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Gastro Flashcards

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1
Q

Pancreatic secretions - exocrine

A

Trypsinogen
Chymotrypsinogen
Pancreatic amylase
Lipase

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2
Q

Pancreatic secretions - endocrine

A

Glucagon - from alpha cells
Insuln from beta cells
Somatostatin from delta cells
Pancreatic polypeptide by PP cells

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3
Q

Gastrin source

A

G cells in antrum

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4
Q

Gastrin stimulated by

A

Gastric distension and amino acid in antrum

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5
Q

Gastrin action

A

Secretion of pepsin, gastric acid and intrinsic factor

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6
Q

Cholecystokinin-pancreozymin (CCK-PK) source

A

duodenum and jejunum

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7
Q

Cholecystokinin-pancreozymin (CCK-PK) stimulated by

A

fats, and amino acids in SI

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8
Q

Cholecystokinin-pancreozymin (CCK-PK) action

A

Pancreatic secretion
gallbladder contraction
delayed gastric emptying

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9
Q

Secretin source

A

Duodenum and jejunum

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10
Q

Secretin stimulated by

A

ACID in the small bowel

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11
Q

Secretin action

A

pancreatic bicarbonate secretion

delays gastric emptying

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12
Q

Motilin source

A

Duodenum and jejunum

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13
Q

Motilin stimulated by

A

acid in the small bowerl

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14
Q

Motilin action

A

increased motility

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15
Q

Vasoactive intestinal peptide (VIP) source

A

SI

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16
Q

Vasoactive intestinal peptide (VIP) stimulated by

A

neural stimulation

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17
Q

Vasoactive intestinal peptide (VIP) action

A

inhibits gastric acid/peptin secretion - stimulates secretion by intestine and pancreas

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18
Q

Gastric Inhibitory peptide (GIP) source

A

duodenum and jejunum

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19
Q

Gastric Inhibitory peptide (GIP) stimulated by

A

glucose ,fats and amino acids

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20
Q

Gastric Inhibitory peptide (GIP) action

A

inbihits gastric secretion

stimulates insulin secretion

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21
Q

Somatostatin source

A

D cells in pancreas

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22
Q

Somatostatin stimulated by

A

Vagal and adrenergic stimulation

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23
Q

Somatostatin action

A

Inhibits gastric and pancreatic secretion

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24
Q

Pancreatic POlypeptide source

A

PP cells

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25
Pancreatic Polypeptide PP stimulated by
Protein rich meal
26
Pancreatic Polypeptide action
inhibition of pancreatic and billiary secretion
27
factors increasing Fe absorption
increased erethropoesis (ie pregnancy) GI blood loss Vitamin C/Gastric acid
28
Factors decreasing Fe absorption
Gasrtrectomy Achlorydria SI disease Drugs such as desferrioxamine
29
Folate deficiency caused by
body demand increase such as prengnacy and haemolysis | methotrexate
30
B12 defiecincy caused by
``` Dietary deficiency post-gastrectomy (lack of IF) Atrophic gastritis (pernicious anaemia) terminal ileal disease blind loops ```
31
Causes of mouth ulcers
``` IBD HIV Drugs Ca Nutritional deficiency Bechets celiac sweet syndrome ```
32
Achalasia
- -lack of peristalsis and lack of relaxation of lower oesophageal sphincter - -1/100,000 per year - -any age but rarely children - -CXR may show air/fluid behind the heart
33
GORD/GERD predisposing factors
``` Hiatus hernia Obesity Smoking Etoh Caffiene Large meals late at night Drugs - theophyllines, nitrates, antibholinergics ```
34
Causes of oesophagitis
Candidal - immunosuppressed - on abx on steroids particularly inhaled Chemical - nsaids eosinophillic HSV
35
two types of hiatus hernia
sliding - 80% may cause aspiration./acid reflux | rolling - 20% may obstruct or strangulate
36
Oesophogeal Ca risk factors
``` Smoking Etoh Plummer-Vinson syndrome Achalasia Barrets Chinese/Russian ethnicity Obesity Tylosis ```
37
Osophogeal Ca clinical features
Pain and dyspepsia Progressive dysphagia for liquids then solids Weight loss Vomiting
38
Clinical symptoms of peptic ulcer disease
``` Epigastric pain (can radiate to back if posterior duodenal ) vomiting relapsing and remitting course weight loss fe deficiency acute haemorrage ```
39
causes of upper GI bleeds
``` Common Duodenal - 35% Gasrtic 20% Gastric erosions 18% Mallory Weiss tear - 10% ``` 5% or less Duo or osophagitis upper GI ca varices ``` Rare 1% or less Angiodysplasia Hereditary Talengiectasia POrtal hypertension Aorto-duodenal fistula ```
40
Risk assessment tool for upper Gi bleed
Glasgow-Blatchford
41
Clinical signs of Zollinger-Ellinson
pain and dyspepsia from multiple ulcers steatorrhoea/diarrhoea diagnosis - high serum fasting gastrin levels - CT/MR scanning
42
Treatment of zollinger ellinson
HIgh dose PPI (80-120mg od) Surgery Chemotherapy Somatostatin analogues
43
Gastric Ca risk factors
``` Japanese Hypo/achlorhydria (ie pernicious anemmia partial gastrectomy) male high salt/nitrates gastric polyps ```
44
Gastric Ca clinical presentation
``` Dyspepsia weight loss Epigastric pain anorexia early satiety Fe deficiency anemia maelena ```
45
Scoring systems for acute pancreatitis
APCHE Ransom Glasgow criteria most unreliable in first 48 hours
46
Causes of acute pancreatitis
``` Gallstones Etoh Viral (mumps) Trauma Drugs (azothioprine, coocp furusomide, steroids) Hypercalcemia Hypertriglyceridemia Post surgery/ERCP ```
47
Early complications of pancreatitis
ARDS renal failure DIC pleaural effusions
48
Late complications of pancreatitis
splennic/portal vein thrombosis pseudocyst abscess
49
Pancreatitis clnical features
secere epigastric pain - radiating to the back - vomiting. Amylase raised above circa 300 Plain Xray may show sentinal loop
50
Chronic pancreatitis features
Malaborption and steatorrhea Abdo pain T2DM
51
Coeliac Disease clinical features
``` Diarrhoea mouth ulcers Weight loss Malaise weakness - ataxia abdo pain amenorrhoea ```
52
Coeliac complications
``` Nutriotional deficiency increased Gi malargnany but this returns to normal with treatment dermatitis herpetiformis osteomalacia abnormal LFTs ```
53
Refeeding syndrome pathophysiology
Overenthusiastic feeding surge in insulin intracellulur shift in potassum phosphate and magnesium Can cause cardiac problems, seizures, delerium, parasthesia
54
refeeding monitoring and treatment
U&E daily including Mg Ca and Po4 | Thiamine
55
Transmural inflamation (Chrohns or UC)?
Chrohns
56
Mucosa and submcusoa only (Chrohns or UC)?
UC
57
Crypt abcesses (Chrohns or UC)?
UC
58
smoking? (Chrohns or UC)?
Smokers more prone to Chrohns but less likely in UC
59
Primary SCLEROSING cholangitis (Chrohns or UC)?
C
60
Primary BILIARY cirrhosis (Chrohns or UC)?
UC
61
Cobblestone mucosa (Chrohns or UC)?
C
62
Rose thorn ulcers (Chrohns or UC)?
C
63
Skip lesions (Chrohns or UC)?
C
64
Fistulae? (Chrohns or UC)?
C
65
Definition of acute severe colitis
True-love and witts criteria >6 bloody stools plus any signs of systemic shock
66
Psuudomembrinous colitis otherwise known as
Cdiff
67
Campylobactor features
Gram negative rods fecal oral headache and malaise prior to diarrhoea abdo pain may be severe
68
Cholera features
Vibrio Cholerae - gram negative rods spread is fecal oral rice water stools
69
Giardiasis features
flagellate protozoa fecal oral spread bloading and non bloody diarrhoea
70
Salmonella features
Gram negative bacillus divided into enteric (tyhic/paratyhic) and those causing gastro-enteritis
71
GI TB features
mimicks chrohns disease occasionally spontaneous peritonitis clinical features are non-specific Diagnosis by biopsy
72
Causes of jaundice types
Pre-hepatic Hepatic Post Hepatic
73
Prehepatic causes of jaundice
Haemolysis | Gilberts syndrome etc
74
hepatic causes of jaundice
``` Etoh hepatitis Viral hepatitis Drugs - augmentin etc Wilsons disease Chirrosis Hepatic Metastases Hepatic congestion in cardiac failure ```
75
Post-Hepatic causes of jaundice
``` Gallstones carcinom of pancreas lymphadenopathy PBC PSC Biliary artresia ```
76
Synthetic measurs of liver function
Albumin and PT
77
Obstructive jaundice
ALP raised
78
hepatocellular jaundice
ALT raised
79
Chronic livery disease LFTs
May be "normal" but poor synthetic function
80
Investigations for Jaundice
LFT Viral serology autoantibodies Liver USS - single most useful test CT scan MRCP
81
Congenital Hyperbilirubinaemia types
Gilbert Crigler Najjar Dubin-Johnson Rotor
82
Congenital Hyperbilirubinaemia benign except
Crigler Najjar
83
Congenital Hyperbilirubinaemia fatal no treatment
Crigler Najjar type 1
84
Congenital Hyperbilirubinaemia survive to adulthood
Crigler Najjar type 2
85
Gilbert syndrome genetics
Autosomal dominant
86
Crigler Najarr genetics
Type 1 autosomal recesive | Type 2 autosomal dominant
87
Dumin Johnson/Rotor genetics
Autosomal recessive
88
Gilbert Syndrome clinical features
increased unconjigated bilirubin asymptomatic jaundice increases with fasting
89
Dubin-Johnson clinical features
jaundice, right upper quadrant pain and malaise
90
Rotor clinical features
increase in CONJUGATED bilirubin
91
Ascitis types
Transudates and exudative
92
Causes of transudative ascities
portal hypertension nephrotic syndrome malnutrition myxoedema
93
Causes of exudative ascititis
Ca Intra-abdominal TB Pancreatitis
94
Hepato-renal syndrome
Acute kidney injury can complicate chronic liver disease Type 1 rapidly progressive renal failure - high mortality rate Type 2 mortality again high but onset and progression slower
95
Hep A features
``` Spread: fecal oral Virus: RNA Clinical: anorexia/jaundice/nausea/joint pain/fever Treatment: supportive Chronicity: none Vaccine: Yes ```
96
Hep B features
``` Spread: blood born Virus: DNA Clinical: acute fever, arteritis, glomerulonephritis, arthorpathy Treatment: supportive and ?antivirals Chronicity: 5% chronic carriage Vaccine: Yes ```
97
Hep C features
``` Spread: blood born/sti Virus: RNA Clinical: acute hepatitis Treatment: peg interferon alpha Chronicity: 60-80% Vaccine: No ```
98
Hep D features
Spread: blood born but depends on Hep B infection Virus: incomplete Clinical: exacerbates Hep B infection Treatment: Interferon of limited benefit Chronicity: increased incidence of chirosis Vaccine: No
99
Hep E features
``` Spread: Blood born Virus: RNA Clinical: acute self limiting but 25% mortality in pregnancy Treatment: supportive Chronicity: none Vaccine: No ```
100
Hep B serology HBsAg
Acute infection -SiCK NOW
101
Hep B sereology HBeAg
High infectivety - spreading it EVRYWHERE
102
Hep B sereology Anti-HBs
immune from getting SICK
103
Hep B sereology Anti-HBe
Declining infectivity - stopped spreading it EVERYWHERE
104
Hep B serology anti-HBe IgM
recent infection <6 MONTHS
105
Hep B sereology anti Hbc IgG
Lifelong marker of post infection - not immunity | GOT it - might GET it again.
106
Drug induced hepatitis Cholestatis examples
cause bile duct inflammation flucloxaccilin anabolic steroids oral contraceptives
107
Drug induced hepatitis
direct hepatocellular damage from statins anti-TB drugs, ketoconoazole.Fulminant liver failure possible.
108
Hepatic necrosis
where ability of liver to metabolise toxins fails - gluthathione levels fal and toxic metabolites accumulate = ie paracetamol OD
109
Four stages of chirossis
liver cell necrosiss inflammation fibrosis nodular regeneration
110
chirosis definition
irreversible destruction and fibrosis of liver architecture with some nodular regeneration
111
Causes of chirrhosis
``` Etoh Haemochromatosis PBC Wilsons NASH Auto-immune hepatitis ```
112
Clinical features of Chirrhosis
``` Confusion/encephalopathy bruiding/bleeding oedema (hypo-abuminaemia) ascites jaundice palmar erethema/dupetrons contacture/caput medusa/splenomegaly) GI haemorrage. ```
113
Portal Hypertension - Budd Chiari
thrombosis or obstruction of hepatic vein
114
Portal hypertension - thrombotic causes
Portal thrombosis or Budd Chiari
115
Primary Billiary Chirrosis features
Cholestatic jaundice xanthelasma hepatosplenomegaly high ALP/IgM Diagnosis is AM2 antibodies
116
Pyogenic absesses
Hepatic absess following intra-abdominal sepsis or spontaneously - ecoli - proteus/ staph A Patients have swingin pyrexia - weight loss - right upper quadrant pain and anorexia
117
Acute Abdomen causes
``` Appendicitis Perforated viscus IBD Diverticular diseases Obstruction Ischaemia Incaraterd hernia ``` torsion PID endometriosis Pancreatitis Cholycystitis/Cholangitis Peritonitis renal calculi spenic infarcts
118
Ix for Acute Abdomen
``` Bloods - inc amylase and Ca, and VBG CXR AXR ECG CT abdo ```

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