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ESA 4 Rev > GI Revision > Flashcards

GI Revision Flashcards

1
Q

What are the abdominal wall layers?

A 
Skin
Campers fascia (fat)
Scarpers fascia (fibrous)
External oblique
Internal oblique 
Transverse abdominis 
Transversalis fascia 
Parietal peritoneum
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2
Q

What level is the coeliac trunk?

A

T12

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3
Q

Which organs are secondary retroperitoneal?

A

Pancreas
Duodenum
Colon - asc and desc

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4
Q

What is the sympathetic innervation to the gut and its effect?

A

Greater, lesser and least splanchnic nerves

Vasoconstriction

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5
Q

What is different about abdominal sympathetics?

A

Do not synapse at the sympathetic trunk

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6
Q

What is the PS innervation to the gut and its effect?

A

Vagus n - to 2/3 TC
Pelvic n - to anal canal
Innervate SM, HCl secretion, ACh and GRP.

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7
Q

L vagus nerve becomes ______

R vagus nerve becomes _______

A

L - anterior

R - posterior

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8
Q

What are the roots of greater, lesser and least splanchnic nerves?

A

T5-9
T10-11
T12

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9
Q

What is another name for the submucosal plexus?

A

Meissner’s

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10
Q

What is another name for the myenteric plexus?

A

Auerbach’s

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11
Q

What are the 2 groups of hormones in the gut?

A

Gastrin - gastrin + CCK

Secretin - secretin + gastrin inhibitory peptide

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12
Q

Which cells secrete CCK, where are they, what are they stimulated by?

A

I cells - duodenum + jejunum

Fat and protein in lumen

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13
Q

What is the role of secretin?

A

Increases HCO3- from pancreas
Decrease gastric acid secretion
Neutralise chyme

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14
Q

What is the effect of gastrin inhibitory peptide?

A

Increase insulin

Decrease gastric acid secretion

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15
Q

When might there be gut motility issues?

A

Hirschsprungs disease - no enteric plexus

Paralytic ileus - after surgery

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16
Q

Greater omentum is formed from the ________.

A

Dorsal mesentary

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17
Q

Lesser omentum is formed from the __________.

A

Ventral mesentery

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18
Q

Which organs have a dual blood supply?

A

Pancreas + duodenum - CT and SMA

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19
Q

What happens in reversed rotation in midgut development?

A

One rotation clockwise

TC posterior to duodenum

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20
Q

What happens in incomplete rotation?

A

only 1 90 degree rotation - left sided colon as caudal limb returns first.

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21
Q

What are the risks of midgut defects?

A

Volvulus
SMA compress TC
Subhepatic caecum

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22
Q

What is the difference between omphalocoele and gastroschisis?

A

Omphaloceole - incomplete physiological herniation, not isolated condition, amnion covering.
Gastroschisis - failure of abdominal wall, isolated.
Bowel exposed to amniotic fluid.

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23
Q

What is formed from ventral mesentery?

A

Lesser omentum

Falciform ligament

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24
Q

During midgut development, which limb returns to the cavity first?

A

Cranial

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25
Q

What are 3 remnants of the yolk sac?

A

Vitelline cyst
Vitelline fistula
Meckel’s diverticulum

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26
Q

What is the anal canal derived from?

A

Endoderm

Ectoderm - proctodeum

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27
Q

What is the difference between above pectinate line and below pectinate line?

A

Above - splanchnic innervation, stretch only. columnar ep. IMA.
Below - somatic innervation - pain, temp, touch. Strat squamous. Pudendal A.

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28
Q

What are the 4 narrow points of oesophagus?

A

Junction of oes with pharynx
Aorta crosses
L main bronchus crosses
Through diaphragm

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29
Q

What are 5 mechanisms preventing reflex?

A
  • LOS
  • Diaphragm surrounds and pinches
  • Intra-abdominal oesophagus compressed when intra-abdominal pressure rises
  • Acute angle of entry- flap-valve crosses oesophagus
  • Mucosal rosette at cardia - folds prevent pressure rise
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30
Q

What cells are in gastric pits?

A 
Mucous neck cells
Chief cells 
Parietal cells 
D cells
ECL cells 
G cells
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31
Q

What do chief cells secrete?

A

Pepsinogen

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32
Q

How is HCl secretion inhibited?

A

pH drops as food leaves stomach
Activates D cells - somatostatin inhibits G cells.
Reduced distention - less vagal stimulation.

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33
Q

What are the 3 phase of digestion?

A

Cephalic
Gastric
Intestinal

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34
Q

What happens in the cephalic phase of digestion?

A

PS stimuli - smelling, tasting, chewing
Vagus nerve stimulates parietal cells -> G cells stimulated.
Slight increase in gastric motility
30% HCl

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35
Q

What happens in the gastric phase of digestion?

A

60% HCl
Distension of stomach stimulates vagus nerve
AA + peptides stimulate G cells
Food buffers pH, removes inhibition of gastrin

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36
Q

What are G cells stimulated by?

A

Peptides and AA in stomach lumen

Vagus n - GRP and ACh

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37
Q

What happens in the intestinal phase of digestion?

A

10% HCl
Initially - duodenum stretch enhances gastrin secretion
Lipids in lumen stimulate enterogastric reflex - reduces vagal stimulation, inhibits stomach secretion.
Chyme - CCK, secretin and GIP - inhibit stomach secretion.

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38
Q

What are the 4 main proteases?

A

Trypsin
Chymotryrpsin
Elastase
Carboxypeptidase

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39
Q

Why is it important for chyme release into duodenum to be controlled?

A

Mass water influx would can cause hypovolaemia.

Stomach impermeable to water.

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40
Q

What is starch made up of?

A

Straight chain amylose

Branched amylopectin

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41
Q

Which enzymes digest starch?

A

Amylase - 1,4 bonds
Isomaltase - 1,6 bonds
Alpha-dextrins - amylopectin into smaller chunks

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42
Q

What is sucrose?

A

glucose and fructose

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43
Q

Which monosaccharides can be absorbed?q

A

Glucose, galactose, fructose

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44
Q

How is glucose absorbed across the gut lumen?

A

SGLT1 apical

GLUT 2 basolateral = facilitated diffusion

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45
Q

How is fructose absorbed from the gut?

A

GLUT 5

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46
Q

Why is a mixture of salt and glucose used for oral rehydration?

A

Glucose stimulates Na uptake via SGLT1. Water follows Na.

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47
Q

What is the main stomach enzyme?

A

Pepsin

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48
Q

What is the master regulator of proteases in small intestine?

A

Trypsin

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49
Q

What is an exopeptidase?

A

Breaks bonds at the end of polypeptide -> dipeptide or AA

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50
Q

What is an endopeptidase?

A

Breaks bonds in the middle of polypeptide -> smaller polypeptide.

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51
Q

How are proteins absorbed?

A

Na+-AA apical transporters

Dipeptides + tripeptides by PT1 (peptide transporter 1), broken down into AA by cytosolic peptidases.

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52
Q

What stimulates water uptake in large intestine?

A

Aldosterone stimulates Na channels

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53
Q

How is calcium absorbed in the intestine?

A

Low lumen conc - active transport (facilitated diff)

High lumen conc - paracellular

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54
Q

Why is Vit D important for calcium absorption?

A

Essential for calbindin synthesis

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55
Q

What macroscopic features might you see in coeliac disease?

A

Absence of intestinal villi
Crypt lengthening
Mucosal damage

56
Q

How can hepatitis cause cholestatic jaundice?

A

Swollen hepatocytes compress low pressure bile canaliculi and sinusoids -> stasis.

57
Q

What would you see upon investigations with pre-hepatic jaundice?

A

Dark stools - more stercobilin
Raised serum bilirubin
Raised urine urobilinogen

58
Q

What would you see on investigation of intra-hepatic jaundice?

A

Raised serum bilirubin

Conjugated bilirubin in urine - dark

59
Q

What signs are associated with post-hepatic jaundice?

A

Pruritis
Pale stools
Dark urine

60
Q

What investigation results indicate post-hepatic jaundice?

A

Raised serum bilirubin
Decrease urinary urobilinogen
Conjugated bilirubin in urine

61
Q

What are the 2 main causes of bile duct obstruction?

A

Gallstone

Carcinoma of head of pancreas

62
Q

What markers will be raised in bile duct obstruction?

A

Alk phos

Gamma GT

63
Q

What is cholangitis, what is it usually caused by?

A

Infection in common bile duct.
Complication of obstruction.
E.Coli

64
Q

What is charcot’s triad?

A

Fever, RUQ pain, jaundice = cholangitis

65
Q

What is acute cholecystitis?

A

Infection within gallbladder - complication of cystic duct obstruction.
NOT colicky pain

66
Q

What are the 2 causes of pancreatitis?

A

Gallstones

Alcohol

67
Q

What is used to diagnose pancreatitis?

A

Raised amylase and lipase

68
Q

What are the branches of SMA?

A 
Jejunal
Ileal
Ileocolic 
Right colic
Middle colic
69
Q

What are the branches of IMA?

A

Left colic - anastomoses with middle colic to form marginal.
Sigmoid branches
Rectal branches (once superior rectal a)

70
Q

What consequence of chronic reflux disease will commonly cause dysphagia?

A

Fibrous strictures

71
Q

What type of chronic gastritis can lead to a megaloblastic anaemia?

A

Chronic autoimmune gastritis - antibodies that attack parietal cells. Pernicious anaemia.

72
Q

How does the structure of the large intestine differ to the small intestine?

A 
No villi
No plicae circulares
Shorter
Wider
Smoother appearance
73
Q

What are 2 functions of the large intestine?

A

Vit K synthesis by bacteria

Water reabsorption

74
Q

How is the longitudinal muscle different in the large intestine?

A

Incomplete - forms 3 bands called teniae coli
Teniae coli contracting form hausfrau.
Appendices epiploicae - fat appendages.

75
Q

How is water reabsorbed in the large intestine?

A

ENaC - induced by aldosterone

Tight junctions prevent water loss

76
Q

What extra-intestinal problems are associated with IBD?

A

MSK pain - arthritis
Skin - erythema nodosum, psoriasis
Eye problems
Primary sclerosing cholangitis

77
Q

Which IBD is smoking associated with?

A

Crohns

78
Q

What are some causes of IBD?

A 
Genetic
Gut organisms 
Antibiotics
Infections
Diet
79
Q

What is ‘lead pipe colon’?

A

Loss of haustra

Suggests UC

80
Q

Crohn’s pain is most likely to present in which abdominal region?

A

RLQ - ileum

81
Q

What gross pathology is associated with crohn’s?

A 
Hyperaemia - red, inflamed
Mucosal oedema - cobblestone
Scar tissue - thickened wall, narrowed lumen
Fistulae 
Transmural inflammation
82
Q

Name a microscopic feature of Crohn’s?

A

Granuloma

83
Q

What might you find in blood results from patients with IBD?

A

Anaemia

84
Q

What gross pathology is visible in UC?

A

Crypt abscesses and distortion
Pseudopolyps
Loss of haustra

85
Q

What is the underlying cause of UC?

A

Inflammatory infiltrate within lamina propria.

Superficial mucosal inflammation.

86
Q

UC or Crohns: LI only.

A

UC - no malnutrition.

87
Q

How do the patterns of UC and Crohn’s differ?

A

Crohns - discontinuous skip lesions

US - continuous

88
Q

Name 4 types of perianal disease associated with Crohns.

A

Fistula
Perianal fissure
Haemorrhoids
Skin tag

89
Q

Fibrosis and narrowing occurs in Crohns or UC?

A

Crohns - scar tissue formation

90
Q

What are 3 causes of bleeding into the gut?

A

Oesophageal varices
Peptic ulcer
Diverticular disease

91
Q

What signs might you see if there is bleeding into the gut?

A

Malaena

Haematemesis

92
Q

How can urea levels indicate the location of a GI bleed?

A

If upper GI bleed, protein meal to small intestine leads to increased urea levels while creatinine will remain normal.\

93
Q

Name 2 causes of retroperitoneal bleeding.

A

Ruptured AAA

Retroperitoneal veins - if on anti-coagulants

94
Q

Name 2 causes of bleeding into the peritoneum?

A

Ectopic pregnancy

Perforated viscus - peptic ulcer or diverticular disease

95
Q

How does a perforated peptic ulcer differ in severity to perforated diverticular disease?

A

Peptic ulcer - gastric contents cause chemical peritonitis

Diveritular - bacteria and faeces cause peritoneal sepsis.

96
Q

What is the danger of bowel obstruction.

A

Hypovolaemia and dehydration- accumulation of fluid, decreased reabsorption.

97
Q

Why might acute pancreatitis cause dehydration?

A

Accumulation of fluid in retroperitoneum

98
Q

What are red flags for GI cancer?

A 
Anaemia 
Loss of weight
Anorexia
Recent onset progressive symptoms
Malaena + malaise
99
Q

Name some differentials for epigastric pain.

A

Peptic ulcer
Oesophagitis
Pancreatitis
Gastric adenocarcinoma

100
Q

Where is gastric adenocarcinoma usually found?

A

Cardia or antrum

101
Q

RF for gastric cancer?

A

Smoking
High salt diet
FH

102
Q

What are 3 types of gastric cancer.

A
  1. Adenocarcinoma
  2. Gastric lymphoma - H.pylori treatment regresses
  3. GI stromal tumours
103
Q

Which malignancies commonly spread to liver?

A

colon, gastric, oesophageal, breast, prostate

104
Q

What is courvoisier’s law?

A

Jaundice with enlarged, palpable, non-tender cause is not gallstones.

105
Q

What is tenesmus and what is it a sign for?

A

Feeling of incomplete emptying

Rectal cancer

106
Q

What are 2 common causes of anal bleeding?

A

Haemorrhoids

Anal fissures

107
Q

RF for colon adenocarcinoma?

A

Family History
IBD
Polyposis syndrome - FAP
Diet

108
Q

What is the adeno-carcinoma sequence?

A

Benign polyp - polyp grows - dysplasia - adenocarcinoma in situ - invasive adenocarcinoma

109
Q

Which sided colon cancers usually present first, why ?

A

Left - smaller lumen with more solid contents leads to obstruction.

Ride side more distensible so obstructive presentation less likely.

110
Q

Which marker is used for bowel cancers?

A

CEA

111
Q

What are 5 types of small bowel cancer?

A 
Adenocarcinoma
Stromal
Lymphoma 
Sarcoma
Carcinoid
112
Q

How can you identify GI bacterial infections?

A

Stool culture

MacConkey agar for salmonella

113
Q

How does shigella invade large intestine cells?

A

Plasmid encoded virulence genes - lead to endocytosis

MUCOSA only - no bacteraemia as rarely goes deep.

114
Q

Which GI infection causes ‘currant jelly’ stools?

A

Shigella - mucous and blood

115
Q

How does shigella cause diarrhoea?

A
  1. Enters LI and rectal cells by endocytosis.
  2. Escapes endocytic vesicles and invades cell
  3. Invades neighbouring cells
  4. Mucosal abscess as cells die
116
Q

What is a bacterial cause of gastroenteritis?

A

Salmonella

117
Q

What is the pathogenesis of salmonella?

A

Invade epithelial cells of small intestine

118
Q

What is a viral cause of gastroenteritis?

A

Norovirus - winter vomiting bug

119
Q

What does campylobacter look like on gram stain?

A

Gram negative - pink, seagull appearance

120
Q

What is the most common source of campylobacter infections?

A

Uncooked poultry

121
Q

What are complications of campylobacter infection?

A

Early - cholecystitis, rash, peritonitis

Late - gullain-barre syndrome, reactive arthritis

122
Q

What surface landmark can be used to locate the deep ring?

A

Midpoint inguinal ligament - half way ASIS to pubic tubercle.

123
Q

What is the most common cause of bowel obstruction?

A

Hernia

124
Q

Where does the hepatitc portal vein originate from?

A

Behind the neck of pancreas - confluence of splenic and superior mesenteric veins.

125
Q

Which type of hernia affects young infants and usually spontaneously resolves in the first few years?

A

Umbilical

126
Q

Where does the linea alba attach from and to?

A

Xiphoid process to public symphysis

127
Q

Which structure divides the greater sac into supracolic and infracolic compartments?

A

Transverse mesocolon

128
Q

Which structure lies around the oesophageal hiatus to help prevent reflux?

A

Right crus of diaphragm

129
Q

What structure passes through the central tendon of the diaphragm?

A

IVC

130
Q

What type of hernia might be precipitated by a weakened conjoint tendon?

A

Direct Inguinal Hernia

Conjoint tendon reinforces medial part of posterior wall, behind superficial inguinal ring.

131
Q

What is the difference between a strangulated and an incarcerated hernia?

A

Strangulated - compromised blood supply

Incarcerated - irreducible/stuck

132
Q

What forms the anterior boundary of the lesser sac?

A

Posterior stomach

Lesser omentum

133
Q

What forms the posterior boundary of the lesser sac?

A

Diaphragm

Pancreas

134
Q

What provides the liver with the greatest structural support within the abdominal cavity?

A

IVC

135
Q

How does H.pylori cause chronic gastritis?

A

Degrades mucus layer

Releases cytotoxins

136
Q

In pancreatic secretions, what happens to the concentration of HCO3- if flow rates increase?

A

More HCO3- as flow increases

ESA 4 Rev (16 decks)

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