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Y2 - GI > GI Revision Lectures > Flashcards

GI Revision Lectures Flashcards

1
Q

What week does the buccopharyngeal membrane rupture at?

A

Week 4

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2
Q

What week does the cloacal membrane rupture at?

A

Week 7

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3
Q

What part of the gut gives rise to the respiratory tract?

A

Foregut

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4
Q

What structure cleaves off the ventral bud to form the trachea?

A

Tracheoesophageal septum

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5
Q

What is Gastroschisis?

A

When abdominal contents herniate out without being covered by peritoneum

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6
Q

What week does recanalisation happen?

A

Between week 8-10

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7
Q

What are thee intraperitoneal organs?

A

Stomach
Appendix
Liver
Transverese colon
Duodenu
Small intestine
Pancreas (tail)
Rectum
Spleen
Sigmoid colon

SALTDSPRSS

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8
Q

What is the connection between the greater and lesser sac?

A

Foramen of Winslow

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9
Q

What mesentry does the liver form in?

A

Ventral mesentry

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10
Q

What mesentry does the spleen develop in?

A

Dorsal mesentry

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11
Q

What blood vessel does the small intestine and large intestine rotate around/use as an axis of rotation?

A

Superior Mesenteric Artery

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12
Q

What is the name of the condition where the gut contents fail to return back to the abdomen after being pushed through the umbilicus?

A

Omphalocele (contents covered in peritoneum)

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13
Q

What intestine sits above the SMA before roatition and below?

A

Above = small
Below = large

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14
Q

What enzymes are released with hepatocyte damage?

A

ALT
AST

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15
Q

What enzymes are elevated with biliary duct damage and bone damage?

What enzymes shows a raised ALP is due to biliary duct damage?

A

ALP

GGT

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16
Q

What gives colour to urine?

A

Conjugate bilirubin

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17
Q

What is the main cause of pre-hepatic jaundice?

A

Haemolytic anaemias (excess haemolysis)

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18
Q

What levels of bilirubin are high with pre-hepatic jaundice?

A

UNCONJUGATED bilirubin

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19
Q

Go to slide 29 and identify the causes of pre-hepatic jaundice on blood films 1 and then 2:

A

1 = hereditary Spherocytosis

2 = Microangiopathic haemolytic anaemia (like DIC, can see schistocytes)

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20
Q

What is hepatic jaundice?

A

When the liver is damaged reducing the Hepatocyte eats ability to conjugate bilirubin

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21
Q

What levels of bilirubin I’ll be high in hepatic jaundice?

A

Both conjugated and UNCONJUGATED bilirubin

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22
Q

What can cause hepatic jaundice?

A

Paracetamol OD
Wilsons disease (see Fleischers ring (brown ring around iris)
Alcoholic liver disease
Cirrhosis

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23
Q

What is post hepatic jaundice?

A

Anything that obstructs thhe pathway preventing conjugated bilirubin from reaching the intestine

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24
Q

What levels of bilirubin will be raised in post hepatic jaundice?

A

Conjugated bilirubin (makes the urine dark and stools light)

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25
What are the 5 Fs for the risk factors of gall stone formation?
Fat Femal Forty Fertile FHx
26
What can form gallstones?
Cholesterol Bile pigment Mixture of both
27
What is biliary colic?
The pain that comes in waves from gallstones
28
What causes biliary colic?
Cholecystokinin released by small instance during digestion CCK causes contraction of gall bladder to release stored bile Gallstones irritation the entrance of the gall blade as the stone pushes against it
29
Where is the pain in biliary colic?
RUQ
30
What is cholecystitis?
When na gallstone becomes stuck in the cystic duct Fluid stasis inside gall bladder leads to inflammation and infection of the gallbladder causing pain in RUQ and fever
31
What is Murphys sign?
When you palpate the RUQ and ask the patient to breathe in Pain I causes arrest of inspiration indicating cholecystitis
32
What is ascending cholangitis?
Gallstone becomes stuck in CBD Causes inflammation and infection of the biliary system
33
What is the triad for ascending cholangitis?
Charcots triad
34
What ae the 3 signs of Charcots triad indicating ascending cholangitis?
Fever Jaundice RUQ pain
35
What causes acute pancreatitis?
Pancreatic duct obstructed Enzymatic autodigestion occurs
36
What type of pain is seen in acute pancreatitis?
Epigastric pain radiating to the back
37
What are some causes of acute pancreatitis?
Gallstones Ethanol Trauma Autoimmune Drugs
38
What are some signs of acute pancreatitis>
Cullens sign Grey turners sign
39
What is Cullen’s sign (acute pancreatitis) ?
Bruising around umbilicus
40
What is grey turners sign (acute pancreatitis)?
Bruising on flank
41
How do you invest age cholecystitis and ascending cholangitis?
Ultrasound of abdomen Magnetic resonance cholangiopancreatography
42
How do you manage cholecystitis and ascending cholangitis?
IV fluids IV antibiotics Laparoscopic cholecystectomy Endoscopic retrograde cholangiopancreatography
43
What test is done for acute pancreatitis?
Serum AMYLASE (+ lipase) the pancreatic enzymes USS abdo CT abdo and pelvis
44
How do you manage acute pancreatitis?
IV fluids Endoscopic retrograde cholangiopancreatography Laparoscopic cholecystectomy
45
What triad can be used to diagnose ascending cholangitis?
Charcots triad
46
What it’s the definition of cirrhosis?
Progressive fibrotic changes within hte liver de to damage that has occured over a number of years
47
What is meant by saying the liver is decmopensated in cirrhosis?
Liver can no longer be able to function
48
What are some preventable causes of liver cirrhosis?
Alcohol Non alcohol related fatty liver disease (obesity or T2DM) Hepatitis B/C, CMV, EBV
49
what are some non preventable causes of cirrhosis?
Wilsons disease, hereditary Haemochromatosis, Autoimmune - primary sclerosing cholangitis, autoimmune hepatitis alpha 1 antitrypsin disease
50
What are some signs of chronic liver disease/cirrhosis?
Leukonichia (whitening of nails) Hepatic flap (sign of due compensation) Palmar ertythema Jaundice Ascites Caput medusa Spider naevi Hepatic encephalopathy (confusion)
51
How can you treat the Ascites from chronic liver disease?
Diuretics like furosemide and Spironolactone
52
How can you help prevent variceal formation (caput medusa, oesophageal Varices)?
Beta blockers Regular oesophageal disease surveillance
53
What drugs can be given to help treat hepatic encephalopathy? How do they work?
Lactulose Rifaximin Reduce the amount of ammonia reabsorbed into the body
54
Why do you need to do 6 monthly ultrasound on patients with chronic liver disease/cirrhosis?
Increased risk of hepatocellular carcinoma
55
What symptoms do you get due to decreased protein synthesis on chronic liver disease?
Bleeding/easy bruising = less clotting factors Ascites = low albumin
56
What symptoms are caused by decreased breakdown by the h liver?
Encephalopathy = due to inc ammonia Jaundice = inc bilirubin
57
What is a diverticulum?
Small outpouching of large intestine
58
What is diverticulosis?
The presence of diverticula Is an asymptomatic disease
59
What is the most common location of diverticula to form?
Large colon (sigmoid colon)
60
What is diverticula disease?
Having symptoms but not having infectio nor inflammtion
61
What is diverticulitis?
When a single diverticulum/a become inflammed or infected
62
What are the symtoms of acute diverticulitis?
Abdominal pain on left hand side Fever Bloating + constipation Haemotochezia (blood in stool)
63
What are the complications of diverticulitis?
Haemorrhage Fistula Inflammation Abscess Perforation (can lead to peritonitis)
64
What investigations are done for diverticulitis?
Blood tests USS Colonoscopy CT Pregnancy test
65
How is acute diverticulitis managed?
Abx Fluid resus Analgesia If complicated surgery (partial colectomy)
66
Why can the location of pain for appendicitis differ?
Different positions possible
67
What are the possible locations for the appendix?
Pelvic Retrocaecal Post ileal Pre-ileal Sub Cecil
68
What are the 3 stages to appendicitis?
Acute (mucosal oedema) Gangrenous (transmural inflammtion and necrosis) Perforated
69
What causes appendicitis?
Faecoltih blocks appendix Inc venous pressure then makes harder for arterial blood to supply leading to ischaemic damage then bacteria can invade
70
What causes appendicitis?
Faecoltih blocks appendix Inc venous pressure then makes harder for arterial blood to supply leading to ischaemic damage then bacteria can invade
71
How does the pain change as the appendicitis develops?
More diffuse at start when inflamed appendix compresses visceral peritoneum As it becomes larger becomes more localised as it compresses parietal peritoneum Pain goes from supra pubic region to right iliac fossa
72
How does appendicitis presetn?
Sudden right sided pain of abdominal Fever Constipation or diarrhoea Loss of appetitie Nausea and vomiting
73
What point do you palpate/rebound tenderness for appendicitis?
McBurney’s point
74
Where is McBurney’s point?
2/3s distance from umbilicus to right ASIS
75
How is appendicitis treated?
Laparoscopic appendectomy
76
How can you tell you are looking and small bowel in a radiograph?
Central Full thickness Plica circularis
77
How can you tell you are looking and large bowel in a radiograph?
Peripheral Non full thickness haustral folds
78
What can cause small bowel obstruction?
Adhesions Hernias Crohns
79
What can cause obstruction of the large bowel?
Cancer (colorectal most common) Diverticular disease Volvulus
80
What type of sign is seen on a radiograph with a volvulus?
Coffee bean sign
81
Where is the most common location for a volvulus?
Sigmoid colon
82
What is intussusception?
Part of the gut type telescopes into the distal section
83
How does intussusception cause ischaemia?
Compression impairs lymphatic drainage Pressure increases then arterial insufficiency leading to ischameia
84
What is visible on a CXR if the bowel is perforated?
Air under diaphragm
85
Go to the last slide and look at image 1: What vertebral level are is this taken at?
L1 or L2
86
What is bright white in a Type 2 MRI?
Water H20
87
What artery can be perforated by a peptic ulcer perforating posteriorly?
Gastroduodenal artery Splenic artery perforation would be a very end stage of the perforation
88
Go to last slide image 2: What is this sign? What does it indicate?
Coffee bean sign Volvulus
89
Look at last slide: Image 3, what bowel is obstructed?
Small intestine
90
Look at last slide: Image 4 what bowel is obstructed?
Large bowel
91
Why can patients with ALD develop hepatic encephalopathy?
Build up of ammonia in blood travellling to brain
92
What is going to be raised in a patient that is jaundiced with haemolytic anaemia?
UNCONJUGATED bilirubin
93
Where is a gallstone likely to be when a patient has yellow sclera, dark urine, pale stools?
Distal commmon bile duct
94
What part of hte colon do diverticular typically form?
Sigmoid colon
95
Where is appendicitis pain localised to?
Right iliac fossa
96
Look at image 2 on the last slide: What type of volvulus is this?
Sigmoid volvulus
97
What is Murphy’s sign indicative of?
Acute cholecystitis

Y2 - GI (35 decks)

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