What mechanism is responsible at a cellular level for producing stomach acid?
H/K Adenosine Triphosphotase pumps
55 yr old man with 6 wks h/o progressive painless juaundice and weight loos, abdominal palpation is normal. What most likely?
Pancreatic cancer (The progressive painless part gives it away)
What would you find on an abdo x-ray in a patient with a small bowel obstruction?
Centrally distributed loops of bowel
Ingredients in Oral Rehydration TherapY?
What GI sign can result from Overdosing on paracetamol?
What makes up each dissacharide?
Lactose - Glucose + Galactose
Sucrose - Glucose + Fructose
Maltose - 2 glucose
cancer in middle third of oesophagus, what histological type is it?
PRobably squamous cell
Effect of a Vagotomy on HCl secretion?
- Loss of direct Vagal stimulation of Parietal Cells
- Loss of vagal stimulation of G cells to produce Gastrin
- Loss of vagal stimulation histamine release from ECL cells
Effect of a vagotomy on Gastrin secretion
Loss of direct stimulation on G cells during cephalic phase
But some function remains due to distention/peptide induced stimulation of G cells
Effect of a vagotomy on gastric motility?
REduces gastric emptying but some movement remains due to local enteric reflexes
Effect of a vagotomy on defacation?
Impaired ability to defacate
- Vagus controls reflex contraction of rectum
- Sphincter tone
Woman presents with 3wks of RUQ pain & progressive jaundice.
ALT/AST are normal but ALKP is raised.
What questions can you ask to narrow down your diagnosis?
- Alcohol history
- IV drug use history
- H/o gallstnes
- Characterisitcs of pain
- Previous episdoes of colic or jaundice
- Changes in stool
- urine colour & Changes in urine colour
- Are meals related to pain
- Medication history
- Episodes of pyrexia
- Sexual contact
- TRavel Abroad
- Blood transfusion or products
Normal ALT & AST but raised ALKP.
Is the jaundice hepatic or post-hepatic?
ALKP is found in biliary epithelium so damage there increases it
Causes of obstructive jaundice?
Gall stone in common bile duct Tumour of common bile duct Stricture of common bile duct Carcinoma head of pancreas Tumour of ampulla of vater Tumour of common hepatic duct
Complications of Gallstones?
acute cholecystitis Chronic Cholecystitis perforation of gall bladder wall biliary peritonitis empyema mucocele carcinoma of gall bladder secondary biliary cirrhosis jaundice biliary colic pancreatitis small bowel obstruction
Risk factors for Gall stones?
Fat (>30 bmi) Female Forty (>40 yrs) Fertile (has children) Diabetes Small bowel resection or disease Hyperlipidaemia
Why is PTT prolonged in post-hepatic jaundice?
No bile in bowel
- > No fat soluble vitamin absorption
- > No Vit K
- > No clotting factors
Oesophageal varices Oesophageal carcinoma Gastric Carcinoma Mallory Weiss Tear Peptic ulcer Gastritis
Describe the process of development of a gastric canceR?
- > Chronic Gastritis
- > Intestinal metaplasia
- > Dysplasia
- > Tumour
Prognosis for gastric cancer?
20% 5 yr survival
Eradication therapy for H Pylori?
- PPI (omeprazole)
- 2 antibiotics (Amoxicillin, Clarithromycin or metronidazole)
complications of peptic ulcer?
How to diagnose coeliac?
Small bowel biopsy shows villous atrophy
Skin condiiton associated with coeliac?