Block 15 Flashcards

Question

Causes of abnormal motility diarrhoea

Answer 1

Diabetes Post vagotomy Hyperthyroid

Answer 2

``` Chronic haemolytic Inflammation Infection Rapid weight reduction Stasis e.g. Pregnancy, spinal cord injuries Lithogenic bile ```

Answer 3

Most are silent In gall bladder or cystic duct - acute/chronic cholecystitis - empyema - perforations

Answer 4

Stretch ACh Parasympathetics

Answer 5

Exhaustion caused by lack of nourishment

Answer 6

Lack or loss of appetite for food

Answer 7

Wasting syndrome. Loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite in someone not actively trying to lose weight. Loss do body mass than can't be reversed nutritionally.

Answer 8

Hypothalamic arcuate nucleus is where various substances act. Gherlin is released from the stomach and stimulates hunger. This increases neuropeptide Y which increases appetite and increases body weight Leptin is released from adipose tissue and stimulates satiety. This decreases neuropeptide Y which decreases appetite and body weight

Answer 9

Mechanical - tight junctions, longitudinal flow of fluid Chemical - low pH, enzymes (pepsin)' antibacterial peptides released from panneth cells, mucus Biological - commensal bacterial flora

Answer 10

``` Gallstones Alcohol Trauma, surgery, ERCP Viral infections e.g. Mumps Hypothermia Ischaemia Drugs Rare - hyperparathyroidism, hyperlipidaemia ```

Answer 11

Acute abdominal pain Central and severe pain that often radiates to the back Vomiting History of alcohol excess, gall stones and certain drugs Guarding and tenderness in upper abdomen

Answer 12

Raised serum amylase Glucose intolerance Hypocalcaemia Raised CRP, WBC

Answer 13

``` Alcohol, most common in males Biliary tract disease Hypercalcaemia Hyperlipidaemia Cystic fibrosis Idiopathic ```

Answer 14

MALT (mucosal associated lymphoid tissue) 3/4 of all lymphocytes are found in MALT

Answer 15

TH1 TH2 TH17

Answer 16

TR1 TH3 CD26

Answer 17

Gut associated lymphoid tissue - Peyers patches - Isolated lymphoid follicles - Mesenteric lymph nodes

Answer 18

IgA 2 Y shaped antibodies connected end to end Joined by a J chain

Answer 19

- Antigen presented at mucosal system - Need to cross the epithelial barrier to stimulate the immune system - Peyers patches are covered in M cells - They take up the antigen via endocytosis OR dendritic cells extend across epithelial layer to get to bacteria

Answer 20

``` Binds to mucus Neutralises pathogens and toxins Prevents adherence of micro organisms Neutralise LPS and toxins Can't activate complement - no inflammation ```

Answer 21

Protein-energy metabolism Physiological well, anorexia, suppression of appetite Neglect Specific malnutrition Nutrient deficiency

Answer 22

Jejunal diverticulosis Obstruction Motility disorders Blind loop syndrome

Answer 23

``` Gluten enteropathy Immune mediated Subtotal villous atrophy Crypt hyperplasia Intraepithelial lymphocytes Deficiency - iron, folate, vitamin D ```

Answer 24

Anti-tissue tranglutaminase

Answer 25

UC - 11/ 100 000 | Crohn's - 7/ 100 000

Answer 26

UC - 8% | Crohn's - 67%

Answer 27

``` Age - extremes of age Immunodeficiency - HIV Achlorhydria - absence of gastric acid Inoculum size Pathogen virulence factors ```

Answer 28

4 C's Cephalosporin Co-amoxiclav Clindamycin Clarithromycin

Answer 29

``` No invasion of mucosa Enterotoxins Mucosal adherence Proximal small bowel Vibrio cholerae, enterotoxogenic E. Coli ```

Answer 30

Invasion of mucosa Colon Campylobacter, salmonella, shigella

Answer 31

Induced phagocytosis Distal small bowel Salmonella typhi, listeria monocytogenes

Answer 32

``` Malabsorption Steatorrhoea Diarrhoea Macrocytic anaemia Deficiency of fat soluble vitamins >10^5 bacteria per ml ```

Answer 33

``` Surveillence - notifiable under public health act Epidemiology Education Environmental change Immunisation Law ```

Answer 34

``` Public education Staff training Food inspector Equipments well maintained Good raw materials - farm to fork ```

Answer 35

When 2 or more people contract the same infection from a common source

Answer 36

Coeliac trunk - common hepatic - hepatic artery proper Hepatic artery proper - 20% volume, 80% oxygen Hepatic portal vein - 80% volume, 20% oxygen

Answer 37

``` 4 lobes: right, left, caudate, quadrate Falciform ligament (anterior) Anterior and posterior ligament Triangular ligaments Ligamentum venosum (superior) Ligamentum teres (inferior) ```

Answer 38

``` Storages of glycogen Gluconeogenesis Protein synthesis Catabolism of amino acids Lipoprotein synthesis Detoxification of nitrogenous molecules Drug metabolism Bilirubin conjugation ```

Answer 39

Triad - branch of portal vein, branch of hepatic artery, bile duct Sinusoids surrounding by hepatocytes that drains into central vein Bile canaliculous drains in opposite direction

Answer 40

ssRNA Faecal - oral transmission Incubation 2-4 weeks Never causes chronic disease

Answer 41

``` Personal contact Travel to high risk areas Male homosexuality Intravenous drug use Certain occupation (sewage workers) ```

Answer 42

``` Mild flu like symptoms Anorexia Nausea Fatigue Malaise Joint pain Preceding jaundice Potentially diarrhoea ``` Icteric phase - dark urine (appears first), pale stools (not always), jaundice (70-85%), abdominal pain, itch, skin rash, hepatomegaly, splenomegaly, lymphadenopathy

Answer 43

dsDNA Paenteral, sexual, perinatal spread Incubation 1-4 months Chronic frequency 10%

Answer 44

Acute hepatitis with recovery and clearance of virus Fulminant hepatitis Non progressive chronic hepatits Progressive chronic disease ending in cirrhosis Asymptomatic carrier state

Answer 45

60-65% - sub clinical disease (100% recovery) 20-25% - acute hepatitis (99% recovery, 1% fulminant hepatitis --> death) 5-10% - carrier 4% - chronic hepatitis (20-30% cirrhosis, also recovery, hepatocellular carcinoma)

Answer 46

ssRNA Transmission - parenteral, intranasal Incubation - 7-8weeks Chronic frequency - 80%

Answer 47

15% resolution 85% chronic hepatitis (80% stable disease, 20% cirrhosis) Of the 20% that get cirrhosis (50% stable cirrhosis, 50% death) Rare - fulminant hepatitis

Answer 48

Male over 40 Alcohol Asian

Answer 49

Liver: alcoholic hepatitis, cirrhosis, liver cancer GI: oral cavity cancer, oesophageal neoplasm and varices, pancreatitis CV: AF, hypertension, stroke, cardiomyopathy Neuro: loss of consciousness, withdrawal, seizures, subdural haemorrhage, peripheral neuropathy, cerebellar degeneration

Answer 50

Alcohol dependence syndrome Suicidal ideation Depression Anxiety

Answer 51

``` Idiopathic Gall stones Ethanol (alcohol) Trauma Steroid Mumps/malignancy Autoimmune Scorpion bite Hyperlipidaemia/ Hypothermia ERCP Drugs ```

Answer 52

PRSS1 trypsinogen gene | SPINK1 - pancreatic secretory trypsin inhibitor (prevents water digestion)

Answer 53

Pancreatic duct obstruction, increase in duct pressure, accumulation of enzyme fluid into interstitium Acinar cell injury causing release of enzymes Defective intracellular transport - proenzymes inappropriately delivered to intracelluar compartment containing lysosymes

Answer 54

Microvascular damage and leakage causing oedema Necrosis of fat by lipolytic enzyme Acute inflammation Proteolytic destruction of pancreatic parenchyma Destruction of blood vessels causing interstitial haemorrhage

Answer 55

10-20 per 100,000

Answer 56

``` Abdominal pain - constant and intense Often referred to back and occasionally the left shoulder Severity from mild to incapacitating Anorexia Nausea Vomiting Elevated amylase and lipase ``` Medical emergency

Answer 57

Inflammation of the pancreas with irreversible destruction of exocrine parenchyma, fibrosis and in the late stages destruction of endocrine parenchyma

Answer 58

Long term alcohol abuse Long standing obstruction of pancreatic duct Hereditary pancreatitis

Answer 59

Parenchymal fibrosis Decreased number and size of acini Sparing of Langerhans cells Variable dilation of pancreatic ducts Chronic inflammatory infiltrate around lobules and ducts Ductal epithelium = atrophied or hyperplastic or squamous metaplasia

Answer 60

Can present in several ways: 1. Repeated attacks of abdo pain or persistent back and abdo pain 2. Entirely silent until pancreatic insufficiency and diabetes develop 3. Recurrent attacks of jaundice 4. Vague attacks of indigestion Attacks can be precipitated by alcohol abuse, overeating, opiate use Mild fever Weight loss Hypoalbuminaemic oedema

Answer 61

Occurs when bacteria from GI lumen are released into abdo cavity Usually E.Coli, streptococci, S. aureus or enterococci

Answer 62

``` Acute abdo pain Abdo tenderness Abdominal guarding Exacerbated by moving peritoneum Rebound tenderness Fever Sinus tachycardia ```

Answer 63

Dull peritoneal surfaces Turbid fluid accumulation Volume of fluid can vary Dense collection of neutrophils

Answer 64

``` Jaundice and cholestasis Hyperammonaemia Palmar erythema Hypogonadism Weight loss Hypoalbuminaemia Hypoglycaemia Spider angiomas Gynaecomastia Muscle wasting ```

Answer 65

Viral hepatitis Alcoholic liver disease Non alcoholic fatty liver disease Hepatocellular carcinoma

Answer 66

Can develop with acute or chronic liver disease Occurs due to severe loss of hepatocellular function and shuntingof blood from portal to systemic circulation around a chronically diseased liver. Patients show a spectrum of brain dysfunction from subtle abnormalities to coma Rigidity, hyper relfexia, asterixis (flapping tremor)

Answer 67

Diffuse process characterised by fibrosis and conversion of normal liver architecture to structurally abnormal nodules

Answer 68

Death of hepatocytes Extracellular matrix deposition Vascular reorganisation

Answer 69

Activated stellate cells (myofibroblasts) - release chemokines and growth factor Produce excess collagen Dense extracellular matrix Loss of fenestration in endothelial cells (increases pressure in sinusoids and decreases solute exchange) Loss of microvilli on hepatocytes (decrease transport capability) Activated Kupffer cells

Answer 70

``` Can be clinically silent Non specific symptoms Anorexia Weight loss Weakness Incipient or overt hepatic failure Complications related to portal hypertension ```

Answer 71

``` Hep B and C Alcoholic and non alcoholic steatohepatitis Autoimmune Biliary disease metabolic conditions (haemochromatosis) ```

Answer 72

Increased resistance to portal blood flow which can develop from prehepatic, intrahepatic or posthepatic causes

Answer 73

Increase resistnance to flow at level of sinusoids and compression of central veins by perivenular fibrosis and parenchymal nodules Anastamoses between arterial and portal systems Increase in portal blood flow from hyperdynamic circulation Arterial vasodilation in splanchnic circulation

Answer 74

``` Ascites Hepatic encephalopathy Spider angioma Oesophageal varices Splenomegaly Periumbilical caput medusa Testicular atrophy Haemmorhoids ```

Answer 75

With rises in portal venous pressure, shunts develop where systemic and portal circulations share capillary beds

Answer 76

Veins around rectum - haemmorhoids Cardioesophageal junction - varices Retroperitoneum Falciform ligament of liver

Answer 77

Steatosis Hepatitis Fibrosis

Answer 78

``` hepatocyte ballooning Mallory-Denk bodies neutrophil infiltration central vein sclerosis chicken wire fence pattern - fibrosis ```

Answer 79

Shunting of substrates away from catabolism and toward lipid biosynthesis Because of excess nicotinamide-adenine dinucleotide from metabolism of ethanol by alcohol dehydrogenase Impaired assembly and secretion of lipoproteins Increased peripheral catabolism of fat

Answer 80

Acetaldehyde (metabolite of ethanol) induces lipid peroxidation which may disrupt cytoskeleton and membrane function Alcohol affects cytoskeleton organisation, mitochondrial function and decrease membrane fluidity Reactive oxygen species Cytokine mediated inflammation - TNF, IL1, IL6, IL8

Answer 81

Hepatomegaly | mild elevation of serum bilirubin and alkaline phosphatase

Answer 82

``` Acute onset after bout of heavy drinking Malaise Fever Anorexia Weight loss Upper abdominal discomfort Tender hepatomegaly ```

Answer 83

Hyperbilirubinaemia Increased alkaline phosphatase Increased neutrophilic leukocytes Increased serum ALT and aspartate aminotransferase

Answer 84

``` Insulin resistance Metabolic syndrome Type 2 diabetes Obesity Dyslipidaemia Hypertension ```

Answer 85

Steatosis, steatohepatitis, cirrhosis Impaired oxidation of fatty acids Increased synthesis and uptake of fatty acids Decreased hepatic secretion of VLDL Increased levels of TNF, IL6 which cause liver damage and inflammation

Answer 86

autosomal recessive Accumulation of toxic levels of copper in organs and tissues especially in the brain, liver and eye. Mutations in ATP7B gene on chromosome 13 Without ATP7B copper can't be passed onto apoceruloplasmin Can't be excreted into bile Copper causes toxic injury Red cell haemolysis and damage due to deposition Mimics fatty liver disease - cirrhosis

Answer 87

``` Bilirubin Albumin Transferases - ALT (alanine aminotransferase) - AST (aspartate aminotransferase) Gamma gutamyltransferase GGT Alkaline phosphatase ALP ```

Answer 88

Increased ALP Increased GGT Small increase in AST and ALT

Answer 89

Increased AST Increased ALT Small increase in ALP and GGT

Answer 90

Chronic liver disease

Answer 91

Cholestasis

Answer 92

2 reactions: phase 1 and phase 2, usually in liver Phase 1 - catabolic and products are often more chemically reactive and can be more toxic than parent drug Phase 2 - synthetic resulting in inactive produces

Answer 93

Involve the P450 mono oxygenase system CYP... ``` Drug +P450 enzyme +molecular oxygen +NADPH +flavoprotein ``` Addition of an oxygen atom to form a hydroxyl group Not all phase 1 reactions involve the P450 system

Answer 94

After phase 1 it is susceptible to conjugation = attachment of substituent groups Resultant conjugate is almost always inactive e.g. glucaronyl transfer - UDP glucuronyl transferase

Answer 95

Some drugs are extracted so efficiently by liver or gut wall that the amount reaching the systemic circulation is considerably less than the amount absorbed Much larger dose required when given orally and is unpredictable

Answer 96

``` Aspirin Metoprolol Morphine Propranolol Salbutamol Verapamil Lidocaine Levadopa GNT ```

Answer 97

``` Inability to conjugate bilirubin fast Increased serum unconjugated bilirubin Decreased or no bilirubin in urine Increased urobilinogen in urine or faeces Dark brown faeces ``` Unconjugated hyperbilirubinaemia

Answer 98

``` Sickle cell anaemia Thalassaemia Spherocytosis Incompatible blood transfusion Malaria Haemolytic anaemia ```

Answer 99

``` Increase in conjugated or unconjugated bilirubin Decreased faecal urobilinogen Increased urinary urobilinogen Pale stool Dark urine Increased ALT and AST ```

Answer 100

``` Gilberts Cirrhosis Viral hepatitis Alcoholic hepatitis Autoimmune hepatitis Drug induced hepatits ```

Answer 101

``` Increased conjugated bilirubin Bilirubin in urine Decreased faecal urobilinogen No urobilinogen in urine Pale stools Dark urine Increased ALP, ALT, AST ```

Answer 102

``` Gall stones Gall bladder carcinoma Pancreatic carcinoma Primary sclerosing cholangitis Pancreatitis Bile duct strictures ```

Answer 103

3rd most common UK cancer 2nd most common cause of cancer death 47/ 100 000 Higher in men than women

Answer 104

``` Family history of colorectal cancer under 60y IBD Crohns UC Polyposis syndromes Nulliparity Late age of first pregnancy Early menopause Diet: rich in meat and fat, low fibre Sedentary lifestyle Smoking Alcohol Obesity Diabetes ```

Answer 105

``` colicky pain rectal bleeding bowel obstruction tenesemus mass in left iliac fossa early change in bowel habit ```

Answer 106

``` weight loss anaemia occult bleeding mass in right iliac fossa more advanced on presentation ```

Answer 107

Stage 1 = T1/2 M0 N0 = 75% Stage 2 = nodal involvement = 60% Stage 3 = T3/4 - 50% Stage 4 = M1 6%

Answer 108

Common epithelial proliferations in 60s and 70s Results from decreased epithelial cell turnover and a pile up of goblet cells Smooth nodular protrusions <5mm in left colon

Answer 109

Occur sporadically Disorganised tumour like growths with mature cells Increased risk of developing colorectal cancer Pedunculated smooth surfaced red lesions <3cm in diameter

Answer 110

Benign polyps that give rise to colorectal adenocarcinomas Epithelial dysplasia 0.3-10cm can be pedunculated or sessile Size correlates with risk of malignancy

Answer 111

``` Familial adenomatous polyposis Autosomal dominant Mutations in APC gene Need at least 100 polyps on endoscopy Colorectal adenocarcinoma in 100% if untreated by 30 ```

Answer 112

HNPCC - familial clustering of cancers at several sites Colorectal, endometrium, stomach, brain Occurs at a younger age often in right colon Mutation in MSH2/1

Answer 113

Combination of genetic and epigenetic abnormalities Mutations of APC tumour suppressor APC/beta catenin pathway Causes transcription of genes which promote proliferation KRAS (late mutation) - promotes growth TP53 mutation - 70% of cancers BAX enhances survival of genetically abnormal clones

Answer 114

Tumours in proximal colon Rarely cause obstruction Grow along wall Tumours in distal colon Annular lesions, napkin ring contrictions Luminal narrowing Tall columnar cells Dysplastic epithelium

Answer 115

``` Barium swallow/meal/follow through Barium enema Colonoscopy Endoscopy Abdominal ultrasound CT scan MRI ```

Answer 116

``` Availability Patient tolerance Cost Risk of complications Most likely to answer clinical question ```

Answer 117

Single - lumen distended with barium Double - mucosa coated with barium and lumen distended with air

Answer 118

Limited senstivity for cancer and inflammation Miss early lesions Patients need to be fit and mobile Need to retain stomach full of gas and barium Poorly tolerated by elderly

Answer 119

2 days starvation Strong laxative Barium into colon via rectal tube Colon distended with air or CO2

Answer 120

Safe with low complication rate Well tolerated Complete examination Able to detect intrinsic and extrinsic disease

Answer 121

Patients need to be mobile Must be able to retain air and barium in colon Less sensitive than colonoscopy No scope for obtaining histology

Answer 122

Direct inspection of mucosa Detects early pathology Allows for biopsy or therapeutic procedure Identifies conditions not seen at DCBE

Answer 123

``` Less good at assessing motility and extrinsic disease Limited views of pharynx and cervical oesophagus Significant complication rate 0.1% Mortality rate 0.03% Cardiopulmonary problems if sedated Perforation Haemorrhage Transmission of infection ```

Answer 124

``` Duodenal ulcers 20-30% Gastric or duodenal erosions 20-30% Varices 15-20% Gastric ulcer 10-20% Mallory-Weiss tear 5-10% Erosive oesophagitis 5-10% Angioma 5-10% Arteriovenous malformations <5% ```

Answer 125

``` Anal fissures Angiodysplasia Colitis Colonic carcinoma Colonic polyps Diverticular disease IBD Internal haemorrhoids ```

Answer 126

Used to determine risk for endoscopy Age Shock Co-morbidity Predicts mortality

Answer 127

80% in small intestine | 80% of remaining 20% removed in large intestine

Answer 128

Collection of faeces in sigmoid colon and rectum Pressure on walls of large intestine Involuntary - large peristaltic wave, distension of walls and opening of internal anal sphincter Pelvic nerve Voluntary - delay (reverse peristalsis, open external sphincter) Pudendal nerve Open sphincters Levator ani contracts reducing anal-rectal angle

Answer 129

On top of each kidney Inner medulla Outer cortex Surrounded by perinephric fat, enclosed in renal fasica Cortex has 3 areas - Zona glomerulos Zona fasciculata Zona reticularis

Answer 130

``` Superior suprarenal (from inferior phrenic artery) Middle suprarenal (abdominal aorta) Inferior suprarenal (renal arteries) ```

Answer 131

Zona glomerulosa - mineralocorticoids (aldosterone) Zona fasciculata - glucocorticoids (cortisol) Zona reticularis - gonadocorticoids (androgens)

Answer 132

Chromaffin cells in clusters around blood vessels | Produce adrenaline and NA

Block 15 Flashcards

(159 cards)