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Alimentary System Flashcards

1
Q

What type of condition is Coeliac disease

A

Autoimmune

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2
Q

What 2 antibodies mediate, and can be tested to diagnose coeliac disease

A

Anti-TTG
Anti-EMA

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3
Q

Where does coeliac disease mainly effect

A

Jejunum

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4
Q

What would be seen histologically in coeliac disease

A

Villi Atrophy
Crypt Hypertrophy

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5
Q

Coeliac disease presentation

A

Often asymptomatic
Failure to thrive
Diarrhoea
Fatigue
Mouth ulcers
Anaemia
Dermatitis Herpetiformis

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6
Q

What do we test all people for who have just had a new diagnosis of type 1 diabetes

A

Coeliac disease

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7
Q

Which 2 genes are linked to coeliac disease

A

HLA-DQ2
HLA-DQ8

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8
Q

What should people with coeliac disease not consume

A

Gliadin (In gluten)

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9
Q

Why is it important to also test total immunoglobulin A when testing for coeliac antibodies

A

Patients sometimes have an IgA deficiency so their Anti-TTG and Anti-EMA fall within the normal range

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10
Q

What do we do if a suspected coeliac patient has an IgA deficiency

A

Test IgG version
Endoscopy + Biopsy

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11
Q

How is coeliac disease diagnosed

A

WHILE STILL EATING GLUTEN:
-Total IgA
-Anti-TTG + Anti-EMA antibodies
-Endoscopy + biopsy

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12
Q

Which diseases are associate with coeliac disease

A

Type 1 diabetes
Thyroid disease
Autoimmune Hepitits
Primary biliary cirrhosis
Primary sclerosing cholangitis

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13
Q

Complications of untreated coeliac disease

A

Vitamin deficiency + anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T-cell-lymphoma
Non-Hodgkin Lymphoma
Small bowel adenocarcinoma

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14
Q

How is coeliac disease treated

A

Gluten free diet (completely cures disease)

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15
Q

What is refractory coeliac disease

A

Symptoms of coeliac disease continue even after adhering to a strictly gluten-free diet.

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16
Q

Which nerves maintain pelvic floor continence

A

C2,3,4 stops the bowel hitting the floor

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17
Q

How can you tell a colostomy apart from ileostomy

A

Ileostomy stoma: spouted appearance, right ileac fossa

Colostomy stoma: flush with skin, left ileac fossa

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18
Q

Signs and symptoms of bowel obstruction

A

Abdominal distension
Absolute constipation
Vomiting
Abdominal pain

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19
Q

What is dyspepsia

A

Group of symptoms:
-Pain/discomfort in abdomen
-Anorexia
-Nausea +/- vomiting
-Bloating
-Early satiety
-Heartburn

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20
Q

What drugs can cause dyspepsia

A

NSAIDs
Steroids
Biphosphonates
Ca channel antagonists
Nitrates
Theophyllines

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21
Q

What lifestyle aspects can cause dyspepsia

A

Alcohol
Diet
Smoking
Exercise
Weight loss

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22
Q

What investigations do we do for dyspepsia

A

Bloods:
-FBC
-Ferretin
-LFTs
-U&Es
-Calcium
-Glucose
-Coeliac serology

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23
Q

When do we refer for a endoscopy with dyspepsia

A

ALARMS

Anorexia
Loss of weight
Anaemia
Recent onset
Melaena/Heamatemesis or Mass
Swallowing problems

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24
Q

Treatment for H.Pylori infection

A

Triple therapy 7 days
-Clarithromycin
-Amoxicillin
-PPI

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25
How is H.Pylori infection diagnosed non-invasively
Serology - IgG H.Pylori 13c/14c urea breath test Stool antigen test (need to be off PPI for 2wks)
26
How is H.Pylori diagnosed invasively
Histology - biopsy Culture of gastric biopsy Rapid slide urea test (CLO)
27
Peptic ulcer symptoms
Epigastric pain Nocturnal/hunger pain Back pain Nausea/vomiting Weight loss/anorexia Bleeding symptoms
28
Complications of peptic ulcers
Acute bleed Chronic bleed Perforation Fibrotic stricture Gastric outlet obstruction
29
Symptoms of gastric outlet obstruction
Vomit without bile Early satiety Dehydration + loss of HCL in vomit Metabolic alkalosis
30
What can induce hepatitis
Viral Alcohol Drugs
31
How does each hepatitis spread
A&E - fecal oral BCD - blood borne
32
What does HDV require to spread
Prior infection with HBV
33
Which variants of viral hepatitis usually resolve on there own
A&E
34
What is the pathology of alcoholic hepatits
Fatty change (steatohepatitis)
35
Treatment of end stage liver disease
Transplant
36
Complications of liver cirrhosis
Liver failure Portal hypertension Increased risk of hepatocellular carcinoma
37
Causes of common bile duct obstruction
Gallstones Bile duct tumours Benign stricture External compression (tumours?)
38
Effects of common bile duct obstruction
Jaundice No bile in duodenum Ascending cholangitis Secondary biliary cirrhosis
39
Liver cirrhosis causes
Alcohol HBV,HCV Autoimmune hepatitis Primary biliary cholangitis Metabolic disorders -Primary haem chromatosis -Wilson's disease Obesity
40
What are the 3 classifications of jaundice
Pre-hepatic Hepatic Post-hepatic
41
What molecule is increased in the body with jaundice
Bilirubin
42
Causes of pre-hepatic jaundice
Haemolysis
43
Hepatic causes of jaundice
Cholestasis Intra-hepatic bile duct obstruction
44
Post-hepatic causes of jaundice
Cholelithiasis Gallbladder disease Extra-hepatic bile duct obstruction
45
Risk factors of gall stones
Obesity Diabetes
46
What is the difference between cholecystitis and cholangitis
Cholecystitis-Gallbladder inflammation Cholangitis - Inflammation of bile ducts
47
What is cholestasis
Accumulation of bile within hepatocytes
48
Causes of cholestasis
Hepatitis Liver failure
49
3 causes of intra-hepatic bile duct obstruction
Primary biliary cholangitis Primary sclerosing cholangitis Liver tumours
50
Who does primary biliary cholangitis effect mainly
Females 9:1 Males
51
What LFT is raised in primary biliary cholangitis
Alkaline phosphatase
52
Who does primary sclerosing cholangitis mainly effect
Younger men
53
Functions of hepatocytes
Metabolism Detoxification Immune cell activation Protein synthesis
54
Function of stellate cells
Store vitamin A in the liver
55
Function of kupffer cells
Macrophages of the liver
56
Functions of pit cells
NK cells of the liver
57
What stimulates the release of Cholecystokinin
Fat/amino acids in duodenum
58
What does CCK stimulate
Gastric emptying Pancreatic enzyme secretion Galbladder contraction Sphincter of Oddi relaxation
59
What stimulates the release of Secretin
Acid in duodenum
60
What does secretin stimulate
Decreased gastric emptying/secretion Increased duodenal HCO3 secretion Increased pancreatic HCO3 secretion Increased bile duct HCO3 secretion
61
Symptoms of oesophageal disease
Heartburn (reflux) Dysphagia Odynophagia
62
What investigations can we use on the oesophagus
Endoscopy Contrast radiology (barium swallow) pH-metry Manometry (pressure waves)
63
How does hypermotility of the oesophagus appear on a Barium swallow
Corkscrew appearance
64
How is hypermotility of oesophagus treated
Smooth muscle relaxants
65
What causes hypomotility of the oesophagus
Associated with connective tissue disease: -Diabetes -Neuropathy
66
What is the cardinal feature of achalasia
Failure of LOS to relax - results in complete obstruction of the oesophagus
67
Pharmacological treatment of achalasia
Nitrates Calcium channel antagonist
68
Endoscopic treatment of achalasia
Botulinum toxin Pneumatic balloon dilatation
69
Surgical treatment of achalasia
Myotomy
70
3 types of oesophagectomy
Ivor Lewis Trans-hiatal Left thoraco-abdominal
71
GORD symptoms
Heartburn Cough Water brash Sleep disturbance
72
Risk factors for GORD
Pregnancy Obesity Drug use Smoking Alcoholism Hypomotility
73
Treatment of GORD
Lifestyle measures Drugs Anti-reflux surgery
74
What drugs are used in the treatment of GORD
Alginates H2 Receptor antagonist PPIs
75
Who mainly gets eosinophilic oesophagitis
Males > Females Children + young adults
76
Presentation of eosinophilic oesophagitis
Dysphagia Bolus obstruction
77
Eosinophilic oesophagitis treatment
Topical/swallowed cortical steroids Dietary elimination Endoscopic dilatation
78
What is the pathological change in Barret's Oesophagus
Squamous epithelium -> columnar epithelium
79
What are the 3 main categories of gastritis
ABC Autoimmune Bacterial Chemical
80
Specific signs/symptoms of autoimmune gastritis
Loss of intrinsic factor (leads to B12 deficiency) Often seen with other autoimmune disease Loss of specialised gastric epithelial cells
81
What bacteria causes bacterial gastritis usually
Helicobacter Pylori
82
What substances can cause chemical gastritis
Drugs - REMEMBER NSAIDs Alcohol Bile reflux
83
What is the biggest risk factor for gastric cancer
Previos H.Pylori infection
84
What causes peptic ulcers
Too much acid in the GIT
85
Complications of peptic ulcer
Bleeding: -Acute haemorrhage -Chronic, Anaemia Perforation: -peritonitis Fibrosis: -obstruction
86
Where is vitamin B12 absorbed and how
Distal ileum after binding with intrinsic factor from the stomach
87
How and where is iron absorbed, and distributed
In duodenum via enterocytes Incorporated into FERRETIN for storage Transported in blood by TRANSFERRIN
88
Which nerves stimulate salivation
Cranial VII, IX Facial nerve Glossopharyngeal nerve
89
What are the fat soluable vitamins
A, D, E, K
90
What are the water soluable vitamins
B groups, C, folate
91
What are the components of saliva
99% water Mucins Alpha - amylase Electrolytes Lysozymes
92
Liver disease symptoms
Jaundice Ascites Variceal bleeding Hepatic encephalopathy
93
Compensated cirrhosis presentation
Only seen after screening Abnormal LFTs
94
Presentation of decompensated cirrhosis
Ascites Hepatorenal syndrom Variceal bleeding Hepatic encephalopathy
95
Ascites treatment
Diuretics Large volume paracentisis TIPS Aquaretics Liver transplant
96
Hepatorenal syndrome treatment
Vasopressors: -Terlipressin -Octreotide TIPSS Liver transplant
97
What are the effects of alcohol on the liver
Directly toxic Steatosis (fatty liver) Steatohepatitis (fatty lover + inflammation)
98
Spontaneous bacterial peritonitis symptoms
Abdominal pain Fever Rigors
99
Spontaneous bacterial peritonitis signs
Renal impairment Sepsis Tachycardia Temperature
100
Treatment for spontaneous bacterial bacterial peritonitis
IV Antibiotics Ascitic fluid drainage IV Albumin infusion (20% ALBA)
101
Risks for fatty liver disease
Obesity Diabetes Hypercholesterolaemia
102
Presentation of alcoholic hepatitis
Jaundice Encephalopathy Infection is common Decompensated hepatic function
103
How is alcoholic hepatitis diagnosed
Raised bilirubin Raised GGT and Alkaline Phosphatase Hx of alcohol Exclude other causes
104
Where is appendix pain felt
Right ileac region
105
What are the 2 main idiopathic inflammatory bowel diseases
Crohn's Disease Ulcerative Colitis
106
What area can ulcerative colitis be present
Limited to colon
107
What area can Crohn's Disease be present
Mouth to anus
108
Who gets ulcerative colitis most commonly
M = F Ages 20-30 and 70-80
109

Medicine (13 decks)

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