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Flashcards in Gastrointestinal Deck (92):
1

What is the definition of jaundice?

Yellowing of the sclera (white of eyes) and skin caused by an increase in blood levels of bilirubin

2

What is bilirubin? Where does its synthesis occur?

The normal by-product of the break down of red blood cells, in the spleen

3

What does bilirubin form in the liver?

Bile

4

What is the biliary tree?

A set of tubes connecting the liver to the 2nd part of the duodenum

5

What is the gallbladders role?

Important in the storage and concentration of bile

6

What is the role of bile?

Important for the normal absorption of fats from the small intestine

7

To where does the pancreas release digestive enzymes?

The second part of the duodenum

8

What are the three main functions of the liver?

Glycogen storage

Bile secretion

Other metabolic functions

9

Where is the liver located and when does it change (quadrant, ribs?)

RUQ (right upper quadrant)

Protected by ribs 7-11

10

What is the livers relationshop to the right hemi-diaphragm?

Inferior

11

What is the livers relationship to the gallbladder?

Posterior Inferior

12

What is the livers relationshop to the Hepatic flexure

Inferior

13

What is the livers relationshop to the right kidney, right adrenal gland, IVC, abdominal aorta?

Posterior

14

What is the livers relationshop to the stomach?

Posterior at mid/left side

15

How many anatomical lobes does the liver hace and what are their names?

4

  1. right lobe
  2. left lobe
  3. caudate lobe
  4. quadrate lobe

16

How many functional lobes does the liver have?

8 functional lobes

17

Where foes the portal triad enter the liver?

The porta hepatis

18

What does each functional lobe of the liver have?

  • branch of hepatic artery
  • branch of hepatic portal vein
  • bile drainage (to bile duct)
  • Venous drainage (to IVC)

19

what does the portal triad consist of?

Hepatic portal vein

Hepatic artery proper

Bile duct

20

What is the coeliac trunk?

First of three midline branches of the aorta

21

Is the coeliac trunk retroperitoneal or peritoneal?

Retroperitoneal

22

Where does the coeliac trunk leave the aorta?

At the T12 vertebral level

23

What does the coeliac trunk supply?

The organs of the foregut

24

What are the trifurcations of the coeliac trunk?

 

  • splenic artery
  • left gastric artery
  • common hepatic artery

25

What is the course of the splenic artery?

the superior border of the pancreas

26

Where is the spleen located?

Intraperitoneal orgen in the left hypochondrium

27

What is the spleens anatomical relationship to the;

  1. diaphragm 
  2. stomach
  3. splenic flexure
  4. left kidney

  1. diaphragm - posteriorly
  2. stomach - anteriorly
  3. splenic flexure - inferiorly
  4. left kidney - medially

28

What is the major and minor blood supply to the stomach?

Major

  • right and left gastric arteries 
    • ​along junction of lesser curvature and lesser ommentum
    • anastamose together
  • right and left gastro-omental arteries
    • along junction of greater curvature and greater ommentum
    • anastomose together

Major

  • posterior gastric arteries and short gastric arteries
  •  

29

Where does the blood supply to the liver come from?

Right and left hepatic arteries ;

branches of the hepatic artery proper

30

What does the hepatic portal vein do?

Drains blood from foregut, midgut and hindgut to the liver for first pass metabolism 

31

What forms the hepatic portal vein?

Splenic vein (drains foregut)

Superior mesenteric vein (midgut)

32

What foes the inferior mesenteric vein do?

Drains blood from the hindgut to the splenic vein

33

What does the IVC do?

Drains the cleaned blood from the hepatic veins to the right atrium

34

Where does the gallbladder lie?

Posterior aspect of liver (often firmly attached)

anterior to the duodenum

35

What is the function of the gallbladder?

Stores and concentrated bile in between meals

36

What does bile flow through as it leaves the gallbladder?

The cystic duct

37

What supplies the gallbladder with blood?

The cystic artery

It is a branch of the right hepatic artery in 75% of people

 

38

Where is the bifurcation of the right hepatic artery into the cystic artery?

In the triangle of calot

39

What can cause gallbladder pain?

Inflammation of gallbladder or cystic duct

Irritation from or impaction of a gallstone

40

Where do visceral afferents enter the spinal cord from the gallbladder?

 

T6-T9

41

Where will early gallbladder pain present?

The epigastric region

42

Where will later pain be present?

Where might it refer to?

What is this a result of?

Hypochondrium

Right shoulder

Anterior diaphragmatic irritation

43

What are the most common characteristics of asymptomatic oral cancer?

  • A higher proportion are granular not smooth
  • most are no more elevated than 1mm max
  • No ulceration
  • No bleeding
  • not indurated

44

What are some aetiologies of mouth cancer?

  • tobacco
  • alcohol
  • tobacco & alcohol
  • Diet & nutrition
  • HPV
  • UVL
  • Candida
  • Syphilis/dental factors

45

What is the upper drinking limits per week for men and women?

14 units

46

47

What dietry deficits can predispose to oral cancer?

Low vitamin A

Low vitamin C

Low iron

48

What is leukoplakia and what vitamin can be used to treat it?

A thickened white patch on mucous membrane that cannot be rubbed off. It is not a specific disease. Ocassionaly it can become malignant.

 

Vitamin A

49

What is hairy leukoplakia a marker of?

AIDS 

50

What are the high risk sites for oral cancer?

Soft (non keratinising sites)

  • Ventral tongue
  • Floor of mouth 
  • lateral tounge

51

What are the rare sites for Oral Cancer in the UK?

Dorsal tongue

hard palate

buccal mucosa (common in asia)

52

Can you name some potentially malignant lesions of oral cancer?

  • erythoplakia
  • erytholeukoplakia
  • leukoplakia
  • erosive lichen planus
  • submucous fibrosis
  • dyskeratosis congenita
  • sideropenic dysphagia

53

What are some warning signs of oral cancer?

  • red/white/red & white lesion
  • ulcer (exclude trauma, drug, systemic etc.)
  • Numb feeling in lip and face
  • Unexplained pain in mouth or neck
  • Change in voice
  • dysphagia

54

What are some orofacial manifestations of oral cancer?

  • Drooping eye lid or facial palsy
  • Fracture of mandible
  • Double vision
  • Blocker or bleeding from nose
  • Facial Swelling

55

What four key questions should we ask when a suspicious lesion presents?

  • how long has lesion been present?
  • is it painful ? pain is usually a late manifestation of pral cancer but would be expected in benign ulcer
  • Does patient smoke? or drink?.... how much?
  • What colour is the lesion?

56

What are some of the uses of an endoscope?

  • Diagnosis
  • Theraputics
    • emergency
    • elective
  • Screening
  • Surveillance

 

57

What are some visual diagnosis that can be gained from an endoscope?

 

  • oeseophagitis
  • gastritis
  • ulceration
  • coeliac disease
  • chron's disease
  • ulcerative colitis
  • sclerosing cholangitis

58

What are some vascular abnormalities seen with an endoscope?

  • varices
    • ​distended, lengthened and tortuous veins
  • etatic blood vessels (GAVE, dieulafoy)
    • dieulafoy- may cause spontaneuous haemorrhage
  • Angiodysplasia
    • due to degeneration of previously healthy blood vessels

59

What are some newer imaging techniques than endoscopy?

Narrow band imaging

Chromoendoscopy- using iodine

60

What are the steps for a microscopic diagnosis?

Biopsy and histology

brushing and cytology

rarely- aspirated and biopsies for microbiology

61

What is haematesis and melaena?

haematesis- vomitting fresh blood

maleana- dark faeces containing partially digested blood

62

What are the treatment options for life threatening variceal bleeding?

Life threatening medical emergency

  • ABC resus
  • Injection sclerotherapy (entholamine)
  • Banding
  • Histocryl glue

63

What are the treatment options for aterial bleeding?

Injection therapy

  • adrenaline
  • tamponade
  • vasocontriction

​Heater probe (coagulation)

Clips (ligate)

64

What are the treatment options for angiodyslaspia (small vessels)

Argon plasma coagulation

radio frequency ablation

65

What are the treatment options for strictures?

Dilatation

Stenting 

usually reserved for malignancy, removable stents can be used

66

What are some of the common complications of metal self expanding stents?

  • foreign body sensation
  • reflux
  • fever
  • septicaemia 
  • fistula formation

67

What are two methods for dilatation?

Balloon

Bouginage (hard stent)

68

What are some options for tumour treatment via endoscope?

Polypectomy

Endoscopic mucosal removal

69

What are the steps for a polypectomy?

Raise polyp on a bed of saline/adrenaline

snare polyp

hot biospy

usually for colonic polyps

70

What are the steps for endoscopic mucosal resection?

Raise lesion on a bed of adrenaline/saline

Loop and convert into polyp

snare

71

How would you remove stones with an endoscope?

Sphincterotomy

surgical division of any sphincter muscle

Balloon and trawl

lithotripsy

process of breaking stones into smaller fragments using shock waves

72

How would you remove a foreign body with an endoscope?

Snare or basket

overtube

GA with endotracheal tube

73

How are endoscopes relevant to nutrition?

PEG insertion

PEJ

Naso-jejunal tube insertion

74

What is the process of PEG insertion?

  • gastroscopy
  • Identify insertion site
  • transabdominal passage of wire
  • pull wire out of mouth
  • tie peg tube to wire and pull into position
  • fix in place and set up connectors

75

What is the process for insertion of naso-jejunal tube?

  • pass tube under direct vision
  • pull out endoscope
  • feed in nasal overtube
  • draw NJ tube into overtube
  • withdraw through nose
  • fix in place

76

What are the benedits of screening asymptomatic individuals?

Prevention of colorectal cancer

detect polyps

early detection of cancer

77

What is the preparation for endoscopy?

Indication ( clear , justified)

Explanation to patient

Consent

Fasting

Bowel preparation

Monitor bleeding diathesis

Infection prophylaxis (endocarditis, shunt, immunosuppression)

78

What are some complications of endoscopy?

Respiratory arrest 

aspiration

cardiac arrest

bleeding

perforation

infection (prions, viruses, bacterial endocarditis, immunosupression)

79

What is this?

Q image thumb

Submucous fibrosis

80

What is this?

Melanoma

A image thumb
81

What is this?

Q image thumb

Lichen Planus

A image thumb
82

What is this?

Q image thumb

Floor of mouth keratosis

83

What is this?

Q image thumb

Erytholeukoplakia

84

What is this?

Q image thumb

Erosive L planus

85

What is this? What other changes are associated with this condition?

Q image thumb

Dyskeratosis congenita

Nail changes

skin changes

86

What is this?

Q image thumb

Barrett's Cancer

87

What are the physical, social and psychological impacts of oral health?

 

Physical

healthy diet

healthy dentition (pain free)

Social

Eating

Smiling 

Kissing

Phsychological Health

self esteem

Communication

dental anxiety

88

What is are dental caries?

Dental caries is a dynamic process involving the exchange of calcium and phosphate ions between tooth structure and saliva, in the pressence of acids produced by the fermentation of carbohydrated by oral micro-organisms.

tooth-sugar-bacteria

89

What is the DMF index?

Sum of...

  • Decayed
  • Missing 
  • Filled

teeth or surfaces

90

What are DMFT, def and DMFS?

DMFT- a count of all decayed or missing or filled teeth

def- a count of all primary teeth that are decayed, etracted due to caries or filled

DMFS- a count of all decayed or missing or filled tooth surfaces

91

What are some of the associated illnesses of periodontal disease?

  • atherosclerosis, stroke, MI
  • adverse pregnancy outcome
  • diabetes
  • respiratory infections
  • rheumatoid arthirits, osteoporosis
  • obesity

92