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Gastrointestinal > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Bilirubin breakdown occurs mainly where

A

Spleen

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2
Q

The biliary tree connects the liver to which part of the duodenum?

A

2nd part

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3
Q

Function of the gallbladder?

A

Storage and concentration of bile between meals

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4
Q

The liver is protected by which ribs?

A

7-11

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5
Q

In relation to the liver, the gallbladder is…

A

Inferior and posterior to it

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6
Q

Name the 4 anatomical lobes of the liver

A
  • Right (largest)
  • Left
  • Caudal (looks tail-like, but NOT inferior.)
  • Quadrate (4 sides)
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7
Q

The IVC may be superficial or deeply embedded within the liver. True/false?

A

True - this is a normal anatomical variation

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8
Q

What is the name for the site of entrance of portal triad structures?

A

Porta hepatis

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9
Q

What are the superior ligaments of the liver called?

A

Left/right triangle ligaments

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10
Q

Which ligament divides the liver into right and left lobes?

A

Falciform

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11
Q

The round ligament is a remnant of which structure?

A

Umbilical vein

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12
Q

What is the “bare area” of the liver?

A

Site with no peritoneum - touches right hemi-diaphragm

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13
Q

How many functional segments does the liver have?

A

8

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14
Q

Each segment of the liver has what?

A

Its own vascular supply (branch of hepatic artery, branch of hepatic portal vein, bile drainage and venous drainage)

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15
Q

Why does increase in venous blood pressure cause liver enlargement?

A

No valves in the IVC

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16
Q

The hepatic veins come together as how many veins before entering the IVC?

A

3

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17
Q

The portal triad runs within which structure?

A

Hepatoduodenal ligament within the lesser omentum

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18
Q

The coeliac trunk leaves the aorta at which vertebral level?

A

T12

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19
Q

The coeliac trunk splits into which 3 structures?

A
  • Splenic artery
  • Left gastric artery
  • Common hepatic artery
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20
Q

The common hepatic artery splits into what? (2)

A

Gastoduodenal artery and supraduodenal artery

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21
Q

The coeliac trunk supplies which part of the gut?

A

Foregut

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22
Q

Anatomically the spleen is within which region?

A

left hypochondrium

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23
Q

The spleen is protected by which ribs?

A

9-11

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24
Q

Major blood supply to the stomach comes from which 2 arteries?

A

Right and left gastric arteries

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25
Q

Which vessels do the right and left gastric arteries originate from? (2)

A

The left comes from the coeliac trunk and the right comes from the hepatic artery proper

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26
Q

The right and left gastric arteries anastamose together along which junction?

A

Junction of the lesser omentum and the lesser curvature

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27
Q

The right and left gastro-omental arteries anastamose along which

A

Greater curvature of the stomach

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28
Q

Blood supply from the liver comes from which arteries (2)?

A

Right and left hepatic arteries - branches of the hepatic artery proper

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29
Q

What are the two clinically important recesses of the liver? (2)

A
  • Hepatorenal recess (Morison’s Pouch)

- Subphrenic recess

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30
Q

What is the clinical significance of Morison’s Pouch?

A

It is one of the most inferior parts of the abdomen when patient is supine - fluid will collect here

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31
Q

The hepatic portal vein drains which area of the gut?

A

Foregut

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32
Q

The superior mesenteric vein drains which area of the gut?

A

Midgut

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33
Q

Name the portal triad structures from anterior to posterior? (3)

A
  • Bile duct
  • Hepatic artery proper
  • Hepatic portal vein
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34
Q

The gallbladder lies anterior/posterior to the duodenum

A

Anterior

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35
Q

Bile flows in and out of which duct

A

Cystic duct

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36
Q

Blood supply to the gallbladder is via which artery

A

Cystic artery

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37
Q

The cystic artery comes off which structure in 75% of patients?

A

Right hepatic

38
Q

The cystic artery is located within which structure

A

Cystohepatic Triangle of Calot

39
Q

The gallbladder is a ___-gut organ. Afferents enter spine between __ to __.

A

Foregut. T6-T9.

40
Q

Why can gallbladder pain refer to the shoulder?

A

It irritates the diaphragm - C3, C4, C5 - which correspond to right shoulder dermatomes.

41
Q

On gross examination of the otherwise healthy SI, what is the likely cause of red patches?

A

Peyer’s Patches

42
Q

The SI receives blood supply from which artery?

A

SMA

43
Q

Ischaemia of the small bowel can occur as a result of (2)

A

Mesenteric Arterial Occlusion (e.g. in AF) or non-occlusive perfusion insufficiency (e.g. shock)

44
Q

In non-occlusive ischaemia much of the damage occurs before/after reperfusion?

A

After

45
Q

Meckel’s Diverticulum is caused by incomplete regression of the….

A

Vitello-Intestinal Duct

46
Q

A “true” diverticulum contains…

A

All layers of the organ from which it originates

47
Q

Describe “the rule of 2s” with relation to Meckel’s Diverticulum (4)

A
  • 2 inches long tube
  • 2cm above IC valve
  • 2:1 ratio men:women
  • 2% of people
48
Q

Can the mucosa in Meckel’s contain gastric cells?

A

Yes - may cause perforation if secretory

49
Q

Primary tumours of the SI are common. True/false?

A

False

50
Q

Primary tumours of the small bowel include… (3)

A
  • Lymphoma
  • Carcinoids
  • Carcinomas
51
Q

Lymphomas of the SI are commonly which lymphocyte?

A

B-cells / Maltomas

52
Q

T-cell lymphomas of the SI are particularly associated with which condition?

A

Coeliac Disease

53
Q

The most common site of a carcinoid tumour of the GI tract?

A

Appendix

54
Q

Carcinoids may produce hormones. True/false?

A

True

55
Q

Carcinoma of the small bowel is associated with Crohn’s/Coeliac, true/false?

A

True

56
Q

Faecoliths is… and is commonly caused by….

A

Faecal impaction (usually due to dehydration)

57
Q

Potentially severe complications of appendicitis include (6)

A
  • Peritonitis
  • Rupture
  • Abscess
  • Fistula
  • Sepsis
  • Liver abscess
58
Q

Incidence of Coeliac in the UK?

A

1:2000

59
Q

Which HLA-type is strongly associated with Coeliac Disease?

A

HLA-B8

60
Q

Which childhood condition is associated with Coeliac Disease?

A

Diabetes

61
Q

What is dermatitis herpetiformis?

A

A blistering skin condition similar to herpes but not caused directly by the virus - strong association with Coeliac

62
Q

What is suspected to be the agent in wheat to which Coeliac’s are allergic?

A

Gliadin

63
Q

The normal lifespan of an enterocyte is…

A

72 hours

64
Q

Which type of T-lymphocytes are important in Coeliac’s Disease?

A

Intraepithelial Lymphocytes (predominately CD3 and CD8 positive)

65
Q

Which serological tests are available for Coeliac?

A
  • Anti-TTG (very sensitive, not specific to CD)
  • Anti-endomesial
  • Anti-gliadin
66
Q

Coeliac Disease increases risk of which type of cancers

A
  • Tcell lymphoma of GI tract
  • Small bowel carcinoma
  • Colon adenocarcinoma
67
Q

How many sites biopsied in CD?

A

4

68
Q

Type 3 IF is acute/chronic?

A

Chronic

69
Q

Parenteral nutrition is delivered which which line?

A

PICC

70
Q

Type 1 IF commonly occurs in the….

A

Moderately malnourished

71
Q

Type 2 IF is usually seen in

A

Septic patients

72
Q

Drug treatment for SBS?

A

GLP2 / Tedglutide

73
Q

In SBS the SI is approximately which length?

A

<50cm

74
Q

For SBS, which is a better outlook therapy - transplantation or home PN?

A

Home PN

75
Q

Transplantation in SBS is commonly performed with which other type of transplant?

A

Liver

76
Q

Malnutrition is (roughly)….

A

A state of nutrition in which a deficiency or excess of imbalance of energy leads to a negative outcome

77
Q

A MUST score of 0 is…
A MUST score of 1 is…
A MUST score of 2 is…

A

Low Risk
Medium Risk
High Risk

78
Q

Common biochemistry tests for determination of nutritional status?

A
  • Albumin (reduced in malnutrition)
  • Transferrin (iron status -> increased in dehydration)
  • Retinol (increased by alcoholism, decreased by vit A deficiency)
  • Urinary creatine (muscle mass)
  • IGF1
79
Q

Enteral tube feeding is a means of delivering food and includes…

A

PEG, NG, NJ

80
Q

Parenteral nutrition is the process of administering nutrients directly to the….

A

Veins.

81
Q

What is the major obstacle when considering PN or other feeding?

A

Refeeding Syndrome

82
Q

Patients at a BMI of

A

16

83
Q

Patients at a BMI of

A

14

84
Q

In high risk patients, nutrition is to be introduced in which regimen if avoiding refeeding syndrome?

A

50% indicated for first 48 hours, monitor biochemical tests of nutrition and increase as appropriate

85
Q

In extremely high risk patients, nutrition is to be introduced in which regimen if avoiding refeeding syndrome?

A

Check electrolytes first, begin vitamin supplements first for 10 days then start feeding 5-10kcal a day over 4-7days, checking electrolytes regularly. If no decline titrate up over 2 weeks

86
Q

Clinical signs of refeeding include

A

Arrhythmia, fluid overload, altered level of consciousness, seizure, respiratory arrest.

87
Q

Tropical Sprue is caused by what?

A

Unknown exactly what - it might be due to infection

88
Q

Antibiotic treatment of tropical sprue

A

Tetracycline

89
Q

Whipple’s Disease is caused by what?

A

T. whipplei.

90
Q

Treatment of whipple’s disease is with what antibiotic?

A

Metronidazole (1week)

91
Q

Acrodermatis enteropathica is an autosomal (____) condition of impaired (___) uptake)

A

Recessive, zinc

92
Q

Dermatitis herpetiformis may indicate….

A

Coeliac Disease

Gastrointestinal (7 decks)

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