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Flashcards in GI Session 5 Deck (103):
1

What are the causes of GORD?

LOS problems
Delayed gastric emptying --> raised intra-gastric pressure --> increased workload on LOS
Hiatus hernia
Obesity

2

What are the S/S of GORD?

Heartburn
Cough +/- wheeze
Sore throat
Dysphagia
Odynophagia

3

What are the consequences of GORD?

Oesophagitis
Fibrous strictures --> regurgitation
Barrett's oesophagus

4

What Tx can be used for GORD?

Lifestyle modifications: smaller more frequent meals, wait 3 hrs after eating to sleep
Antacids
H2 antagonists
PPIs
Surgery

5

What surgical technique can be used to Tx externae cases of GORD?

Wrap fundus around oesophagus

6

Give an example of a PPI which is slightly more effective than H2 antagonists.

Omeprazole

7

How are H2 antagonists available to pts?

Low does over the counter

8

What is acute gastritis?

Localised/general transient mucosal inflammatory process

9

What causes acute gastritis?

Heavy NSAID use
Excessive alcohol intake
Chemotherapy
Bile reflux in reverse peristalsis of duodenum

10

How does chemotherapy lead to acute gastritis?

Targets rapidly regenerating cells so acts on defence cells in stomach

11

What are the S/S of acute gastritis?

Usually asymptomatic
Pain
N+V
Bleeding

12

When can acute gastritis be fatal?

If generalised gastritis leads to extensive bleeding

13

What is visible on histology in acute gastritis?

Inflammatory cell invasion

14

What are the consequences of acute gastritis?

Stomach ulcer
Polyps
Neoplasm

15

What is the Tx for acute gastritis?

Antacids
H2 antagonists
PPIs
Change away from NSAID painkiller

16

Give two examples of H2 antagonists used to Tx acute gastritis.

Cimetidine
Ranitidine

17

What is chronic gastritis?

Localised/generalised persistent mucosal inflammatory process

18

What are the causes of chronic gastritis?

H.pylori infection
Autoimmun production of antibodies to gastric parietal cells
Chronic alcohol abuse
NSAIDs
Bile reflux

19

What S/S are seen in chronic gastritis due to H.pylori?

Asymptomatic
Similar to acute gastritis
Sometimes due to complications

20

What are the S/S of chronic gastritis due to autoimmune disease?

S/S of aneamia, classically glossitis
Anorexia
Neurological problems e.g. abnormal gait, numbness, tingling

21

What are the consequences of chronic gastritis due to H.pylori?

Peptic ulcers
Adenocarcinoma
MALT lymphoma

22

What are consequences of autoimmune chronic gastritis?

Pernicious anaemia +/- neurological disturbance

23

What causes neurological disturbance in autoimmune chronic gastritis?

Lack of B12 from deficiency in intrinsic factor

24

What is the Tx for chronic gastritis?

Abx if H.pylori (PPI+clarithromycin+amoxicillin)
PPIs
H2 antagonists
Antacids

25

What is dyspepsia?

Umbrella term for upper GI symptoms

26

What is peptic ulcer disease?

Defect in gastric/duodenal mucosa which extends through muscularis mucosa

27

Where are peptic ulcers most commonly found?

First part of duodenum
Lesser curvature of stomach
Body of stomach

28

What are the causes of peptic ulcer disease?

Stomach acid not being removed by adequate mucosal bloodflow
H.pylori
NSAIDs
Massive physiological stress (massive burns/trauma)

29

What effect does smoking have on peptic ulcer disease?

Contributes to relapse but does not initiate disease

30

What are the S/S of peptic ulcer disease?

Asymptomatic
Epigastric pain with burning/gnawing after meals
Bleeding
Anaemia
Early satiety
Weight loss

31

What are the consequences of peptic ulcer disease?

Posterior erosion into gastroduodenal artery --> massive haematemisis
Melaena
Perforation --> peritonitis +/- sepsis
Gastric outlet obstruction

32

What Tx can be used for peptic ulcer disease?

Abx, PPIs, H2 antagonists, antacids

33

What is functional dyspepsia?

Symptoms of peptic ulcer without physical evidence of organic disease

34

Why is functional dyspepsia a diagnosis of exclusion?

Blood tests -ve for anaemia
Endoscopy -ve

35

What Tx are used for functional dyspepsia?

PPIs

36

What aids the survival of H.pylori in the stomach?

Production of urease to create alkaline surroundings
Flagellum for motility in gastric mucosa
Flagellum for adherence to gastric epithelium

37

How does H.pylori damage the host?

Release cytokines --> direct epithelial injury
Production of toxic ammonia
Possible degradation of mucus layer
Promotion of inflammatory response --> self-injury

38

What is the result of H.pylori colonisation in the body of the stomach?

Atrophic effect --> gastric ulcer --> intestinal metaplasia

39

What is the effect of H.pylori colonisation in the antrum?

Increase gastrin
Increase parietal cell acid production

40

When are H.pylori found in the duodenum?

Only after metaplasia to gastric epithelium

41

What is the result of H.pylori colonisation of the duodenum?

Ulcer formation

42

What is Zollinger-Ellison syndrome?

Non-beta islet cell gastrin secreting tumour of the pancreas such may also be in duodenum/abdomen/lymph nodes/ectopic

43

What is the pathogenesis of Zollinger-Ellison syndrome?

Proliferation of parietal cells --> increased acid production --> severe stomach and small bowel ulceration

44

What are the S/S of Zollinger-Ellison syndrome?

Abdominal pain
Diarrhoea
Malabsorption

45

What syndrome can Z-E form part of?

Autosomal dominant familial Multiple Endocrine Neoplasia Type 1 (MEN1)

46

What Tx can be used for Z-E syndrome?

PPI and H2 antagonists before surgery/chemotherapy
Octneotide (mimics somatostatin)

47

Describe the epidemiology of stomach cancer.

3rd most common cancer in the world
~7000 new cases per year in the UK
High rates in Chile, Japan and South America

48

Why does stomach cancer usually present late?

Has to be quite large before it becomes symptomatic

49

What are the risk factors for developing stomach cancer?

Male
H.pylori
High salt intake
Smoking

50

What are the S/S of stomach cancer?

Dysphasia
Loss of appetite
Malaena
Weightloss
N+V
Virchow's nodes

51

What are Virchow's nodes?

Palpable node in L supra clavicular fossa MCL

52

What types of stomach cancer are seen?

Majority adenocarcinomas - intestinal/diffuse
Small numbersof lymphomas, carcinomas, stromal tumours

53

How is stomach cancer diagnosed?

Bloods for tumour markers
Upper GI endoscopy +/- biopsy
CT scan

54

What is the Tx for stomach cancer?

Endoscopic mucosal resection in very early detection
Surgery/chemo/radiotherapy

55

How can diagnosis of GI pathology be made?

Upper GI endoscopy
Urease breath test (measure exhaled radiolabelled carbon)
Erect CXR (space under diaphragm = perforation)
Blood test (anaemia)

56

What is the function of the hepatic artery proper?

Supplies liver with arterial blood from coeliac trunk

57

How is lymph drained from the liver?

Hepatic lymph nodes along vessels and ducts in the lesser omentum --> coeliac nodes

58

What are the ligaments of the liver?

Falciform
L+R coronary
L+R triangular

59

What is the function of the falciform ligament?

Attach anterior lover surface to anterior abdominal wall

60

What does the free edge of the falciform ligament contain?

Ligamentum teres

61

What is the ligamentum teres?

Remnant of the umbilical vein

62

What is the function of the L+R coronary ligaments of the liver?

Attach superior surface to diaphragm

63

What is the function of the L+R triangular ligaments of the liver?

Attach superior liver to diaphragm

64

What innervates Glisson's capsule?

Branches of lower intercostal nerves

65

Does distension of Glisson's capsule cause well localised or diffuse pain?

Sharp, well-localised

66

What is the function of the hepatic portal vein?

Supply deoxygenated blood with nutrients from the small intestine to the liver parenchyma for gut-related functions

67

What two ligaments that attach to the liver are found in the lesser omentum?

Hepatoduodenal
Hepatogastric

68

On postero-inferior views of the liver is the caudate or quadrate lobe more superior?

Caudate

69

Where is the caudate lobe of the liver located?

Between IVC and ligamentum venosum fossa

70

What is the function of the porta hepatis?

Transmit all vessels, nerves, ducts in and out of the liver

71

What are the four lobes of the liver?

L, caudate, quadrate, R

72

What separates the L lobe from the caudate and quadrate lobes?

Umbilical (L sagittal) fissure

73

What forms the R portal fissure?

Position of R hepatic vein

74

What separates the R lobe form the caudate and quadrate loves of the liver?

R sagittal fissure

75

Where is the quadrate lobe of the liver located?

Between gallbladder and ligamentum teres fossa

76

What is found between the R+L coronary ligaments, L triangular ligament and IVC?

Bare area

77

Which 3 hepatic veins drain into the IVC?

Right, intermediate and left

78

What helps to hold the liver in place?

3 hepatic veins draining into IVC in groove of liver

79

What is in the portal triad?

Portal vein
Hepatic artery
Bile passages

80

How is the liver parenchyma innervated?

Hepatic plexus
Sympathetic coeliac plexus
Parasympathetic vagus nerve fibres

81

What are the three hepatic recesses?

L+R subphrenic spaces
Sub hepatic space
Morrison's pouch

82

Where are the L+R subphrenic spaces?

Between diaphragm and lover either side of falciform ligament

83

Where os the subhepatic space?

Between inferior surface of liver and transverse colon

84

Where is Morrion's pouch?

Between visceral surface and R kidney

85

Why does fluid collect in Morrison's pouch when bedridden?

Deepest part of peritoneal cavity when supine

86

What is the result of infected fluid collection in the hepatic recesses?

Abscess

87

Where is Hartmann's pouch?

Neck of gallbladder

88

What is Hartmann's pouch?

Mucosal fold which is a common site of gallstone lodging

89

What perforates the gallbladder when it is in the fossa in the liver?

Cystic veins

90

What does the duodenum secrete to stimulate bile secretion?

CCK

91

Give a brief structure of the biliary tree.

R+L hepatic ducts--> common hepatic duct + cystic duct --> common bile duct + pancreatic duct --> hepatopancreatic Ampulla of Vater controlled by Sphincter of Oddi

92

What gives arterial supply to the gallbladder?

Common hepatic --> hepatic artery --> cystic artery

93

What gives venous drainage to the gallbladder?

Cystic vein --> portal vein

94

What gives neural supply to the gallbladder?

Coeliac plexus (sympathetic and sensory fibres)
Vagus nerve (parasympathetic)

95

What is the action of vagus nerve stimulation of the gallbladder?

Contraction and secretion of bile into cystic duct

96

How is lymph drained from the gallbladder?

Cystic node in gallbladder neck --> hepatic lymph node --> coeliac node

97

Describe the branches of the hepatic portal vein.

SMV+splenic vein --> hepatic portal vein --> R+L branches --> secondary branches to medial and lateral divisions --> tertiary branches to supply 7 out of 8 hepatic segments

98

Are gallstones more common in males or females?

Females

99

Where is the head of the pancreas located?

Curve of duodenum

100

Where is the neck of the pancreas positioned?

Overlies SMA+V with anterior surface adjacent to Pylorus of stomach

101

Where is the body of the pancreas located?

Left of SMVA+V in omental bursa

102

Does the posterior surface of the pancreatic body have peritoneum?

No

103

Where is the pancreatic tail positioned?

Anterior to L kidney between layers of splenorenal ligament