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Describe the functions of the GIT

Nutrients: movement, breakdown, absorption

Wastes: collect,absorb

Vitamins: absorption, synthesis

Hormones: synthesizes, augments, responds

Keeps dangerous gut contents out of blood

Keeps blood contents from being lost into gut


What are the four layers of the tubular structure of the gut?

  1. Mucosa - innermost layer which secretes digestive juices, involved in absorption. Mucosa is thrown into folds known as villi which greatly increase surface area for absorption
  2. Submucosa - layer of connective tissues containing blood vessels, lymphatics and nerves
  3. Muscular layer - smooth muscle arranged in circular and longitudinal layers
  4. Peritoneum - outermost layer – double layered serous membrane – parietal and visceral. Does not cover oral cavity, pharynx, oesophagus or rectum


Gastroduodenal mucosa can withstand the digestive action of hydrochloric acid, pepsin and bile due to...?

  • Mucous bicarbonate barrier
  • Phospholipids
  • Mucus
  • Prostaglandin E2 (PGE2)
  • Renewal of epithelial cells
  • Delivery of bicarbonate ion


Give some predisposing factors for inflammatory bowel disease

Genetic factors

Immunological factors


Environmental factors



Dietary factors

Geographical factors


Which condition does the following describe?

  • Recurrent granulomatous type of inflammatory response that can affect any part of the GI tract
  • Slowly progressive, often disabling disease
  • Sharply demarcated granulomatous lesions surrounded by normal-appearing mucosal tissue – Skip lesions
  • All layers of bowel involved (transmural)
  • Marked inflammatory and fibrotic changes of the sub-mucosal layer
  • Fissures and crevices develop, surrounded by areas of mucosal oedema
  • Bowel wall becomes thickened and inflexible – narrow lumen which may become totally obstructed
  • Adjacent mesentery may become inflamed and regional lymph nodes and channels become enlarged

Crohn's Disease


Describe some signs and symptoms a patient presenting with Crohn's disease may have

Periods of exacerbations & remissions

Colicky pain (right lower quadrant)

Intermittent diarrhoea

Melena (if ulcer erodes blood vessels)

Anorexia, weight loss



Fluid & electrolyte imbalances

Nutritional deficiencies – malabsorption

Abscess and fistula formation



  1. Which inflammatory bowel disease is A showing?
  2. Which inflammatory bowel disease is B showing?


  1. Crohn's 
  2. Ulcerative Colitis 


What is Ulcerative Colitis?

(Give a detailed description of it's features)

  • Nonspecific inflammatory condition of the colon
  • Usually begins in rectum and spreads proximally affecting primarily the mucosal layer
  • Inflammatory process is confluent & continuous
  • Lesions form in the crypts of Lieberkühn
  • Inflammatory process leads to formation of pinpoint haemorrhages – suppurate and become crypt abscesses
  • Become necrotic and ulcerate
  • Often develop pseudopolyps
  • Bowel wall thickens in response to repeated ulcerations


How might Ulcerative Colitis present?

  • Presents as a relapsing disorder marked by attacks of diarrhoea – blood and mucus
  • Mild abdominal cramping
  • Anorexia
  • Anaemia
  • Weakness
  • Fatigue
  • May be classified as mild, moderate, severe or fulminant


Name 5 investigations which may help in the diagnosis of inflammatory bowel disease

  1. History and physical examination
  2. Sigmoidoscopy, colonoscopy
  3. Biopsy
  4. Stool cultures
  5. Radiology – radiographic contrast e.g. Barium Enema/Meal, CT scan


Describe the pharmacological management of inflammatory bowel disease

  • Corticosteroids e.g. prednisolone, hydrocortisone
  • 5-aminosalicylic acid e.g. balsalazide, mesalazine
  • Immunosuppressant e.g. azathioprine, 6-mercaptopurine
  • Anti- TNF therapies e.g. infliximab
  • Antibiotic therapy e.g. metronidazole



In which quadrant is the liver located?



How many lobes does the liver have?

4: right, left, caudate and quadrate


Describe the blood supply of the liver

Portal Vein (75%)
Hepatic Artery (25%)


How does blood leave the liver?

Blood leaves the liver via the hepatic vein, draining into the inferior vena cava


Name the functions of the liver

Excretory/Secretory – bile excretion Protective
Circulatory – large blood storage organ Coagulation – production of clotting factors



What is hepatitis?

inflammation of the liver, caused mainly by various viruses but also by some poisons, autoimmunity or hereditary conditions


What is cirrhosis?

the formation of fibrous tissue in the liver, replacing dead liver cells. The death of the liver cells can for example be caused by viral hepatitis, alcoholism or contact with other liver- toxic chemicals


What is Haemochromatosis?

a hereditary disease causing the accumulation of iron in the body, eventually leading to liver damage


What is Budd-Chiari Syndrome?

obstruction of the hepatic vein


What is Gilbert's Syndrome?

a genetic disorder of bilirubin metabolism, found in about 5% of the population


What is Glycogen storage disease type II?

The build-up of glycogen causes progressive muscle weakness (myopathy) throughout the body and affects various body tissues, particularly in the heart, skeletal muscles, liver and nervous system


What is an acute liver disease?

Acute onset of liver disease with coagulopathy but with no previous evidence of liver disease.


Describe a chronic liver disease

Chronic liver disease tends not to be defined - it is discussed in terms of cirrhosis.

In chronic liver disease - hepatocytes are destroyed faster than they can be regenerated – irreversible


Describe the characteristics of liver cirrhosis

Consequence of chronic liver disease Represents end stage of chronic liver disease

replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function.

– the formation of macro- and micro-nodules, affect the structure of the liver and its blood supply.

– These structural changes impede blood flow through the liver, causing portal hypertension (high pressure in the portal vein).


Name some causes of chronic liver disease

Alcoholic liver disease

Chronic Viral Hepatitis

Non-alcoholic Steatohepatitis (obesity, coronary artery disease)

Metabolic causes – for example, Wilson’s disease, genetic Haemochromatosis, alpha1-antitrypsin deficiency


Name some causes of liver cirrhosis

Biliary disease – for example, extrahepatic biliary obstruction, primary biliary cirrhosis, primary sclerosing cholangitis,

Venous outflow obstruction – for example, Budd-Chiari syndrome

Drugs or toxins – for example, methotrexate, amiodarone– Immunological causes – for example, autoimmune disease


What are the signs and symptoms of liver cirrhosis?

Ranges from asymptomatic hepatomegaly to hepatic failure

May be no symptoms until disease is far advanced

Most common:

  • Weight loss, anoxeria
  • Weakness, fatigue
  • Abdominal pain – epigastric region, dull, aching, sensation of fullness



Name some late manifestations of liver cirrhosis 

  • Jaundice –hepatocellular
  • Ascites – Portosystemic shunts - variceal haemorrhage, haemorrhoids, caput medusae
  • Splenomegaly Hepatomegaly
  • Fetor hepaticus
  • Asterixis
  • Spider angiomata (spider nevi)
  • Gynaecomastia
  • Hypogonadism


Describe the pathophysiology of portal hypertension