Gastrointestinal Flashcards
1
Q
Name the sections of the small and large intestines in order.
A
duodenum jejunum ileum Caecum Appendix Colon
2
Q
Name the neurones/plexus found in the following:
mucosa
submucosa
muscularis externa
A
mucosa- enteric neurones
submucosa- submucous plexus
muscularis externa- myenteric plexus
3
Q
From which cells does excitation originate in the circular and longitudinal smooth muscle of the gut? Name the waves that are produced
A
Interstitial cells of Cajal
Slow waves
4
Q
With ______ _______ contraction in the gut, the longer the excitation exceeds the threshold for an action potential, the greater the strength of __________.
A
smooth muscle
contraction
5
Q
Which three types of neurones are located in the enteric nervous system apart from autonomic nerves.
A
Sensory
Interneurones
motor
6
Q
Name the six main sphincters of the alimentary canal.
A
Upper and lower oesophageal
pyloric
ileocaecal
internal and external anal
7
Q
Name the two tissues in which glycogen is stored in the body.
A
Liver
muscle
8
Q
when does glycogenesis, glycogenolysis and glucogenesis occur
A
glycogenesis- during/after meals
glycogenolysis- in between meals
glucogenesis- overnight/fasting
9
Q
Name the main enzyme involved in glygogenesis and glycogenolysis
A
glycogenesis- glycogen synthase
glycogenolysis- glycogen phosphorylase
10
Q
Insulin causes an increase in _______ ________ and a decrease in ________ ________. Glucagon has the opposite effect.
A
glycogen synthase
glycogen phosphorylase
11
Q
Which four vitamins are stored transported in lipids
A
Vitamins A D E K
12
Q
Name the compound that facilitates long chain fatty acid transport into the mitochondria.
A
Carnitine
13
Q
Name the histological feature that is characteristic of the following: duodenum, jejunum, ileum
A
Duodenum- Brunners glands- secrete alkaline liquid to neutralise chyme
Jejunum- plicae terminalis- folds covered in villi
Ileum- Peyer’s patches- GALT
14
Q
What is the longitudinal muscle of the large intestines called?
A
teniae coli
15
Q
What does the portal triad consist of?
A
hepatic artery, hepatic portal vein, Bile duct
16
Q
The central vein at the centre of each hepatocyte is a venule of what vein?
A
the hepatic vein
17
Q
What cells line the bile ducts?
A
Cholangiocytes
18
Q
Through what channels does blood flow to the central vein of the hepatocyte? What is the space beside these channels called?
A
sinusoids perisinusoidal space (space of Disse)
19
Q
What do you call the resident macrophages of the liver?
A
Kupffer cells
20
Q
What is bilirubin and how is it produced?
A
A brown pigment produced by the breakdown of red blood cells in the spleen
21
Q
How is bile transported to the bile ducts in the hepatocytes of the liver?
A
through bile cannaliculi
22
Q
In what way is the bile modified in the gall bladder?
A
It is made more concentrated. Na+ and Cl- ions are actively transported into out of the bladder setting up an osmotic gradient which the water within the lumen follows.
23
Q
What are zymogens?
A
Precursors of enzymes
24
Q
What effect does histamine, gastrin and acetylcholine have on the gastric secretion of H+ ions.
A
Increase H+ secretion
25
How do you calculate BMI?
BMI=mass/height2
26
What area of the brain mediates body mass?
Hypothalmus
27
What is Ghrelin and by which cells is it produced?
A hunger signal molecule produced by the Oxyntic cells of the gastric mucosa
28
_______ and ______ are ________ signals. They increase in concentration in the blood when more fat is stored.
Leptin
insulin
adiposity
29
peptide YY and Glucagon-like peptide 1 _______ gastric emptying and food intake
decrease
30
The Orad stomach exhibits _____ contraction while the caudad stomach exhibits ______ contraction.
tonic
| phasic
31
What do you call the peristaltic contraction/relaxation of the caudad stomach?
Antral pump
32
What cells are found in 1.Pyloric glands and 2. oxyntic glands
1. D cells (somatostatin) G cells (Gastrin)
| 2. Parietal glands (HCL) Chief cells (enzymes)
33
What effect does Somatostatin have on gastric HCL secretion?
Decreases it
34
What is the migrating motor complex?
strong peristaltic contractions that slowly pass the length of the intestine
35
Polysaccharides are catabolised to _____________ by __________ within the lumen. They are subsequently broken down to monosaccharides by ______________ integrated with the membrane.
Oligosaccharides e.g. sucrose, maltose, Lactose
Alpha-amylase- breaks down 1,4 glycosidic bonds
oligosaccharidases
36
Intrinsic factor is needed for the absorption of what vitamin?
Vitamin B12
37
Name a proton pump inhibitor
Omeprazole, Iansoprazole
38
Name a Histamine (H2) receptor antagonist
Ranitidine
39
Name an anti-muscarinic drug.
Buscopan
40
Name an anti-diarrhoeal drug
Loperamide
41
Name two Aminosalicylates. they are the firstline treatment of what disease?
Sulfalazine, Mesalazine
| Ulcerative colitis
42
Name a Dopamine receptor antagonist.
Domperidone, metaclopramide
43
Ondansetron is an example of what drug?
A 5-HT3 receptor antagonist
44
Name an immunosuppressive drug used in the treatment of UC and CD
Azathioprine
45
Name two Anti-TNF therapy drugs used to treat UC and CD
Infliximab
| adalimumab
46
What clinical sign is caused by an excess of bilirubin in the blood?
Jaundice
47
The liver has __ segments and __ lobes. name the anatomical lobes.
8
4
right lobe, left lobe, quadrate lobe, caudate lobe
48
The IVC and Hepatic veins have no ______. Back pressure on the liver causes __________. this can occur as a result of heart failure
valves
| hepatomegaly
49
What leukocyte cell is found between roughly every 10 enterocytes?
Intraepithelial lymphocytes
50
Apart from intraepithelial lymphocytes, what other immune cells are found in the mucosa?
Dendritic cells
51
After _________, T cells within the gut mucosa migrate to the __________ lymph nodes and then enter the bloodstream and return in numbers to the intestines. T cells bind to ____________ on the capillary endothelium of the lamina propria then they bind to _________ and initiate ________.
```
activation
mesenteric
MAdCAMs
enterocytes
necrosis
```
52
The ratio of different immunoglobulins in the intestines is the opposite of that in the gut. list the three main immunoglobulins from greatest abundance to least.
IgA:IgM:IgG
53
The gut is said to be ___________ to accommodate for the commensal bacteria.
Hyporesponsive
54
Patients with Coeliac disease possess intraepithelial T-cells which are specific to ______ _________. These cells proliferate and destroy epithelial cells leading to _____ _______ and ___________of the small intestines
Gamma Interferon
Villus atrophy
Scalloping
55
Vomiting is mediated by the ______ centre of the brainstem. emetic stimulus is mainly sensed in the ________ _______ ______.
emetic
| Chemoreceptor trigger zone
56
Name three types of antagonists which are used as anti-emetic drugs.
dopamine receptor
muscarinic receptor
H2 receptor
5-HT3
57
The combination of circular muscle and longitudinal muscle contraction in the large intestine creates bulges called ________.
Haustra
58
The cells of the colon are known as _________ which are responsible for __, ___ and ____ absorption the colonic crypts are responsible for __ and _____ secretion.
```
Na+
Cl-
H20
K+
HCO3-
```
59
Name four important proteins that are synthesised in the liver.
albumin
complement proteins
apoproteins
60
Define diarrhoea.
Loss of 500ml of fluid and solutes in one day from the GI tract.
61
State three dangerous effects of diarrhoea.
dehydration, hypokalaemia, metabolic acidosis (HCO3- loss)
62
State three causes of diarrhoea.
hypermotility, impaired NaCl absorption, poorly absorbable solutes.
63
The protrusion of the sphincter of Oddi into the duodenum is known as the ________________.
hepatopancreatic ampulla
| ampulla of Vater
64
ERCP is used to investigate what vessels?
Those associated with the pancreas and gall bladder
65
Jaundice occurs when the _____ ___ is blocked because the _________ returns to the liver and then into the __________.
bile duct
bilirubin
bloodstream
66
Reflux Oesophagitis causes superficial squamous epithelial damage leading to_________. If this continues, _______ oesophagus may ensue. Metaplasia occurs and the stratified squamous epithelium transitions to ________ epithelium. This appears _____ macroscopically. If the disease progresses there is a risk of developing ____________ where the metaplasia becomes dysplasia.
```
hyperplasia
Barrett's
Columnar
red
adenocarcinoma
```
67
State the three causes of chronic gastritis
Bacterial- H. Pylori infection
Autoimmune-antibodies to parietal cells
Chemical- NSAIDS, Alcohol, bile reflux
68
How do H. Pylori cause Chronic gastritis?
They occupy an ecological niche between the mucus and epithelial cells. They damage these cells leading to reduced mucus production, therefore the wall is exposed to the gastric acid and pepsin leading to peptic ulceration.
69
As well as causing Chronic gastritis, H. Pylori is also a risk factor for ___________ and __________.
Adenocarcinoma
| lymphoma
70
Acute ischaemia of the small bowel is classified by the degree of infarction. Identify the effect of mucosal, mural and transmural infarction.
MUCOSAL- resolution
MURAL- fibrosis--stricture--chronic ischaemia--obstruction
TRANSMURAL- gangrene--perforation--peritonitis--sepsis
71
What causes Meckel's diverticulum?
Incomplete regression of the vitello-intestinal duct
72
What does GORD stand for? name three possible causes of this condition
Gastro-Oesophageal Reflux Disease
raised intra-abdominal pressure
dysfunctional LOS
abnormal oesophagus motility
73
What is gastroparesis?
delayed gastric emptying
74
Dyspepsia is associated with what condition?
Peptic ulcer disease
75
Identify three hallmarks of oral malignancy
red and white patches, bleeding, ulceration
76
What is melaena and what is haematemesis?
Melaena- black faeces discoloured by digested blood
| Haematemesis- vomiting up fresh blood
77
Where is Crohn's disease most common in the body?
ileum and colon
78
CD presents with __________ lesions throughout the GI tract. They cause deep ________ within the mucosa which cause a macroscopic ____________ pattern. It exhibits _________ inflammation and non-caseating __________.
```
skip
fissures
cobblestoning
transmural
granulomas
```
79
UC presents with __________ lesions and is restricted to the _______ and _______ in the GI tract. It exhibits ________ and _________ inflammation. Inflammatory cell influx destroys the mucosa, and the tissue left forms _________.
```
continuous
rectum
colon
mural
mucosal
pseudopolyps
```
80
What is the MUST score used for?
Score determining level of malnutrition.
81
Refeeding Syndrome can occur after prolonged starvation. What electrolyte shifts occur as a result of this condition?
hypokalaemia
hypophosphataemia
hypomagnesaemia
82
McBurney's point marks the position of what part of the bowel?
appendix
83
What symptoms characterise Appendicitis?
Central abdominal pain radiating to the right iliac fossa
84
Name one potentially fatal complication of appendicitis
peritonitis
85
In most cases appendicitis is treated by ___________ _______________. However, if an appendix mass is present it is treated with _________ and __ ____________.
Laparoscopic appendectomy
analgesics
antibiotics
86
Repeated/major small bowel resection can cause ____- _______ _________.
Small Bowel syndrome
87
The sigmoid colon possesses a mesentery called the ________ _________. This allows a significant amount of movement which may lead to a _______ ________.
Sigmoid Volvulus
88
What is the name of the premalignant precursor to adenocarcinoma?
Adenoma
89
Define Diverticula
A mucosal herniation through the muscle coat. diverticulosis is the presence of diverticulum
90
How do you treat uncomplicated Diverticulitis?
Oral antibiotics
91
What virus commonly causes diarrhoea and vomiting in young children?
Rotavirus
92
What virus is known as the winter vomiting bug?
Noravirus
93
What is the main bacterial cause of gastroenteritis? How is it mainly spread?
Campylobacter
94
What is the main cause of bacterial gastroenteritis? How is it mainly spread?
Campylobacter
| faecal-oral spread
95
What bacteria causes Dysentery? Identify the characteristic symptom of dysentery.
Shigella
| Diarrhoea with blood and mucus
96
In addition to the external anal sphincter, name a skeletal muscle that acts as a sphincter of the rectum
Puborectalis
97
The Truelove and Witt criteria are used to assess the severity of what condition?
Ulcerative Colitis
98
The Rome III criteria is used for the diagnosis of irritable bowel syndrome. Identify what this criteria states
Patient experiences abdominal pain three times a month associated with 2/3 of the following:
improves with defaecation
change in stool frequency
change in stool appearance
99
Identify the three types of IBS
IBS-D diarrhoea
IBS-C constipation
IBS-M mixed
100
What dietary advice is given to IBS patients?
High soluble fibre diet
| Low FODMAPS
101
Name two anti-diarrhoeal drugs
Loperamide, imodium
102
Laxido and movicol are examples of what type of drug?
Osmotic laxatives
103
Name two anti-spasmodics used in the treatment of IBS.
colofac, colpermin
104
What is Anorexia Nervosa?
Psychiatric condition- Self-induced weight loss due to an overvalued idea- fear of fatness
105
What is Bulimia Nervosa?
Psychiatric condition- failure to restrict eating leading to binges
106
Name a characteristic symptom of Right sided colorectal cancer
Unexplained Iron deficient anaemia
107
Identify three investigations of colorectal cancer
Barium enema
colonoscopy
sigmoidoscopy
108
Identify three symptoms of bowel obstruction
abdominal distension- due to trapped swallowed air
colicky abdominal pain
constipation
109
Jaundice is classified by the site of origin- identify the three types
pre-hepatic, hepatic, post-hepatic
110
________ is the endpoint of liver disease where bands of ___________ separate the hepatocyte nodules.
Cirrhosis
| fibrosis
111
Portal hypertension is a complication of liver disease. Identify the signs that this creates.
Oesophageal varices
medusa
ascites
haemorrhoids
112
Pathology of Alcoholic liver disease:
alcohol induces ____ _________ appearance in the liver. Continued alcohol use results in hepatitis which exhibits _________ inflammation, _________ bodies and fibrosis. Fatty liver and hepatitis are reversible but fibrosis and cirrhosis are not.
Fat vacuoles
neutrophilic
Mallory bodies
113
What is Haemochromatosis
Excess of Iron in the liver
114
Identify the four stages of NAFLD
steatosis- steatohepatitis- fibrosis- cirrrhosis
115
identify the intermediate in alcohol metabolism between ethanol and acetate
Acetaldehyde
116
Name the site of an inguinal hernia
Hesselbach's triangle
117
identify some of the main symptoms of Cholestasis
Biliary colic
-RUQ pain radiates to shoulder
jaundice
118
What acid is used in the treatment of cholestasis?
Ursodeoxychloric acid
119
What is acute cholecystitis and how is it treated?
Inflammation of the gall bladder because the bile duct is blocked by a gallstone. treated by urgent cholecystectomy
120
Acute pancreatitis is caused by obstruction of the _______ _________ ______. The proteases and lipases within the organ become activated meaning autodigestion occurs
Common bile duct
121
What is the best investigation for cholestasis and pancreatitis?
Ultrasound scan
122
What type of colitis is caused by C. difficile infection
Pseudomembranous colitis
123
What is Rovsing's sign?
pressing the LIF causes pain in the RIF
124
Most appendix are found in which position?
Retrocaecal
125
Hyperamylasaemia is a sign of disease in which organ?
Pancreas
126
What is the most common cause of pernicious anaemia?
Loss of the parietal cells which produce intrinsic factor for vitamin B12 absorption
127
Identify three tests for H. pylori
Serological tests-IgG antibodies
C-Urea breath tests
CLO- biopsy urease test
128
Under 55s with H. Pylori peptic ulceration can move straight to __________ therapy meanwhile elderly patients require an __________.
Eradication
| endoscopy
129
What characterises stools of cholera patients?
Rice water stools
