Gastrology

Question 1

What is a choledochal cyst

Answer 1

sever liver dysfunction
+ / - abdominal mass

large common channel drainage pancreatic and bile duct - juices cause wall destruction this with stenosis cause cysts

Question 2

What would be seen in protein-losing enteropathy

Answer 2

high levels of alpha-1 antityrptase in stool

Hypoalbuminae

Question 3

Name a type of protein-losing enteropathy

Answer 3

lymphangiectasis

high levels of alpha1 antitryptase in stool
Hypoalbuminae
Loose stools

Question 4

Embryology of diaphragm

Answer 4

formed between 5th and 7th week
Fusion of septum transverse, pleuroperitoneal folds, cervical somites

Septum transverse - central tendon
Pleuroperitoneal folds - parietal membranes surrounding viscera
Cervical somites - C5-C7 muscular components

Question 5

Embryology of GI tract

Answer 5

Endoderm - epithelial lining of GI tract
Mesoderm - smooth muscle
ectoderm - enteric nervous system

Question 6

What structures make up the foregut

Answer 6

Pharynx
Oesophagus
Stomach
Proximal duodenum

Question 7

What structures make up mid gut

Answer 7

forming distal duodenum
Small bowel
Distal colon

Question 8

What structures Make up hind gut

Answer 8

Distal colon
Rectum

Question 9

Timeline of rotation of GI tract

Answer 9

5th week - intestine elongates and form loop - protrudes into umbilicus
6th week - stomach and duodenum rotate 90 degrees
8th week - duodenum and jejunum herniate further from superior mesenteric artery
11th week - GI retracts into abdomen

Question 10

What is villous atrophy

Answer 10

Villi surrounding small intestine erode away

Question 11

What causes villious atrophy

Answer 11

Coeliac disease
NSAIDS
Giardsis
H. pylori gastritis

Question 12

What produces gastric acid

Answer 12

Parietal cells in the stomach

Maintained by H+ / K+ / ATPase pump

Question 13

What is stomach pH ?

Answer 13

around 2

1.5-3.5

Question 14

Pathophysiology of gastric acid production

Answer 14

Sodium and chloride cells secreted from parietal cells to canniculis
Negative gradient - K+ and Na cells move down into it
H20 and CO2 from to make carbonic anhydrase
Carbonic anhydrase dissociates - H + move out of cells into stomach lumen, Na and K+ move into cells - leaves Cl and H+ ions in cannaiculis

Question 15

What increases gastric cell production

Answer 15

Vagal nerve stimulation
Gastrin release
Histmaine release

Question 16

Where is the gastrin released from

Answer 16

Released from G cells in pyloric antrum and duodenum

Question 17

How does gastrin work

Answer 17

Directly- Stimulates parietal cells to release HCL

Indirectly work on enterochromaffin cells - binds to CCK2 receptors -> releases histamines -> parietal cells

Question 18

Where is pepsinogen released

Answer 18

chief cells

Question 19

Other functions of gastrin

Answer 19

Causes chief cells to release pepsinogen -> pepsin
Promotes muscle contraction
Strengthens antrum contractions - > increases rate of gastric emptying
Induces pancreatic secretions

Question 20

What factors increase gastrin

Answer 20

partially digested proteins
Hypercalcaemia
Stomach distension
Vagal stimulation

Question 21

What inhibits gastrin

Answer 21

Too much HCl - negative feedback
Glucagon
Somatostatin
GIP / VIP

Question 22

What pH of the duodenum

Answer 22

7-8

Question 23

What released CCK

Answer 23

presence of proteins, fats and low pH

Question 24

Where is CCK released from

Answer 24

I cells of duodenum

Question 25

Where is secretin released from

Answer 25

s cells of duodenum

Question 26

How does CCK act

Answer 26

inhibits smooth muscle contractions from stomach - slow process of food movement acts on pancreas to increase digestive enzyme - > protease and amylases (break down of carbs)

Question 27

How does secretin acts

Answer 27

Released due to carbs in duodenum Increase production of bicarbonate ions from pancreases and liver (with CCK)

Question 28

What does bicarbonate do

Answer 28

Binds to H+ ions in chyme Rise pH

Question 29

Cause of acute pancreatitis

Answer 29

Mumps - need to test rNA

Question 30

Risk factors of pyloric stenosis

Answer 30

Bottle feeding Male Macrolide use White ethnicity Family Hx Smoking Prematurity

Question 31

In pyloric stenosis what affect does hypochlormia have?

Answer 31

Increases plasma bicarbonate levels as there is an increase in excretion of bircarbonate to maintain pH Urine is alkaline

Question 32

In pyloric stenosis what affect does hypovolaemia have

Answer 32

Causes stimulation of aldosterone which acts of distal tubule -> retain Na and excrete K+ and hydrogen ions = causing hypokalmaia

Question 33

What defiency is likely to be present in binary atresia

Answer 33

Fat-soluble vitamin defiency A, D, E, K Reduced absorption lack to bile

Question 34

Pathophysiology biliary areas

Answer 34

Progression of obliteration of extra-hepatic biliary duct -> obstruction of bile flow

Question 35

Features of biliary atresia

Answer 35

jaundice pale stools dark urine hepatemegly

Question 36

Where is mUCIN 2 produced

Answer 36

goblet cells of intestines

Question 37

Action of Mucin 2

Answer 37

Act to organise two mucus layers

Question 38

How does lack of fibre affect Mucin 2

Answer 38

increase in inner layer mucus degradation due to lack of energy from intestinal microbes

Question 39

Commonest cause of acute pancreaitis

Answer 39

gall stones - most common cholesterol

Question 40

When do you complete an UGI biopsy if suspecting coeliac disease with duodenal biopsy

Answer 40

If tTG is <10 time s upper limit of normal

Question 41

What HLA is ass. with coeliac disease

Answer 41

HLA-DQ2 - DQ 8 - test if tTG >10 times upper limit of normal

Question 42

Histological findings of biliary atresia

Answer 42

bile duct proliferation and fibrosis portal tract oedema a inflammation bile duct bile plugs

Question 43

Which type of cells act as a protective layer in stomach

Answer 43

mucus neck cells Produce bicarbonate and mucus Protect from mechanical trauma from peristalsis auto digestion acid

Question 44

Where is somatostatin produced

Answer 44

D cells in stomach D cells in pancreas Inhibits everything

Question 45

What are the 6 secretions from the stomach

Answer 45

Hcl - parietal cells -> absorb vit B 12 by intrinsic factor Pepsinogen - chief cells Gastrin - G cells Moucous - goblet cells mucus cells - protective, alkaline Somatostatin - delta cella Histamine - enterchromffain cells - > pepsinogen

Question 46

What is pernicious anaemia

Answer 46

Autoantibodies against parietal cells in stomach - reduced intrinsic factor reduced vit B12 macrocytosis

Question 47

Where does CCK act in pancreas

Answer 47

acincar cells

Question 48

Where does secretin act in pancreas

Answer 48

duct

Question 49

Vasoactive intestinal peptide

Answer 49

Relaxes smooth muscle Vasodilation of blood cells Decrease gastric motility and secretions

Question 50

Glucose dependent insulinotropic peptide Gastric inhibitory peptide where is it secreted from

Answer 50

K cells upper part of SI

Question 51

GIP function

Answer 51

helps release insulin when eaten glucose

Question 52

motilin

Answer 52

Pro - motility from M cells of upper part of SI

Question 53

What is octreotide

Answer 53

mimics somatostatin

Question 54

What is octreotide used for

Answer 54

Treatment for oesophageal varice gastronoma insulinoma glucagonoma

Question 55

What absorbs first - iron folate vit b12

Answer 55

Iron your clothes - iron Fold you clothes - folate then you put them in your closest - cobalamin vit b12