GI tract Flashcards
(377 cards)
1
Q
How is the stomach lining protected against autodigestion?
A
gastric lining is protected by:
- mucus secreted by surface epithelial and mucous neck cells
- bicarbonate secreted by epithelial cells under mucous layer
these processes are prostaglandin-dependent so using NSAIDs inhibits them and increases risk of gastritis and ulcers
2
Q
what are the phases of regulation of gastric acid secretion and stomach emptying?
A
cephalic phase
gastric phase
intestinal phase
3
Q
what stimulates the cephalic phase?
A
sight, smell, taste and thoughts of food activates the parasympathetic nervous system
4
Q
what happens in the cephalic phase?
A
stimulus activates the submucosal plexus which causes the secretion of mucus from mucus cells, pepsinogen and HCl from parietal cells
Gherlin is also released from stomach when it is empty and acts on hypothalamus to stimulate appetite, gastric secretions and motility
5
Q
16SrRNA sequencing
A
for identifying bacteria - new species
6
Q
what stimulates the gastric phase?
A
process of food entering the stimulates stretch receptors in the stomach
7
Q
what happens in the gastric phase?
A
stretch receptors activate the submucosal plexus, myenteric plexus and parasympathetic nervous system - vagus nerve
submucosal plexus = causes the release of mucus, pepsinogen, HCl and gastrin
myenteric plexus increases the contractions of stomach
presence of gastrin and vagus nerve causes release of histamine
8
Q
what does histamine do?
A
stimulates the parietal cells to release more HCl
9
Q
where is mucus produced?
A
mucous cells of stomach
10
Q
where is pepsinogen produced?
A
chief cells of stomach
11
Q
where is gastrin produced?
A
G cells of stomach
12
Q
where is somatostatin produced?
A
D cells of stomach
13
Q
where is HCl produced?
A
parietal cells of stomach
14
Q
where is intrinsic factor produced?
A
parietal cells of stomach
15
Q
what stimulates the intestinal phase?
A
process of chyme being in duodenum activating duodenal stretch receptors and chemoreceptors
16
Q
what happens in the intestinal phase?
A
stretch receptors and chemoreceptors stimulate myenteric plexus and release of inhibitory hormones
myenteric plexus is inhibited by this process, reducing contraction and motility
small intestine releases secretin, somatostatin, leptin and CCK
17
Q
secretin
A
released from S cells in response to low pH which stimulates pancreatic and bile secretions
18
Q
somatostatin
A
released from D cells
inhibits chief cells, reducing the concentration of pepsinogen and inhibits parietal cells, reducing secretion of HCl
19
Q
leptin
A
released by adipose tissue, acts on hypothalamus to suppress appetite and regulate adipose tissue mass
20
Q
CCK
A
released from I cells which causes the gallbladder to contract to release bile from gallbladder and stimulates pancreatic secretions
21
Q
stomach motility
A
- pacemaker cells initiate weak peristaltic waves that move towards antrum and last 15-20 seconds
- peristaltic wave reaches antrum and intensity of contraction increases, causing contents within antrum to become under higher pressure
wave continues towards the pylorus, digging deep into the food
wave continues to pylorus, which contracts preventing the majority of contents from entering duodenum so only a few ml of chyme enter duodenum with each mixing wave
forces contents of antrum back up to main body of stomach - retropulsion
22
Q
retropulsion
A
important for mixing of stomach contents
takes around 1-3 hours to empty stomach
23
Q
what factors inhibit the stomach emptying?
A
factors that inhibit stomach motility and secretions are caused by food entering duodenum:
- duodenal distension
- irritation of duodenal mucosa
- lipids, fatty acids, proteins and CHO
- acidity - pH>3.5-4
- increase in osmolarity
myenteric reflex - stretching of stomach promotes and increases pyloric pump and inhibits pylorus tone
CCK, GIP and secretin are released to inhibit
24
Q
GIP
A
gastric inhibitory polypeptide
25
what mediates the vomiting centre?
histamine - H1 and serotonin 5-HT3
26
what are the vomiting trigger zones?
chemoreceptor trigger zone in medulla oblongata
cortex
labyrinth - vestibular nuclei
GI receptors to nucleus tractus solitarius to vomiting centre
27
chemoreceptor trigger zone in medulla oblongata
mediated by dopamine - D2 and histamine - H1
| triggered by chemotherapy, opioids and anaesthetics
28
cortex
triggered by smell, sight and anxiety
29
Labyrinth
vestibular nuclei
mediated by ACh M1 and histamine H1
triggered by motion and anaesthetics
30
GI receptors
to nucleus tractus solitarius to vomiting centre
mediated by serotonin - 5-HT3
triggered by distension and toxins
31
how does emesis occur?
held inspiration/ breath held which increases abdominal pressure
glottis closes preventing aspiration
duodenum contracts, blocking transit of contents in the stomach
gastro-oesophageal sphincter relaxes
abdominal wall contracts abruptly
causing gastric contents to be ejected forcefully
32
what is the function of the small intestine?
continued digestion and absorption of nutrients
90% of nutrient absorption occurs here
most occurs in first 1/4 of small intestine - duodenum and jejunum
33
what are the sections of the small intestine?
3:
- duodenum
- jejunum
- ileum
34
what does the duodenum receive and from what?
receives secretions from the liver, gallbladder and pancreas
35
what breaks down sucrose?
sucrase-isomultase - brush border enzyme
36
what are the types of lipases?
lingual lipase
gastric lipase
pancreatic lipase
lipoprotein lipase
37
what does lipoprotein lipase do?
breaks down chylomicrons into free fatty acids in blood vessels and lymphatic vessels
38
Lipoproteins
involved in transport of lipids:
- chylomicrons
- very low density lipoproteins
- intermediate density lipoproteins
- low density lipoproteins
- high density lipoproteins
39
chylomicrons
transports dietary triglycerides to peripheral tissues
40
very low density lipoproteins
transports endogenous to peripheral tissues
41
low density lipoproteins
transports cholesterol to peripheral tissues and can cause atherosclerosis
42
high density lipoproteins
transports cholesterol from peripheral tissues to liver
43
what is the function of the pancreas?
involved with secreting substances for digestion
44
what exocrine substances does the pancreas secrete?
```
bicarbonate
enzymes in response to secretin and CCK:
- trypsin
- chromotrypsin
- carboxypeptidase
lipase
- amylase
- ribonuclease
```
45
bicarbonate
released by ductular cells to provide optimum pH for enzyme activity
46
trypsin
released by acinar cells
| activated by enteropeptidase
47
chromotrypsin
released by acinar cells
48
carboxypeptidase
breaks down proteins and released by acinar cells
49
what cells produce lipase, ribonuclease, deoxyribonuclease and amylase
acinar cells of pancreas
50
ribonuclease and deoxyribonuclease
break down nucleic acids
51
endocrine pancreas
```
secretes:
insulin
somatostatin
glucagon
pancreatic polypeptide
ghrelin
```
52
insulin
beta cells
53
somatostatin
D cells
54
glucagon
Alpha cells
55
pancreatic polypeptide
F cells
56
what is bile made up of?
bile salts, lecithin - phospholipids, bicarbonate ions and cholesterol
57
how much bile is produced daily?
3-4g
58
what does the liver and gallbladder secrete?
bile
cholesterol
bile pigments - including metabolic end products
trace metals
59
what are the main functions of the liver?
```
carbohydrate, amino acid and lipid metabolism
drug/ toxin metabolism
synthesis of proteins - albumin and coagulation factors
synthesis and secretion of bile
storage of vitamins and minerals
immune regulation
glycogenolysis and glyconeogenesis
involved in metabolism of LDL and HDL
```
60
role of liver in clotting cascade
makes clotting factors
| vitamin K dependent factors - 10,9,7,2
61
bilirubin metabolism
RBCs broken down into free haemoglobin in kidneys
free heamoglobin is broken down at liver, kidneys and bone marrow into haem and globin
globin broken down into amino acids and recycled
haem is broken down into biliverdin and iron
iron is recycled
biliverdin converted to unconjugated bilirubin > conjugated bilirubin in liver
bilirubin secreted into bile and into duodenum via biliary tree
bilirubin reabsorbed from GI tract and enters enterohepatic circulation back to liver, it is filterd from kidneys into urobilin and some bilirubin remains in GI tract
forms sterocobilin - faeces
62
liver role in drug metabolism
principle site of drug metabolism:
•Drugs (orally taken) are absorbed in the gut and pass to the liver via the portal vein.
•The drugs undergo 'first pass metabolism' before entering the systemic circulation.
-Cytochrome P450 enzymes are abundant in the liver, they are involved in drug metabolism. Such reactions include oxidation, hydrolysis and hydroxylation.
63
role of liver in vitamins and minerals
stores vitamin B12, A, D in large amounts
stores vitamin K and folate in small amounts
stores minerals like iron and copper
64
parts of the large intestine
```
cecum
ascending colon
transverse colon
haustra
descending colon
sigmoid colon
rectum
```
65
functions of the large intestine
reabsorption of water and some nutrients
| •Storage and compaction of faecal material prior to defacation
66
defecation reflex
the mass movement of faeces, which has been caused by the stretch of the rectum which causes the internal anal sphincter to relax and the rectum and sigmoid colon to contract. If the external anal sphincter is relaxed, defecation occurs.
67
what are the functions of the gut microbiome?
* Metabolise, digest, ferment CHOs and lipids which aid absorption.
* Synthesis vitamins such as vitamin B and vitamin K.
* Protect the gut from pathogens and are involved with developing the immune system.
68
main cause of stomach ulcers
helicobacter pylori
69
what is the microbiome?
all the microorganisms in an environment
70
what is the microbiota?
microorganisms themselves in a microbiome
71
what is species richness?
how many species
72
what is species eveness
measure of evenness
73
how can microbiome affect change of developing health conditions?
* C-section leads to increased asthma and obesity (diff microbes break down sugars, gut handling of sugar and appetite) (diff microbiome).
* Bacteria can affect immunity.
* Autism.
* Cancer.
* Bacterial vaginosis.
* Liver disease.
* MS.
* Depression/stress.
* Rheumatoid arthritis.
74
what factors affect the microbiome?
* Diet.
* Antibiotics.
* Animals.
* Human genetics.
* Sleep deprivation.
* Stress.
* Occupation.
* Local environment.
* Physical interaction.
75
what are the functions of the liver?
```
metabolism of drugs
produces bile
glycogen storage
synthesis of clotting factors
deamination of amino acids
production of proteins, such as albumin
storage of vitamins and minerals
carbohydrate, amino acid and lipid metabolism
```
76
what makes up the liver?
liver lobules
77
liver lobules
make up liver segments
6 acinus make up one lobule
contain portal triad
78
what makes up the portal triad?
hepatic artery
hepatic portal vein
bile duct
79
how many acinus zones are there?
3 zones, relative to the portal tract and have different metabolic functions
80
what are the acinus
zone 1
zone 2
zone 3
81
acinus zone 1
closest to oxygenated blood supply, nutrients and toxins
| these cells are more metabolically active
82
acinus zone 3
furthers from the portal tracts and closest to the central vein
deal with hypoxia and have lower concentration of nutrients and toxins
83
liver cells
hepatocytes, carry out the major functions of the liver
84
what are the different types of liver cells?
sinusoidal epithelial cells
kupffer cells
stellate cells
85
sinusoidal epithelial cells
line sinuses between hepatocytes
86
kupffer cells
macrophages
remove bacteria from blood
remove haemoglobin from the blood
87
stellate cells
store vitamin A
| produce collagen and extracellular matrix
88
flow of bile through the liver
bile synthesised by hepatocytes
secreted into bile canaliculi
canaliculi merge and drain into bile ductile and then larger ducts
bile goes from right and left hepatic duct
enters common hepatic duct and joins with cystic duct to form the common bile duct which enters the duodenum
89
fatty acids as an alternative fuel
used by heart and skeletal muscle
| converted by beta oxidation to acetyl coenzyme A and used by krebs cycle
90
ketone bodies
produced from fatty acids in liver
91
starvation
lack of fuel rather than a water/ electrolyte deprivation
92
responses to starvation
production of more glucose by glycogenolysis and gluconeogenesis
or other sources:
- lactate
- amino acids - ketone bodies which can then be used by the brain to maintain consciousness without glucose
glycerol and fatty acids
93
what hormones regulate starvation?
glucagon
cortisol
adrenaline
94
what are the main sources of glycogen?
fat
muscle
liver
95
body's response to high glucose
insulin released from beta cells in islets of langerhands in pancreas
96
what does insulin do?
glycogenesis
lipogenesis
protein synthesis
anabolism
97
use of ketone bodies
used mostly by brain tissues as they can cross the BBB and then be converted back to acetyl coenzyme A and enter krebs cycle
98
what are the 4 quadrants of the abdomen?
right and left upper quadrants
| right and left lower quadrants
99
what are the 9 sections of the abdomen?
```
right and left hypochondrium
epigastric
right and left flank/ lumbar
umbilical
right and left groin/ inguinal
pubic
```
100
what does glucagon do?
released from alpha cells
causes glycogenolysis - only occurs fully in liver as muscles lack glucose-6-phosphatase
only occurs for 24 hours
101
what does adrenaline do?
lipolysis
102
what does cortisol do?
gluconeogenesis in liver using:
- lactate
- amino acids
- triglycerides
103
liver function tests
```
ALT - alanine aminotransferase
AST - aspartame aminotransferase
Alk P - alkaline phosphatase
Gamma-GT - gamma glutamyltransferase
albumin
bilirubin
```
104
ALT liver function test
liver cell damage
| could indicate cardiac or skeletal damage
105
AST liver function test
liver cell damage
| could indicate cardiac or skeletal damage
106
AST>ALT
cirrhosis
107
Alk P
biliary tree blockage
| may be due to bone disease or from placenta
108
Gamma-GT
biliary tree blockage, may be due to chronic drug exposure - alcohol or anticonvulsants
109
albumin
impaired synthetic function
| may be decreased in malnutrition, sepsis or major trauma
110
bilirubin
disturbance of bilirubin handling
| may be from myoglobin break down - muscle damage
111
grouping of liver function tests
liver injury - ALT, AST, Alk P and Gamma-GT
liver synthesis - albumin
liver excretion - bilirubin
112
cori cycle
lactate created by anaerobic respiration is transported from muscles to liver
converted to pyruvate
which is converted to glucose - requiring ATP
glucose can then be used by other tissues
113
lipolysis
triglycerides are broken down into fatty acids, used directly, broken down further to form ketone bodies
glycerol used in gluconeogenesis
114
chronic liver disease - blood tests
liver function tests
hepatitis B and C screen
fasting glucose, cholesterol and triglyceride
autoimmune liver screen
immunoglobulins
ferritin, transferrin saturation and iron studies
alpha 1 trypsin
TSH
anti-TTG - coeliac screen
caeruloplasma/ serum copper screen in young
115
autoimmune liver screen
ANA
SMA
LKMA
AMA
116
immunoglobulins in chronic liver disease testing
IgG
IgM
IgA
117
chronic liver disease imaging
liver ultrasound
liver CT triple phase
fibroscan
118
liver ultrasound
texture
focal lesions, assess portal vein for thrombus
flow rate - portal hypertensions
splenomegaly
119
liver CT triple phase
looks for liver masses
120
fibroscan
measures stiffness of liver
121
diagnosis of chronic liver disease
blood tests
imaging
liver biopsy
122
liver biopsy
used to determine cause of cirrhosis/ degree of liver damage if uncertain
conducted by percutaneous methods or transjugular methods
123
how to manage chronic liver disease acutely
treat cause of decompensation - alcohol, infection or bleed
ascitic tap if ascites present to rule out spontaneous bacterial peritonitis
diuretics
ascitic drain
check INR - vitamin K >1.4
UGI endoscopy if bleeding/ varices
give banding/ beta blockers
lactulose / enemas to prevent encephalopathy
if acute kidney injury give terlipressin
124
terlipressin
human albumin solution
125
long term management of chronic liver disease
- treat underlying cause of liver disease and liver biopsy if unsure
- alcohol cessation
- lactulose and rifaximin to excrete ammonia
- nutrition
- diuretics
- beta blockers if varices
- liver transplant
- prophylaxis for spontaneous bacterial peritonitis
126
causes of jaundice
pre-hepatic haemolysis
hepatic
post-hepatic
127
pre-hepatic haemolysis
when RBCs are broken down in kidney
128
hepatic
hepatocytes impairment when the liver cannot convert unconjugated bilirubin into conjugated bilirubin
129
post-hepatic
biliary stasis - when the bilirubin cannot get into GI tract via biliary tree and goes into blood instead
130
causes of liver disease
alcohol
obesity
hepatitis B and C
131
risk factors of liver disease
alcohol
blood transfusions - hepatitis
high BMI
132
signs and symptoms of liver disease
Ascites - fluid in the abdomen and increased oedema.
•Anaemia.
•Haemotemesis.
•Itchy.
•Confusion.
•Chest - gynaecomastia and spider naevae.
•Hands - palmar erythema, leukonychia (white nails) and clubbing.
•Abdomen - hepatomegaly. Splenomegaly and caput medusae (bobbly looking swollen veins).
•Legs - oedema.
•Eyes/skin - jaundiced, loss of hair and bruising.
133
HELLP syndrome
severe variant of advanced pre-eclampsia with 3 features
134
3 features of HELLP syndrome
haemolysis
elevated liver enzymes
low platelet count
135
signs and symptoms of HELLP syndrome
```
Raised blood pressure.
•Oedema.
•Proteinuria.
•Headache.
•Epigastric pain.
•Poor fetal growth.
•Massively raised AST and ALT.
•Raised mixed bilirubin.
•Lowered haemoglobin.
•Lowered platelets.
•Raised creatinine.
```
136
treatment for HELLP syndrome
* Magnesium to prevent maternal seizures.
| * Blood or platelet transfusion depending on severity.
137
mortality in HELLP syndrome
high
up to 30% for mother
up to 60% for baby
138
hereditary spherocytosis with haemolysis
t is an inherited condition (autosomal dominant) where red cell wall proteins are abnormal, resulting in an inability to adjust their shape to pass through capillaries.
139
signs and symptoms of hereditary spherocytosis with haemolysis
* LUQ pain (spleen).
* Mild anaemia.
* Jaundice.
* Splenomegaly (Use to fragile red cells being destroyed by the spleen).
* Raised unconjugated bilirubin.
* Lowered haemoglobin.
* Raised reticulocytes
140
treatment for hereditary spherocytosis
transfusion
| splenectomy
141
alcohol cirrhosis with GI bleed cause
excessive alcohol consumption
142
signs and symptoms of alcohol cirrhosis with GI bleed
* History of vomiting blood.
* Increased heart rate.
* Decreased blood pressure.
* Ascites.
* Massively raised Gamma-GT.
* AST > ALT.
* Decreased haemoglobin
* Raised INR.
143
management of alcohol cirrhosis with GI bleed
Fluid resuscitation so give fluids.
•Then correct coagulopathy and endoscopy to try to band or sclerose any Varices.
•Restrict sodium and give diuretics to manage ascites.
•If drastic, abdominal paracentesis may be required, portal vein decompression or liver transplant.
•Abstinence from alcohol is essential.
144
What are the signs and symptoms of a carcinoma of the head of the pancreas?
```
Patient age.
•Weight loss.
•Abdominal pain.
•Palpable gallbladder.
•Deep jaundice.
•Dark urine due to bilirubin being majorly conjugated so urine is dark.
•Light faeces as pigments do not reach the intestine.
•Raised ALT
•Raised Gamma-GT.
•Raised conjugated bilirubin.
•Raised INR.
•Dilated biliary system.
```
Anatomy of
145
who is chronic hep C common in?
homeless and poor people
146
what are the signs and symptoms of chronic hep C?
AST > ALT.
•Raised gamma-GT.
•Anti-HCV positive.
-Can lead to cirrhosis (20-30%) or hepatocellular carcinoma (up to 4%).
147
causes of chronic hep C
blood to blood contact
| usually from needle sharing
148
what is the management of chronic hep C?
antivirals
| abstinence from alcohol
149
what is gilbert's syndrome?
It is an inherited (autosomal recessive) condition where UDP-glucuronosyltransferase is defective (Involved in the glucuronidation pathway).
150
what are the signs and symptoms of gilbert's syndrome?
few and may be unnoticed for years
- mild jaundice
- exacerbated by illness, fasting or extreme exercise
- raised unconjugated bilirubin
- enzymes normal
151
what is the daily protein allowance?
50g
152
what is primary biliary cirrhosis
It is an auto-immune condition which leads to inflammation and fibrosis of the small intra-hepatic biliary ducts
diagnosis is primary sclerosing cholangitis where biliary obstruction is exta-hepatic
153
what are the signs and symptoms of primary biliary cirrhosis
* Dark urine.
* Splenomegaly.
* Raised ALP.
* Raised Gamma-GT.
* Raised mixed bilirubin.
* AMA positive.
* Biliary dilatation is intrahepatic.
154
what are some complications of primary biliary cirrhosis?
portal hypertension
splenomegaly
oesophageal varices
vomiting large volumes of blood
155
who is at risk of primary biliary cirrhosis?
Female (90%) and usually 40-60.
| -Usually high cholesterol is seen and may lead to nodular xanthomas.
156
what is the treatment for primary biliary cirrhosis?
little treatment available
| liver transplants as last resort
157
vitamin A
retinol
158
sources of vitamin A
```
dairy
egg
fish
liver
vegetables
```
159
signs and symptoms of vitamin A deficiency
xerophthalmia - dryness of conjunctiva and cornea and inflammation
night blindness
keratomalacia
follicular hyperkeratosis - keratin build up around hair follicles
160
calories in carbohydrates
4kcal/ g
161
calories in fat
9kcal/g
162
calories in protein
4kcal/ g
163
vitamin D
cholecalciferol
164
sources of vitamin D
fish
| egg
165
signs of vitamin D deficiency
rickets
| osteomalacia
166
what are macronutrients?
larger energy yielding nutrients - carbohydrates, proteins and lipids
non-energy nutrient = fibre, helps with digestion
167
what are micronutrients?
smaller non-energy yielding nutrients such as vitamins and minerals
168
basal metabolic rate
rate at which body expends energy for maintenance activities
169
how is basal metabolic rate calculated for women?
•BMR for Women = 65.51 + (9.6 x weight [kg]) + (1.8 x height [cm]) - (4.7 x age [years]).
170
how is basal metabolic rate calculated for men?
•BMR for Men = 66.47 + (13.7 x weight [kg]) + (5 x height [cm]) - (6.8 x age [years]).
171
what is EER?
estimated energy requirement
the average dietary energy intake that will maintain energy balance in a healthy person of a given age, gender, height and physical activity level
172
vitamin B6
pyridoxine
173
sources of vitamin B6
meat
| grains
174
signs of vitamin B6 deficiency
polyneuropathy
175
vitamin B9
folate
176
source of vitamin B9
vegetables
177
signs of vitamin B9 deficiency
megaloblastic anaemia
178
vitamin C
ascorbate
179
sources of vitamin C
fresh fruit
180
signs of vitamin C deficiency
scurvy
181
daily carbohydrate allowance
260g
182
signs of sodium/ salt deficiency
fatigue
nausea
cramps
183
what are the sections of the oesophagus?
```
cervical
upper thoracic
middle thoracic
lower thoracic
abdominal
```
184
sources of calcium
dairy
vegetables
cereals
185
signs of deficiency of calcium
problems with bones/ teeth
| clotting
186
daily fat allowance
<70g
| saturates <20g
187
what are the parts of the stomach?
fundus
body
antrum
pylorus
188
peritoneal ligaments
falciform ligament
lesser omentum
greater omentum
189
sources of iron
meat
cereal
veg
190
signs of iron deficiency
microcytic anaemia
191
lesser omentum
made up of hepatogastric and hepatoduodenal ligaments
192
vitamin E
tocopherol
193
source of vitamin E
vegetables
194
vitamin K
quinone
195
source of vitamin K
vegetables
196
signs of vitamin K deficiency
coagulation defects
| neurological defects
197
source of fluoride
fluoridated water
198
sign of fluoride deficiency
tooth decay
199
vitamin B1
thaimin
200
sources of vitamin B1
cereals and nuts
201
signs of vitamin B1 deficiency
beriberi
| wernicke-korsakoff syndrome
202
vitamin B2
riboflavin
203
sources if vitamin B2
liver
| dairy
204
signs of vitamin B2 deficiency
angular stomatitis
205
vitamin B3
niacin
206
sources of vitamin B3
liver and meat
207
signs of vitamin B3 deficiency
pellagra
208
vitamin B12
cobalamin
209
difference between jejunum and ileum structure
jejunum has longer vasa recta and fewer arterial arcades
| ileum has shorter vasa recta and more arterial arcades
210
sources of vitamin B12
meat
fish
eggs
211
signs of vitamin B12 deficiency
megaloblastic anaemia
| neurological deficiencies
212
rectus sheath
contains rectus abdominis
213
what connects part of rectus abdominis?
tendinous intersections
214
what are the tendinous intersections made of?
aponeurosis of transverse abdominis
| internal and external oblique muscles
215
sources of potassium
fruit
veg
dairy
216
signs of potassium deficiency
confusion
weakness
heart failure
217
sources of phosphorus
dairy
meat
fish
eggs
218
anterior lobes of liver
right posterior
right anterior
left medial
left lateral
219
arterial blood supply of GI tract
foregut - coeliac trunk via common hepatic, left gastric and splenic arteries
midgut - superior mesenteric artery
hindgut - inferior mesenteric artery
220
magnesium sources
cereals
fruits
vegetables
221
signs of magnesium deficiency
cardiovascular problems
bone problems
nerve problems
222
venous drainage of GI tract
```
hepatic portal vein
inferior vena cava
foregut - splenic vein
midgut - superior mesenteric vein
hindgut - inferior mesenteric vein
```
223
posterior lobes of liver
left lateral
left medial
right anterior
right posterior
224
innervation of GI tract
autonomic
225
sympathetic innervation of GI tract
```
abdominopelvic splanchnic nerves
lower thoracic splanchnic nerves
greater splanchnic - T5-T9/10
lesser splanchnic - T10-11
lumbar splanchnic - L1-2/3
```
226
parasympathetic innervation of GI tract
vagus nerve
| pelvic splanchnic nerves -S2-4
227
sources of zinc
dairy
egg
fish
cereal
228
signs of zinc deficiency
delayed puberty
| impaired growth
229
vestibule of mouth
space between teeth and the lips and cheeks
230
what is located in the vestibule?
```
superior labial frenulum
inferior labial frenulum
opening of parotid gland
buccinator muscle
pads of fat in babies
```
231
superior labial frenulum
connects upper lips to vestibule
232
inferior labial frenulim
connects posterior part of the tongue to the bottom of the mouth cavity
233
sources of copper
shellfish
cereal
nuts
234
signs of copper deficiency
impaired growth
mental retardation
bone lesions
brittle hair
235
incisor teeth to cricopharyngeal junction
15cm
236
cricopharyngeal junction to lower oesophageal sphincter
25cm
237
sources of iodine
seafood
| milk
238
signs of iodine deficiency
hypothyroidism
239
what medications lead to C difficile
clindamycin
ciprofloxacin
co-amoxiclav
cephalosporins
240
what causes the symptoms of C difficile
toxins released by C difficile bacteria
toxin A - enterotoxin
Toxin B - cytotoxin
cause chloride permeability and tissue necrosis
241
microbiology of C difficile
gram positive bacillus which is spore forming
| obligate anaerobe
242
sources of selenium
```
cereal
meat
fish
dairy
egg
```
243
signs of selenium deficiency
heart disease
244
signs of C difficile infection
```
occur after taking antibiotics
Yellow and runny stools (blood is rare).
•Abdominal pain.
•Fever.
•Albumin under 25.
•Lactate above 2.4
•WCC above 15.
•Temperature 38.5.
•CRP above 200.
•Toxic mega colon - surgery may be needed. The cause is myenteric plexus damage and muscular injury which causes segmental paralysis.
•Pseudomembranes containing neutrophils, debris and fibrin thrombus
```
245
drug contraindications with C difficile
ramipril - other antihypertensives
omeprazole
salbutamol inhaler
246
diagnosis for C difficile
•C Diff toxin vs antigen:
-Antigen detects presence of C diff.
-Toxin detects presence of acute C diff toxic infection.
-If antigen positive, toxin negative then may do PCR.
-If PCR negative - no C diff infection.
-If PCR positive may have C diff - isolate and consider treatment.
•AXR for toxic mega colon and CXR to chest for perforation of toxic mega colon.
247
treatment for C difficile infection
```
isolation
PPE
IV rehydration
oral metronidazole first then vancomycin
faecal transplant if needed
```
248
what makes up the GI system
```
GI tract
accessory organs:
- teeth
- tongue
- salivary
- pancreas
- liver
- gallbladder
```
249
where is norovirus common in?
hospitals
care homes
schools
elderly are at risk
250
signs of norovirus
diarrhoea
| vomiting
251
management of norovirus
isolate to prevent further spread
hydrate with fluids
confirm causative organism and notify public health england
252
how long does norovirus take to resolve?
1-3 days
253
Bacillus cereus
common in rice dishes that have been improperly refrigerated
| entertoxins survive reheating
254
what are the signs of bacillus cereus?
diarrhoea
vomiting
self-limiting and resolves within 1-2 days
255
listeria incubation period
3 days to 10 weeks
256
signs and symptoms of listeria
meningitis
sepsis
fever
257
sources of listeria
soft cheeses
unpasteurised milk
ready to eat deli meats
258
what are located on the anterior 2/3 of the tongue?
medial sulcus
| vallate papilla
259
what are located on posterior 1/3 of tongue
lingual tonsil
260
what are the abdominal planes?
* Transpyloric plane (L1).
* Transumbilical plane.
* Midclavicular line.
* Median plane.
* Subcostal plane.
* Transtubercular plane.
261
signs of cholera
rice-water diarrhoea
262
effects of vomiting
hypokalaemia
alkalosis
dehydration
263
when is vomiting treated with drugs?
when the cause is known only
264
what are the types of drugs used to treat vomiting?
D2 dopamine antagonist.
•H1 histamine antagonist.
•Muscarinic ACh antagonist.
•5-HT3 antagonists.
265
when are D2 dopamine antagonists used?
post-operative nausea and vomiting
266
H1 histamine antagonists
used to treat most nausea and vomiting
| e.g. clyclizine
267
what are the tissue layers of the anterolateral abdominal wall?
```
skin
subcutaneous tissue layers
external oblique muscle and aponeurosis
transversus abdominis muscle and aponeurosis
extraperitoneal fat
parietal peritoneum
```
268
what are the subcutaneous tissue layers of the anterolateral abdominal wall?
campers fascia - loose superficial fatty fascial layer
| scarpa's fascia - deep membranous fascial layer
269
muscarinic ACh antagonist
used for motion sickness
| e.g. hyoscine
270
5-HT3 antagonist
used for post operative nausea and vomiting
| e.g. ondansetron
271
treatment for acid reflux
proton pump inhibitors
272
PPIs
used to treat gastric/ duodenal ulcers
dyspepsia
GORD
e.g. omeprazole
273
surface anatomy of the stomach
left hypochondrion
epigastric region
umbilical region sometimes
274
H2 antagonists
used to treat gastric/ duodenal ulcers, dyspepsia, GORD
only used when PPIs dont work
e.g. ranitidine
275
synthetic prostaglandin
used to treat gastric/ duodenal ulcers and NSAID associated ulcers
e.g. misoprostol
276
internal surface of the anterolateral abdominal wall
5 umbilical peritoneal folds
3 peritoneal fossae
falciform ligament
277
umbilical peritoneal folds
median umbilical fold
2 medial umbilical folds
2 lateral umbilical folds
278
peritoneal fossae
supravesicle fossae
lateral inguinal fossa
medial inguinal fossae - site of the direct inguinal hernia
279
antacids
used to treat ulcer dyspepsia and GORD
| e.g. aluminium hydorxide
280
nerve supply of anterolateral abdominal wall
cutaneous branches of the lower thoracic spinal nerve (T7-T11).
•Subcostal nerve from T12.
•Terminal branches of the anterior ramus of the lumbar spinal nerve (L1):
-Iliohypogastric nerve.
-Ilio-inguinal nerves.
281
what is H pylori?
gram negative bacteria living in stomach
| present in 15% of people but does not cause problems in most
282
what does H pylori do?
causes stomach ulcers
283
what antibiotics are used to kill H pylori?
clarithromycin
| metronidazole
284
how is GI motility decreased?
increasing smooth muscle tone
suppression of peristalsis
raised sphincter tone
reduced sensitivity to rectal distension
285
causes of constipation
* Dehydration.
* Diet (low fibre).
* Opioids.
* IBS.
* Laxative abuse.
* Pregnancy.
* Anorectal Disease such as fissures or haemorrhoids.
* Parkinson's.
* Nerve damage.
286
what are mesenteries?
double layers of peritoneum that enclose organs and connect them to either the anterior or posterior abdominal walls
287
what are the mesenteries ?
Greater omentum
Lesser omentum
•Falciform ligament
288
greater omentum
connects the stomach to the transverse colon.
289
lesser omentum
connects the stomach and part of the duodenum to the liver.
290
falciform ligament
connects the liver to the anterior abdominal wall.
291
how to treat constipation?
bulk forming laxatives
osmotic laxatives
stimulant laxatives
faecal softeners
292
bulk forming laxatives
increase in faecal mass
| e.g. bran/ isphagula husk
293
osmotic laxatives
to increase fluid in large bowel
e.g. lactulose - often given to children
294
stimulant laxatives
increases intestinal motility
| e.g. senna
295
faecal softeners
to lubricate and soften
| e.g. arachis - peanut oil
296
bowel cleansing solutions
picolax
297
what does picolax contain?
sodium picosulphate - stimulant
| magnesium citrate - osmotic
298
what is the peritoneal cavity divided into?
omental burse - lesser sac
299
what connects the lesser and greater sac?
omental foramen of winslow by hepatoduodenal ligament of lesser omentum
300
what is found in the omental foramen of winslow?
```
anteriorly - portal triad:
- bile duct
- hepatic artery
- portal vein
posteriorly - inferior vena cava
inferiorly - 1st part of duodenum
superiorly - caudate lobe of liver
```
301
treatment of diarrhoes
anti-motility drugs
bulking agents
symptomatic treatments
302
anti-motility drugs
opioids - loperamide
303
bulking agents
ispaghula
304
anterior part of hard palate
maxilla bone
305
posterior part of hard palate
palatine bone
306
symptomatic treatment of diarrhoes
correction of fluid and electrolyte loss
| e.g. diarolyte
307
ileum
longer segment - distal 3/5 of small intestine
| located mostly in right lower quadrant
308
jejunum
proximal 2/5 part of the small intestine
| located in the left upper quadrant of the infracolic compartment of the abdominal cavity
309
what pathogens cause foodbourne diseases?
```
norovirus
rotavirus
adenovirus
campylobacter
E.coli
salmonella
shigella
```
310
neurovascular bundle
medial to lateral
artery, nerve, vein
nerve used for local anaesthetic
vein used for administering oral drugs
311
borders of the jejunum and ileum
mesenteric
| anti-mesenteric
312
mesenteric border
concave margin of a small bowel loop, facing towards the axis of the root of the mesentery
313
anti-mesenteric border
the convex margin of a small bowel loop, facing away from the axis of the root of the mesentery
314
distinguishing between the borders of the jejunum and ileum?
important for diagnosis
diverticulosis = occurs at the mesenteric border
meckel's diverticulum = occurs at anti-mesenteric border
315
where is the oesophagus located?
C6-T10
316
how long is the oesophagus?
25cm
317
where does the oesophagus go through the diaphragm?
T10
318
what does the mesentery connect?
connects intestines to posterior abdominal wall
319
what are the variations of the appendix position?
```
retro-colic
retro-caecal
sub-caecal
pelvic
retro-ileal
pre-ileal
```
320
where is the appendix located?
McBurney's point which is retro-colic or retro-caecal
321
what is the peritoneum?
smooth thin serous membrane which lines the walls of the abdominal cavity and covers most of the viscera
322
what are the layers of the peritoneum?
parietal layer
| visceral layer
323
parietal layer of peritoneum
lines the inner surface of the walls of the abdominal cavity
324
visceral layer of peritoneum
covers most of the abdominal viscera
325
what is the peritoneal cavity?
the space between the parietal and visceral peritoneal layers
326
intraperitoneal
when the organs are covered by the visceral peritoneal layers
327
retroperitoneal
when organs lie behind the peritoneum - e.g. kidney
328
lymphatic drainage of the stomach
pyloric lymph nodes
| drain into celiac -preaortic lymph nodes
329
what is the blood supply of the rectum and anal canal
superior to pectinate line = inferior mesenteric artery
| inferior to pectinate line = internal iliac artery
330
venous drainage of rectum and anal canal
superior to pectinate line = portal venous system
| inferior to pectinate line = caval venous system
331
where is campylobacter common?
south-east asia
332
what is the incubation period of campylobacter
2-5 days
333
symptoms of campylobacter
fever
nausea
abdominal cramps
diarrhoea - can be bloody
334
what foods does campylobacter come from?
raw and undercooked poultry
unpasteurised milk
contaminated water
335
composition of gallstones
cholesterol in western world
| pigments in rest of world
336
what are the risk factors for gallstones
```
fair
forty
fat
fertile
female
```
337
what are the signs of gallstones?
biliary colic pain caused by gallstones getting stuck in the neck of the gallbladder
- 70-80% are asymptomatic
- 4% are symptomatic
- pain in right upper quadrant
- pain may be precipitated by fatty meals
338
lymphatic drainage of rectum and anal canal
superior to pectinate line = internal iliac lymph nodes
| inferior to pectinate line = superficial inguinal lymph nodes
339
differences between jejunum and ileum
jejunum has fewer loops of arterial arcades and a longer vasa recta within its mesentery than the ileum
340
nervous supply to rectum and anal canal
superior to pectinate line = sympathetic and parasympathetic visceral motor and sensory innervation to internal anal sphincter
inferior to pectinate line = somatic motor and sensory innervation to external anal sphincter
341
what are the muscles of the tongue?
hyoglossus
genioglossus
styloglossus
342
salmonella incubation time
6-72 hours
343
signs and symptoms of salmonella
```
headache
fever
abdominal cramps
diarrhoea
vomiting and nausea
```
344
what foods does salmonella come from?
```
undercooked poultry
raw egg desserts
mayonnaise
sprouts
tahini
```
345
signs of E.coli
bloody stools
triad of HUS - haemolytic uraemic syndrome
acute renal failure - high creatinine
microangiopathic haemolytic anaemia - low Hb
thrombocytopaenia - low platelet count
346
management of E.coli
fluids
replace electrolytes
monitor Hb/ platelets and potentially replace
347
surface anatomy of liver
right hypochondrium and epigastric region
348
what is acute cholecystitis
inflammation of the gallbladder caused by obstruction, distension, disruption of glycoprotein mucous layer and chemical injury
349
what are the causes of acute cholecystitis
90% caused by gallstones and 10% other causes
350
what are the signs of acute cholecystitis
right upper quadrant pain
| fever
351
how is acute cholecystitis diagnosed?
RUQ pain/ mass/ Murphy's sign
evidence of inflammatory response - fever, white cell count and CRP
imaging - ultrasound
352
management of acute cholecystitis
```
fasting - takes strain off gallbladder
IV fluids
analgesics
antibiotics
cholecystectomy - removal of gallbladder
percutaneous cholecystostomy
```
353
differential diagnosis of acute cholecystitis
pancreatitis
appendicitis
stomach ulcers
354
what does the large intestine consist of ?
```
cecum
appendix
ascending colon
transverse colon
descending colon
sigmoid colon
rectum
anal canal
```
355
features of the colon
omental appendices
teniae coli -
haustra
356
omental appendices
- small fatty projections
357
teniae coli
3 longitudinal muscle bands
358
haustra
sacculations of the wall of the colon between the teniae
359
structures of the stomach bed
```
left dome of diaphragm
spleen
left kidney
left adrenal gland
splenic artery
pancreas
transverse mesocolon
```
360
how is diarrhoea managed?
```
in side room
rehydration
monitor electrolytes
analgesia
antiemetics
consider loperaminde
```
361
anterior to oesophagus
trachea
left bronchus
left atrium
362
posterior to oesophagus
vertebral bodies
| descending aorta
363
right of oesophagus
right lung
364
left of oesophagus
aortic arch
| left lung
365
anterior to stomach
liver
366
left of stomach
spleen
367
inferior to stomach
```
greater omentum
pancreas
spleen
transverse colon
kidney
adrenal gland
```
368
posterior to stomach
pancreas
| duodenum
369
incubation of shigella
5-7 days
| symptoms occur a day or two after bacteria exposure
370
signs and symptoms of shigella
water diarrhoea - may be bloody
fever
stomach cramps
371
what food does shigella come from?
salads and sandwiches - lots of hand contact in preparation
| raw vegetables contaminated from a field
372
signs and symptoms of pancreatic insufficiency
```
loose, pale and greasy stools which float - steatorrhoea
weight loss
fatigue
abdominal distension
lack of vitamins
amylase enzymes in blood
```
373
treating pancreatic insufficiency
pancreatic enzyme replacement - creole
| vitamin supplementation - A,D,E,K
374
what is ascending cholangitis
infection of biliary tree
375
what causes ascending cholangitis?
cancer of pancreas or gallbladder
| obstruction in common bile duct can lead to infection - usually gram negative
376
signs of ascending cholangitis
charcot's triad
| raynaud's pentard
377
what is charcot's traid?
jaundice
fever
right upper quadrant abdominal pain
