29/04

Question 1

liver cirrhosis glucose

Answer 1

hypoglycaemia- encalopathy

Question 2

Nodules in the palm of the hands.

Answer 2

alcoholic liver disease symptoms

Question 3

anti 1 antitrypsin deficiency

type of emphysema

Answer 3

panacinar

Question 4

liver cirrhosis histology

Answer 4

excess collagen and extracellular matrix deposition in periportal and pericentral zones making regenerative nodules

Question 5

varicose veins investiagtions

Answer 5

duplex US

Question 6

mesenteric ischaemia, what part affects mostly

Answer 6

splenic flexure

Question 7

Interstitial Cells of Cajal (ICCs)–

Answer 7

pacemaker cells located between circular and longitudinal smooth muscle. Determines Max frequency, direction + velocity of rhythmic contractions.

Question 8

Enteric Nervous system

Answer 8

parasympathetic and sympathetic

autonomic

Question 9

Sympathetic

Answer 9

increase sphincter tone. Decreases motility, secretion and blood flow

Question 10

affarent

Answer 10

signals to CNS/pons+medulla

CN 9,10

Question 11

efferent

Answer 11

signals away from CNS

CN12, 9, 10, 11

to pharynx and laynx

Question 12

parotid

Answer 12

innervated by the glossopharyngeal nerve

Question 13

Formation of saliva

Answer 13

Primary secretion by acinar cells then secondary modification by duct cells

Question 14

cephalic stage of gastric secretion

Answer 14

before food reaches stomach

Question 15

Muscuranic receptor antagonists (e.g. pirenzipine)

Answer 15

block competitively M3

Question 16

H2 histamine receptor antagonists (e.g. ranitidine

Answer 16

block competitively (reversible).

Question 17

Proton-pump inhibitors (e.g. omeprazole

Answer 17

inhibit active H+/K+ dependent ATPase (proton pump). Must be present in plasma at an effective concentration whilst proton pumps are active

Question 18

NSAIDs (e.g. aspirin

Answer 18

block irreversibly cyclo-oxygenase

reduce prostaglandin formation so may trigger gastric ulceration and bleeding

Question 19

BMI

Answer 19

Weight (kg) / Square of height (m)

Question 20

adiposity signals (hormones)

Answer 20

Leptin (from fat cells), reduced levels mimics starvation causing unrestrained appetite.
-Insulin (pancreatic cells), high levels inhibit food intake and decrease body weight. (Deletion of insulin receptors = obesity)

Question 21

Drug Treatment of Obesity

Answer 21

-Orlistat – inhibits pancreatic lipase so decreases triglyceride absorption. (Causes cramping and diarrhoea).
-Contrave (Mysimba) – combination of dopamine re-uptake inhibitor + opioid antagonist
Liraglutide (Saxenda) – Glucagon like peptide 1 receptor agonist (GLP-1 a satiety peptide) injected.
Bariatric Surgery – gastric bypass surgery – weight loss + reduces mortality. Induces resolution of type II diabetes.

Question 22

Carbs

Answer 22

starch, cellulose, glycogen, dissacharides

Question 23

lipids

Answer 23

triacylglycerols, phospholipids, cholesterol, free fatty acids, lipid vitamins

Question 24

luminal digestion

Answer 24

by pancreatic enzymes secreted into the duodenum

Question 25

Absorption

Answer 25

where absorbable products are transferred across both apical (brush border) and basolateral membranes of enterocytes

Question 26

CARB DIGESTION

Answer 26

polysaccharides (45-60%) starch and glycogen, - oligossacharides (30-40%) sucrose and lactose, - monosaccharides (5-10%) Glucose and fructose all converted to monosaccharides for absorption

Question 27

PROTEIN DIGESTION

Answer 27

digested to oligopeptides and amino acids Peptides are hydrolysed (by peptidases) to amino acids which cross basolateral membrane by Na+ independent transporters. In Duodenum – pancreatic lipase + bile salts (HCO3- in pancreatic juice neutralises stomach acid). [Bile salts – emulsify large lipid droplets to small so greater surface area for lipase to act. Colipase allows access of lipase to hydrophobic core of small droplets. Failure to secret bile salts causes Steatorrhea, and secondary vitamin deficiency.]

Question 28

Plasma protein secretion

Answer 28

- Albumin - Alpha Globulins – transport lipoproteins, lipids, hormones and bilirubin (eg ceruloplasmin transports copper). Retinol binding protein transports vitamin A. - Beta Globulins – transferrin (transports Fe3+, stored bound to ferritin), Fibrinogen (inactive form of fibrin, clotting of blood

Question 29

GGT

Answer 29

gamma-glutamyl transferase (GGT) blood test measures the activity of GGT in your blood. GGT may leak into your bloodstream if your liver or bile duct is damaged, so having high levels of GGT in your blood may indicate liver disease or damage to your liver's bile ducts

Question 30

Achalasia symptoms signs treatment

Answer 30

unknown aetiology which causes failure of the lower oesophageal sphincter to relax. associated with underlying oesophageal cancer Dysphagia – gradual onset (months to years) Regurgitation of undigested food Aspiration Retrosternal chest pain / heartburn – often does not respond to PPI Weight loss – often mild dilated oesophagus, containing residual materia 'bird's beak appearance' in barium swallow Botulinum toxin injections (botox) Medical therapy can be tried (calcium channel blockers / nitrites) in patients who fail botox therapy or are not suitable surgical candidates Surgery: Options include oesophageal dilatation and surgical cleavage of the muscle, called 'Heller's Myotomy'.

Question 31

Bacillus cereus

Answer 31

Gram-positive rods that produce 2 toxins, an emetic pre-formed enterotoxin that is absorbed into the blood-stream from the stomach, and a diarrhoea-causing enterotoxin that acts on receptors in the small intestine and large bowel. Symptoms start 30 minutes to 6 hours after eating contaminated food (due to the pre-formed toxin), and profuse vomiting is a common feature. Fever is usually absent. Rice is a common source, as it provides the carbohydrate for the bacteria to produce the toxins. These are heat stable, so when the rice is reheated they remain active

Question 32

types of ascities

Answer 32

exudate- malignancy/infection transudate- increased pressure from portal hypertension

Question 33

causes of oesophageal varicies

Answer 33

portal hypertension from liver cirrhosis, hep, liver disease, budd chiari leads to enlarged spleen but GB isn't affected!! because the hepatic vein doesn't supply the gall bladder

Question 34

icterus

Answer 34

jaundice

Question 35

painless jaundice, old age and weight loss which cancer?

Answer 35

pancreatic more likely than cholangiocarcinoma

Question 36

which IBD has transmural/ mucosal involvement

Answer 36

t- crohns | m- UC

Question 37

crypt abscess with which IBD

Answer 37

UC