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Medicine Phase 2a GI > General > Flashcards

General Flashcards

1
Q

Causes of gastro-intestinal malabsorption

A 
Decrease in bile
Pancreatic insufficiency
Small bowel mucosa
Bacterial overgrowth
Infection
Intestinal hurry
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2
Q

Examples of diseases of intestinal malabsorption common in UK

A

Crohns
Coeliac
Chronic pancreatitis

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3
Q

GI malabsorption: Causes of decreased bile

A

Primary Biliary cholangitis
Ileal resection
Biliary obstruction
Colestyramine

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4
Q

GI malabsorption: Causes of pancreatic insufficiency causing GI malabsorption

A

Pancreatic cancer

Cystic fibrosis

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5
Q

GI malabsorption: Causes of Bacterial overgrowth causing malabsorption

A

Spontaneous in elderly
Jejunal diverticula
Post-op blind loops
Diabetes M and PPI are risk factors

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6
Q

Treat Bacterial overgrowth causing GI malabsorption

A

Metronidazole

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7
Q

GI malabsorption: Causes of Infection causing malabsorption

A

Giardiasis
Cryptosporidium
Diphyllobothriasis (B12 malabsorption)
Strongyloidiasis

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8
Q

GI malabsorption: Causes of Small bowel mucosa causing malabsorption

A 
Whipple's disease
Radiation enteritis
Tropical sprue
Brush border enzyme deficiencies e.g. lactase insufficiencies
Drugs (Metformin, alcohol)
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9
Q

GI malabsorption: Causes of intestinal hurry causing malabsorption

A

Post-gastrectomy dumping
Post-vagotomy
Gastrojejunostomy

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10
Q

Symptoms of GI malabsorption

A 
Diarrhoea
Decreased weight
Lethargy
Steatorrhoea
Bloating
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11
Q

Deficiency signs (of GI malabsorption)

A 
Anaemia (low iron, B12, folate)
Bleeding disorders (decreased Vitamin K)
Oedema (decreased protein)
Metabolic bone disease (decreased vitamin D)
Neurological features e.g. neuropathy
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12
Q

Tests of GI malabsorption

A

(FBC)
Stools
Breath hydrogen analysis (for bacterial overgrowth)
Endoscopy + small bowel biopsy

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13
Q

GI malabsorption expected FBC results

A

low Ca2+
low Fe
low B12 + folate
increased INR

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14
Q

Describe stool test of GI malabsorption

A 
Sudan stain for fat globules
Stool microscopy (infection)
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15
Q

How does tropical sprue cause infectious malabsorption

A

Villous atrophy

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16
Q

What could you give for infection causing GI malabsorption

A

Tetracycline

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17
Q

Causes of splenomegaly

A
  • Liver disease (cirrhosis, hepatitis)
  • Acute or chronic infection (bacterial endocarditis, infectious mononucleosis, HIV, malaria, tuberculosis, histiocytosis)
  • Hematologic malignancy (lymphomas, leukemias, myeloproliferative disorders)
  • Congestion (splenic vein thrombosis, portal hypertension, congestive heart failure)
  • Inflammation (sarcoidosis, lupus, rheumatoid arthritis, systemic lupus)
  • Splenic sequestration (pediatric sickle cell, hemolytic anemias, thalassemias)
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18
Q

What is dyspepsia

A

One or more of following:

  • Postprandial (after eating) fullness
  • Early satiation
  • Epigastric pain or burning for more than 4 weeks
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19
Q

Red alarm flag symptoms for cancer

A
  • Unexplained weight loss
  • Anaemia
  • Evidence of GI bleeding e.g. melaena (dark tar like black stools) or haematemesis
  • Dysphagia
  • Upper abdominal mass - Persistent vomiting
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20
Q

Management of dyspepsia

A
  • Reassurance
  • Dietary review
  • Antidepressants e.g. selective serotonin reuptake inhibitors e.g. CITALOPRAM (low doses are use to reduce the sensitivity of the gullet)
  • Look for Helicobacter pylori using faecal antigen testing or breath test (less common now)
  • Endoscopy to find clear picture of whats going on
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21
Q

How many layers does the smooth muscle wall of the stomach have

A

3

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22
Q

What are 3 layers of smooth muscle of the stomach called

A

(Outer) Longitudinal
Inner Circular
(Innermost) Oblique

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23
Q

What are 2 sphincters of stomach called

A

Gastro-oesophageal sphincter

Pyloric sphincter

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24
Q

Which smooth muscle layer of the stomach makes up most of the pyloric sphincter

A

Circular muscle layer thickening makes up most of pyloric sphincter
Controls exit of gastric contents into the duodenum

25
Q

How many smooth muscle layers does the duodenum have and what are they called

A

2
Outer longitudinal
Inner smooth muscle

26
Q

What shape is duodenum and where does pancreas sit in relation

A

C-shaped

Pancreas sits in the concavity

27
Q

Where does duodenum end

A

Duodenojejunal flexure, where it becomes the jejunum

28
Q

What are the names of the thick folds of the greater curvature of the stomach (that allow extension)

A

Rugae

29
Q

What specialised cells are found in upper 2/3s of the stomach

A

Parietal cells
Chief cells
Enterochromaffin-like cells (ECL cells)

30
Q

What is secreted by parietal cells

A

HCl and intrinsic factor

31
Q

What is secreted by chief cells

A

Pepsinogen

initiates proteolysis

32
Q

Enterochromaffin-like cells - what do they secrete

A

Histamine (stimulates acid release)

33
Q

What are the different zones of the stomach

A

Cardia (Where GO sphincter is)
Fundus (above gastro-oesophageal sphincter)
Body
(Pyloric) Antrum (second last bit before the duodenum)
Pylorus (last bit before duodenum)

34
Q

What cells are found in antral mucosa of stomach

A

Mucus secreting cells
G cells
D cells

35
Q

What 2 chemicals are secreted by mucus secreting cells

A

Mucin

Bicarbonate

36
Q

What is released by G cells

A

Gastrin (stimulates acid release)

37
Q

What is released by D cells

A

Somatostatin (suppresses acid secretion)

38
Q

What makes up the mucosal barrier (stomach)

A

Plasma membranes of mucosal cells and mucus layer (made up of mucin)

39
Q

What is purpose of mucosal barrier of stomach

A

Protects gastric epithelium from damage by acid as well as alcohol, aspirin, NSAIDs and bile salts

40
Q

What is effect of prostaglandins on mucus secretion

A

Stimulate mucus secretion

41
Q

What drugs can inhibit synthesis of prostaglandins and thus mucus secretion

A

Aspirin

NSAIDs

42
Q

What enzyme is inhibited by Aspirin and NSAIDs to prevent prostaglandin synthesis and thus mucus release

A

Cyclo-oxygenase (1)

43
Q

What specialised cell is found in duodenal mucosa only

A

Brunner’s glands

44
Q

What is secreted by Brunner’s glands in duodenum

A

Alkaline mucus

45
Q

What helps neutralise acid secretion form stomach in duodenum

A

Pancreatic and biliary secretions (bile salts etc)

Alkaline mucus from Brunner’s glands

46
Q

What is general function of prostaglandins

A

In inflamed tissue, prostaglandin triggers inflammatory response (thus inhibition means less inflammation).
Mucus secretion stimulated by prostaglandins.

47
Q

2 types of peritoneum

A

Parietal - covered abdominal wall

Visceral - on organs e.g. stomach, liver and colon

48
Q

Describe innervation and sensation of parietal peritoneum

A

Somatic innervation

Sensation is well localised

49
Q

Describe innervation and sensation of visceral peritoneum

A

Autonomic innervation

Sensation is poorly localised

50
Q

Site of autonomic pain from foregut

A

Epigastric

51
Q

Site of autonomic pain from midgut

A

Periumbilical

52
Q

Site of autonomic pain from hindgut

A

Hypogastric

53
Q

Peritoneal cavity is a closed sac lined by what cells?

A

Mesothelial cells

54
Q

What do mesothelial cells of peritoneal cavity secrete

A

Surfactant

acts as a lubricant within the peritoneal cavity

55
Q

How much fluid and protein/transudate is found within the peritoneal cavity

A

<100ml serous fluid

<30g/L protein (transudate)

56
Q

Where does fluid from the peritoneal cavity drain?

A

1/3 drains through lymphatics
Remainder through the parietal peritoneum
(particulate matter can be rapidly removed)

57
Q

What is the start and end of foregut

A

Lower oesophagus to D2 (liver, spleen and gallbladder)

58
Q

What is the start and end of the midgut

A

D2 to 2/3s across Transverse Colon (majority of abdomen)

59
Q

What is the start and end of the hindgut

A

Last 1/3 of Transverse colon to Upper rectum

Medicine Phase 2a GI (35 decks)

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