anywhere in the oesophagus (usually by LES).

Caused by chronic reflux of acid stomach contents

Question 3

2 possible types of cancer that can arise in the oesophagus

Answer 3

Squamous cell carcinoma

Adenocarcinoma (if metaplastic columnar epithelia present)

Question 4

Things that may cause dysphagia

Answer 4

Difficulty coordinating swallowing (e.g. Bulbar Palsy; bilateral probs with cranial nerves)

Narrowing of food pathway, which can be malignant

Benign narrowing of food pathway (e.g. Fibrous rings)

Achalasia (failure to relax LOS)

Question 5

What are oesophageal varices?

Answer 5

Dilated mucosal veins in oesophagus that can bleed torrentially

Formed following portal hypertension as result of porto-systemic anastomosis

Question 6

Mechanisms which help prevent stomach contents refluxing into oesophagus

Answer 6

Mucosal folds at end of oesophagus

Acute angle that oesophagus joins stomach

Higher abdominal pressure than thoracic pressure

Right crus of diaphragm acts like sling around oesophagus

Question 7

Name/label the regions if the stomach

Answer 7

http://upload.wikimedia.org/wikipedia/commons/thumb/2/29/Regions_of_stomach.svg/2000px-Regions_of_stomach.svg.png

Cardia
Fundus
Body
Pylorus
(Lesser & greater curve)

Question 8

Define peptic ulceration

Answer 8

Damage occurs & extends through muscularis mucosa layer of stomach or duodenum

Question 9

Which part of the duodenum is prone to ulceration & why?

Answer 9

First part

Receives acidic Chyme from stomach before neutralised by various secretions which only enter duodenum in 2nd part

Question 10

If a peptic ulcer erodes posteriorly through the 1st part of the duodenum, what structure might be damaged?

Answer 10

Gastro-duodenal artery

May result in haemorrhage, haematemesis & malaena

Question 11

What is delivered through the second part of the duodenum?

Answer 11

Secretions from the gallbladder & exocrine pancreas (bile, pancreatic enzymes, neutralising juices)

Question 12

Where does fluid entering the GIT come from?

Answer 12

Food, water, gastric secretions, alkali

Question 13

What changes would there be in faeces if the small intestine was removed?

Answer 13

Watery stool
Fatty stool

Small intestine is the major site of water & fat absorption

Question 14

2 conditions that affect small intestine & potentially result in malabsorption

Answer 14

Crohn’s Disease

Coeliac disease

Question 15

What is a Meckel’s Diverticulum

Answer 15

Vestigial remnant of the vitello-intestinal duct, following a diverticulum which usually follows a rule of two’s
(2ft from ileo-caecal valve, 2in long, affects 2% of pop)

Question 16

What might be the clinical presentation of someone with acutely blocked small intestine?

Answer 16

Abdominal pain (colicky: comes & goes)

Abdominal distension

Vomiting

Question 17

2 common causes of Appendicitis

Answer 17

Lymphoid hyperplasia (lymphoid tissue around base if appendix occuludes opening, causing inflammation)

Faecolith

Question 18

In Appendicitis, where does pain start and then move to?

Answer 18

Starts as vague peri-umbilical pain

Moves to right iliac fossa

Question 19

What are diverticula & where do they develop?

Answer 19

Small mucosal herniations, which protrude through intestinal layers

Most common in sigmoid colon

Question 20

Where is the Dentate (Pectinate line) & what epithelia is present in each?

Answer 20

Junction in anal canal that divides hindgut from Procto-deum
Different embryological derivatives & so different epithelia, blood supply & nerve innervation

Epithelia above = columnar
Epithelia below = stratified squamous

Question 21

What type of cancer may occur above & below the Dentate line

Answer 21

Above: adenocarcinomas (columnar epithelium)

Below: squamous cell carcinoma

Question 22

What are haemorrhoids?

What are the symptoms of troublesome haemorrhoids?

Answer 22

Swelling of haemorrhoidal venous cushions (vascular structures supporting anal continence), distending beyond normal limits

Pathological when start to cause symptoms:
Pain, itching, bleeding, prolapse

Question 23

Which structures are retroperitoneal?

Answer 23

Mnemonic: SAD PUCKER

Suprarenal (adrenal) gland
Aorta / IVC
Duodenum
Pancreas
Ureters
Colon (ascending & descending)
Kidneys
E(o)esophagus
Rectum

Question 24

Which structures are intraperitoneal?

Answer 24

Mneumonic: SLITS CATS JIROD
Stomach
Liver
Ileum
Tail of pancreas
Spleen
Caecum
Appendix
Transverse colon
Sigmoid colon
Jejunum
Ileum
Rectum (upper 1/3)
Ovaries
Duodenum (1st part)