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Gastro Flashcards

1
Q

Gastro-oesophageal junction 2 features

A

Epithelial transition: change in function

Gastric folds: allow stomach distention

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2
Q

Oesophagus motility measurement and regulation

A

Measured using manometry(peristaltic waves 40mmHg, resting LOS 20mmHg)

Mediated by inhibitory noncholinergic nonadrenergic neurons of myenteric plexus

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3
Q

Hypermotility(Achalasia) pathophysiology

A

Environmental trigger->inflammation
Fibrosis->neuron apoptosis
Loss of ganglion cells in LOS wall
Less NCNA activity->less inhibition so higher resting LOS pressure

Increased risk of oesophageal cancer

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4
Q

Achalasia causes

A

Chagas’ disease

Protozoa infection

Amyloid/sarcoma/eosinophilic oesophagitis

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5
Q

Achalasia treatment

A

Pneumatic dilation: circumferential stretching/tearing of muscle fibres

Heller’s myotomy:6cm oesophagus, 3cm stomach

Dor fundoplication: anterior fundus folded over oesophagis and sutured

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6
Q

Risks of surgery for achalasia

A

Perforation
Splenic injury
Division of vagus nerve

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7
Q

Hypomotility(scleroderma) pathophysiology

A 
Autoimmune disease
Neuronal defects->smooth muscle atrophy
Distal peristalsis ceases
Low resting LOS pressure
CREST syndrome
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8
Q

Scleroderma treatment

A

Exclude organic obstruction

Improve peristaltic force with prokinetics

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9
Q

Corkscrew oesophagus pathophysiology and symptoms

A 
Diffuse oesophageal spasm
Disordered coordination
Hypertrophy of circular muscle
Dysphagia and chest pain
400-500mmHg
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10
Q

Corkscrew oesophagus treatment

A

Forceful pneumatic dilation of cardia

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11
Q

Oesophageal perforation symptoms

A

Pain
Fever
Dysphagia
Emphysema(uncommon)

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12
Q

Oesophageal perforation causes

A

Boerhaave’s(vomiting against a closed glottis)

Foreign body(batteries, sharp objects)

Trauma(neck, thorax)

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13
Q

3 protective mechanisms against GORD

A

Volume clearance by oesophageal peristalsis reflex

pH clearance by saliva

Oesophageal epithelium barrier properties

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14
Q

GORD risk factors

A 
Smoking
Chocolate
Alcohol
Sliding hiatus hernia
Rolling hiatus hernia
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15
Q

GORD treatment

A

Lifestyle changes
PPIs
Dilation peptic strictures
Laparoscopic Nissen’s fundoplication

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16
Q

Stomach cells and secretions

A

Chief cell: pepsinogen

Parietal cell: acid

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17
Q

Gastritis causes

A 
H. pylori
Atrophic gastritis(autoimmune against parietal cell)->pernicious anaemia, G cell hyperplasia(carcinoma)
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18
Q

Gastric ulcer pathology

A

Lack of mucosal protection

Erosive haemorrhagic gastritis->acute ulcer->gastric bleed & perforation

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19
Q

H. Pylori secretions

A

VacA toxin: gastric mucosal injury

Urease: neutralise acid

Enzymes: mucinase, lipase, protease

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20
Q

Portal triad

A

Hepatic artery: O2 rich blood

Portal vein: process nutrients, detoxify blood

Bile duct: produce bile

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21
Q

Liver cells and function

A

Sinusoidal endothelial cells: fenestrated, movement of molecules
Kuppfer cells: macrophages
Hepatic stellate cells: damage->deposit collagen
Hepatocyte: metabolism and synthesis of albumin/clotting factors
Cholangiocyte: secrete HCO3 and H2O into bile duct

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22
Q

Enzyme for detoxification in liver

A

P450: modification followed by conjugation

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23
Q

Functions of bile

A

Cholesterol homeostasis
Lipid and soluble vitamin absorption
Excretion of waste

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24
Q

Pancreas exocrine cells

A

Acinar cells: low volume, enzyme rich, viscous

Ductal and centroacinar cells: high volume, bicarbonate rich, watery

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25
Regulation of pancreas exocrine function
Vagus nerve(enzyme) Cholecystokinin(enzyme) Secretin(bicarbonate)
26
Small bowel cells
Enterocytes: columnar Stem cells: pluripotent Goblet cells: more abundant distally Paneth cells: engulf bacteria/protozoa Enteroendocrine cells: columnar
27
Small bowel motility
Segmentation: circular muscles Peristalsis: sequential contraction Migrating motor complex
28
Proteases activation in small bowel
Enterokinase activates trypsinogen | Trypsin activates other proteases
29
Carbohydrate absorption
Glucose: SGLT-1(apical) GLUT-2(basolateral) Fructose: GLUT-5(apical)
30
Calcium absorption
Duodenum and ileum Absorbed by IMcal Ca binds to calbindin Ca leaves cell by Na-Ca antiporter or Ca ATPase
31
Iron absorption
Heme iron absorbed by HCP-1 Fe2+ absorbed by DMT-1 Fe enters blood by ferroportin and travels as transferrin
32
Vit B12 absorption
B12 binds to intrinsic factor from parietal cells | Absorbed in distal ileum
33
Enteric nervous system
Myenteric plexus: senses distention, controls motility Submucosal plexus: senses chemicals, controls secretions
34
Hirschsprung’s disease
Congenital absence of myenteric and submucosal plexus Affected segment is contracted, unaffected part proximal to it is dilated Reuires surgery
35
Gut hormones and cells
Gastin: G cells(acid) Secretin: S cells(alkali) CCK: I cells(gall bladder contraction) GIP: K cells(insulin) GLP-1: L cells(satiety) Somatostatin: D cells(universal inhibitor) Pancreatic polypeptide: PP cells Peptide YY: L cells
36
Hepatocellular cancer tests/investigations
Hepatocellular cancer: ultrasound and alpha feto protein(AFP) for high risk patients
37
Types of oesophageal cancers
Squamous cell carcinoma: upper 2/3 Adenocarcinoma: lower 1/3, acid reflux
38
Oesophageal cancer symptoms
Dysphagia Weight loss Elderly More commonly male
39
Oesophageal/gastric cancer diagnosis
Oesophagogastroduodenoscopy(OGD), biopsy to diagnose CT chest and abdo to stage PET to check for metastasis
40
Oesophageal cancer treatment
Curative: neoadjuvant, oesophagectomy Palliative: palliative chemo, steroids, stent
41
Gastric cancer symptoms (ALARMS55)
``` Anaemia Loss of weight/appetite Abdominal mass Recent onset of progressive symptoms Melaena/haematemesis Swallowing difficulty 55 years old ```
42
Gastric cancer treatment
OG junction: oesophagogastrectomy Close to OG junction: total gastrectomy Far from OG junction: subtotal gastrectomy
43
Colorectal cancer risk factors
Previous cancer Family history Smoking Obesity
44
Colorectal cancer aetiology and type of carcinoma
Adenocarcinoma Most common GI cancer More often in descending/sigmoid colon or rectum
45
Colorectal cancer presentation and symptoms
Bowel obstruction causing tenderness Bone pain/hepatomegaly if metastasis Abdominal mass Right sided/caecal: iron deficiency anaemia, diarrhoea Left sided/sigmoid: PR bleed, mucus Rectal: PR bleed, mucus, tenesmus
46
Colorectal cancer investigations
``` DRE<12cm reached by finger Rigid sigmoidoscopy FIT: faecal occult blood Colonoscopy CT colonoscopy(non-invasive) MRI pelvis for rectal cancer ```
47
Colorectal cancer management
Ascending/transverse: resection and primary anastomosis Left sided: Hartmann’s procedure, primary anastomosis, palliative stent
48
Pancreatic cancer aetiology
Highly lethal Late presentation Male more common
49
Pancreatic cancer risk factors
Chronic pancreatitis T2DM Smoking Family history
50
Most common type of pancreatic cancer
Pancreatic ductal adenocarcinoma(PDA)
51
Pancreatic cancer presentation
``` Jaundice Weight loss Pain GI bleed Acute pancreatitis If at body/tail, more advanced ```
52
Pancreatic cancer investigations
CA19-9 >200u/mol Dual phase CT & MRI checks resectability Laparoscopy and PET for occult metastasis
53
Types of liver cancer
Hepatocellular carcinoma Cholangiocarcinoma Gall bladder cancer Secondary liver metastasis
54
Pancreas protective mechanisms against autodigestion
Inactive pro-enzymes Trypsin inhibitor Enzymes only activated in duodenum
55
Acute pancreatitis causes(GETSMASHED)
``` Gall stones Ethanol Trauma Steroids Mumps/other viruses Autoimmune(SLE) Scorpion/snake bite Hypercalcaemia, hyperlipidaemia ERCP Drugs: steroids, azothioprine, NSAIDs, diuretics ```
56
Acute pancreatitis types
Oedematous pancreatitis Haemorrhagic pancreatitis Necrotic pancreatitis
57
Acute pancreatitis symptoms
``` Epigastric pain radiating to back Nausea and vomiting Fever Haemodynamic instability(hypotension, tachycardia) Peritonism Haemorrhagic: Grey-Turner’s sign(flank bruising) Cullen’s sign(umbilical bruising) ```
58
Acute pancreatitis investigations
``` Blood test-> high amylase X ray Ultrasound-> gall stones ERCP->remove gall stones MRCP->gall stone pancreatitis ```
59
Acute pancreatitis severity(PANCREAS)
``` PO2<8kPa (hypoxia) Age>55 Neutrophil>15 (neutrophilia) Calcium<2mmol/L (hypercalcaemia) Renal: urea>16mmol/L (renal failure) Enzymes: AST>200iu/L, LDH>600iu/L Albumin<32g/L (hypoalbuminuria) Sugar>10mmol/L (hyperglycaemia) ``` Score of 3 or more is severe CRP>200 is severe
60
Acute pancreatitis management
Airway, breathing, circulation Fluid resuscitation Analgesia Pancreatic rest Determine underlying cause HDU if severe
61
Acute pancreatitis complications
Hypocalcaemia Hyperglycaemia ARDS Renal failure Pancreatic necrosis Haemorrhage
62
Pancreatitis infected necrosis treatment
Antibiotics | Percutaneous drainage
63
Chronic pancreatitis complications
Insulin dependent DM | Steatorrhoea
64
Chronic pancreatitis symptoms
``` Pain Malabsorption Weight loss Diabetes mellitus Thrombosis Obstructive jaundice ```
65
Chronic pancreatitis treatment
Surgical resection Total pancreatectomy Distal pancreatectomy
66
Causes of jaundice
Prehepatic: haemolysis, massive transfusion Posthepatic: gallstones, tumours Intrahepatic: low BR uptake, low conjugated BR, low secreted BR, cholestasis, liver failure
67
Acute liver failure causes
Toxins Inflammation Pregnancy Drugs
68
Chronic liver failure causes(cirrhosis)
``` Inflammation Alcohol Drugs Cardiovascular causes Autoimmune ```
69
Liver failure complications
``` Hypoglycaemia Coagulopathy & bleeding Encephalopathy Vulnerable to infection Renal failure ```
70
Hormone affected in liver failure
Secondary hyperaldosteronism causing hypokalaemic alkalosis
71
Effect of low albumin in liver failure
Ascites
72
Liver failure treatment
Encephalopathy: reduce protein intake Hypoglycaemia: dextrose Hypocalcaemia: calcium gluconate Renal failure: haemofiltration Resp failure: ventilation Hypotension: albumin, vasoconstriction Infection: antibodies Bleeding: vit K, FFP, platelets
73
Visceral vs parietal abdominal pain
Visceral: autonomic, dull/cramping/burning Parietal: somatic, well-localised, sharp/ache
74
Character of abdominal pain
Inflammation: constant pain thats worse when moving Obstructive: colicky, fluctuates in severity, moves to relieve pain
75
Abdominal pain radiation
Kidney: groin Stomach/pancreas/duodenum: back Gall bladder: right and back
76
Regulation of hunger in brain(which nucleus and which neurons)
Arcuate nucleus Excitatory: NPY/Agrp neurons Inhibitory: POMC neurons Act on paraventricular nucleus
77
Hormones in appetite
Leptin: deficiency/resistance causes obesity. Acts on hypothalamus Ghrelin: stimulates NPY/Agrp, inhibits POMC Peptide YY: inhibits NPY, stimulates POMC
78
Secondary polydipsia causes
``` Medications Dehydration Diabetes mellitus Acute kidney failure Conn’s syndrome Addison’s disease ```
79
Eating disorders
Anorexia nervosa: avoid eating Bulimia nervosa: eat then purge Pica: eating non-food items Rumination syndrome: food brought back from stomach
80
Obesity treatment
Bariatric surgery BMI>40 or >35 with comorbidities Gastric bypass and sleeve gastrectomy Remission of diabetes and OSA Reduced ghrelin, raised peptide YY,GLP1
81
Immunological barrier in mucosal defense
MALT: mucosa associated lymphoid tissue GALT: gut associated lymphoid tissue
82
What is MALT
Lymphoid mass in submucosa, containing lymphoid follicles surrounded by high endothelial venule(HEV)
83
What are Peyer’s patches
Organised GALT in submucosal distal ileum Lymphoid follicles covered in follicle associated epithelium(FAE) Naive B and T cells Antigen uptake by M cells Antigen sampling by transepithelial dendritic cells
84
Gut B cell adaptive response
Naive B cells express IgM, switch to IgA after antigen exposure Mature B cells secrete IgA and populate lamina propria
85
Cholera transporter, symptoms, diagnosis and treatment
``` Secretes cholera enterotoxin Causes CFTR to secrete chloride Severe dehydration & watery diarrhoea Diagnose with stool sample culture Treat with oral rehydration ```
86
Infectious diarrhoea viruses
Rotavirus: young children Norovirus: closed communities
87
Infectious diarrhoea bacteria
Campylobacter(curved bacteria) 6 pathotypes of E. coli Clostridium difficile
88
Severe C. diff infection criteria
WCC>15 | Creatinine>150
89
Types of IBD
Crohn’s disease: non-continuous, cobblestone, transmural, non-caseating granulomas Ulcerative colitis: continuous, ulcerations, mucosa only Both are autoimmune
90
Types of artificial nutritional support
Enteral nutrition: superior to parenteral, NGT/NJT/NDT depending on gastric feed Parenteral nutrition: nutrients directly into venous blood using central venous catheter
91
Complications of enteral nutrition
Mechanical: misplacement, blockage GI: aspiration, ulceration
92
Complications of parenteral nutrition
Mechanical: pneumothorax, haemothorax Catheter related infections
93
What is refeeding syndrome
Biochemical shift and clinical symptoms when reintroducing nutrition
94
Symptoms of refeeding syndrome
Hypokalaemia Hypophosphataemia Thiamine deficiency Salt and water retention Arrythmia, tachycardia Encephalopathy, coma, seizures Respiratory depression
95
Bowel ischaemia presentation
Sudden onset crampy abdo pain Bloody, loose stool Fever, septic shock
96
Bowel ischaemia large vs small(cause, onset and name)
``` Small occlusive, large atherosclerotic Large more gradual and mild Small more painful Small: acute mesenteric ischaemia Large: ischaemic colitis ```
97
Bowel ischaemia investigations
FBC: neutrophilic leukocytosis VBG: lactic acidosis CT abdo/pelvis: vascular stenosis Endoscopy for mild/moderate large b
98
Bowel ischaemia conservative management
``` Only for ischaemic colitis IV fluid Anticoagulants Bowel rest Broad spectrum antibiotics ```
99
Bowel ischaemia surgery
Exploratory laparotomy: resect necrotic bowel, embolectomy, mesenteric artery bypass Endovascular revascularisation(patients without signs of ischaemia): balloon angioplasty/thrombectomy
100
Acute appendicitis presentations
Anorexia, nausea, vomiting ``` McBurnery’s point Blumberg’s sign: rebound tenderness Rovsing sign: LLQ->RLQ Psoas sign Obturator sign ```
101
Acute appendicitis investigations
FBC: neutrophilic leukocytosis, CRP CT scan gold standard USS for pregnant/child, MRI if USS inconclusive
102
Acute appendicitis conservative management
IV fluids Analgesia Antibiotics Percutaneous drainage if abscess
103
Acute appendicitis surgery
Laparoscopic or open surgery | Laparoscopic: cost, pain, hospital stay length, infection rate
104
Small bowel obstruction presentations
``` Colicky central pain Early vomiting Early high pitched bowel sounds Dehydration Abdominal tenderness ```
105
Large bowel obstruction presentations
``` Colicky central pain Early constipation Early & significant abdominal distention Early high pitched bowel sounds Dehydration Abdominal tenderness ```
106
Small bowel obstruction causes
Adhesions Neoplasia Incarcerated hernia Crohn’s
107
Large bowel obstruction causes
Colorectal carcinoma Volvulus Diverticulitis Faecal impaction
108
Important points of bowel obstruction
Diagnose using symptoms Check for hernia Strangulating or simple
109
Bowel obstruction investigations
``` FBC: high CRP&WCC if strangulated U&E: imbalance VBG(vomiting):hypoCl,hypoK,M alkalosis VBG(strangulated): M acidosis(lactate) Erect AXR: S bowel 3cm dilation, L bowel 6cm dilation, caecum 9cm CT abdo ```
110
Bowel obstruction conservative management
``` Nil by mouth Fluid resuscitation Analgesia, anti-emetics Faecal impaction: stool evac Sigmoid volvulus: rigid sigmoidoscopic decompression SBO: oral gastrogaffin for adhesion ```
111
Bowel obstruction surgery
Exploratory laparoscopy/laparotomy | Bowel resection with primary anastomosis/stoma formation
112
GI perforation presentations
``` Sudden pain with distention Guarding rigidity, rebound tenderness Nausea, vomiting, constipation Fever, tachycardia, hypotention Little to no bowel sounds ```
113
GI perforation investigations
``` FBC: leukocytosis High urea, creatinine VBG: M acidosis(lactate) Erect CXR: free subdiaphragmatic air CTAP: pneumoperitoneum, GI content ```
114
GI perforation conservative management
Nil by mouth, NG tube Broad spectrum antibiotics PPIs Analgesia, anti-emetics
115
GI perforation surgery
``` Exploratory laparoscopy/laprotomy Primary closure of perforation Resect perforated segment Culture abdominal fluid, peritoneal lavage Biopsy if malignancy ```
116
Biliary colic symptoms
Postprandial RUQ pain with radiation to shoulder | Nausea
117
Acute cholangitis symptoms
Charcot’s triad: Jaundice RUQ pain Fever
118
Acute cholecystitis symptoms
Acute, severe RUQ pain Fever Murphy’s sign
119
Biliary colic investigations
Normal bloods | USS: cholelithiasis
120
Acute cholecystitis investigations
Elevated WCC/CRP | USS: thick gall bladder wall
121
Acute cholangitis investigations
Raised LFT/WCC/CRP Blood MC&S positive USS: biliary dilation
122
Biliary colic management
Analgesia Anti-emetics Elective cholecystectomy
123
Acute cholecystitis management
Fluid Antibiotics Analgesia Early/elective cholecystectomy
124
Acute cholangitis managenent
Fluid Antibiotics Analgesia ERCP to clear bile duct or stent
125
CNS mutations causing obesity
POMC deficiency | MC4R loss of function mutation
126
Hormone in anorexia
Serotonin
127
Bowel obstruction AXR signs
Small bowel: ladder distension | Large bowel: coffee bean sign
128
3 areas for oesophageal perforation
``` Cricopharyngeal constriction (OGD related) Aortic and bronchial constriction Diaphragmatic constriction ```

Y2 (10 decks)

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