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week 3 Flashcards

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1
Q

What is coeliac disease?

A

gluten sensitive enteropathy

small intestinal villous atrophy that resolve when no gluten in diet

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2
Q

What is the pathophysiology of coeliac disease?

A

inappropriate T cell mediated immune response in genetically susceptible individuals
alpha-gliadin most toxic moiety

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3
Q

Who is affected more by coeliac disease?

A

females

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4
Q

What is the main gene implicated in coeliac disease?

A

HLA-DQ2

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5
Q

What virus is associated with coeliac disease?

A

adenovirus 12

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6
Q

How do infants present with coeliac disease?

A

impaired growth, diarrhoea, vomiting, abdominal distension

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7
Q

How do older children present with coeliac disease?

A

anaemia, short stature, pubertal delay, recurrent abdominal pain or behavioural disturbances

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8
Q

How do adults present with coeliac disease?

A 
Symptomatic
Chronic or recurrent IDA
Nutritional deficiency
osteoporosis
Unexplained increased ASTT/ALT
Neurological / psychiatric symptoms
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9
Q

Describe the mucousal surface in coeliac disease

A

villi may be completely flat or short and broad
no change in total thickness as crypts become elongated
Increased plasma cells and lymphocytes

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10
Q

What are the serology tests used to diagnose coeliac disease?

A 
IgA tTG (more sensitive)
IgA EMA (more specific)
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11
Q

What can be seen at endoscopy of a coeliac disease patient?

A 
scalloping of folds
paucity of folds
mosaic pattern
prominent submucosal blood vessels
nodular pattern to the mucosa
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12
Q

What are some of the complications of coeliac disease?

A

infection
osteoporosis
refractory coeliac disease
malignancy

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13
Q

What is cholecystitis?

A

inflammation of the gallbladder

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14
Q

what is Cholelithiasis?

A

Gall stone (within gallbladder)

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15
Q

what is Cholecystectomy?

A

removal of gallbladder

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16
Q

what is cholecholithiasis?

A

gallstone within bile duct

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17
Q

What is cholangitis?

A

infection of bile duct

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18
Q

What is MRCP?

A

magnetic resonance cholangiopancreatography

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19
Q

What is ERCP?

A

endoscopic retrograde cholagniopancreatography

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20
Q

What is PTC?

A

percutaneous transheatic cholangiography

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21
Q

Why are bile salts more effective than bile acids?

A

the are amphipathic - they have both hydrophilic and lipophilic moieties which improves ability to emulsify

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22
Q

What are the three main events that lead to gall stone formation?

Study These Flashcards
A

cholesterol supersaturation
biliary stasis
increased secretion of bilirubin

23
Q

What type of amylase is most powerful?

Study These Flashcards
A

pancreatic amylase

24
Q

What are almost all carbohydrates converted into?

Study These Flashcards
A

maltose and other small glucose polymers

25
What is sucrose broken down into?
glucose and fructose
26
What is lactose broken down into?
galactose and glucose
27
What is maltose broken down into?
glucose
28
How is glucose absorbed in the small intestine?
sodium co-transort mechanism
29
What is the sodium co-transport mechanism?
active transport of sodium into the intestinal lumen sodium combines with protein and glucose which is secondary transport into the enterocyte facilitated diffusion of glucose into portal blood
30
How is galactose absorbed into the small intestine?
sodium co-transport
31
How is fructose absorbed in the small intestine?
facilitated diffusion
32
What are the pancreatic enzymes involved in protein digestion?
trypsin, chymotrypsin, carboxypolypeptidases, elastase
33
What is the action of trypsin?
breaks proteins into small polypeptides
34
What is the action of chymotrypsin?
breaks proteins into small polypeptides
35
What is the action of carboxypolypeptidase?
cleaves individual amino acids from carboxyl ended of polypeptides
36
What is the action of elastase?
digests elastin which holds meat together
37
How are most peptides absorbed?
as di and tripeptides
38
How are peptides absorbed?
most sodium co-transport | some with facilitated diffusion
39
Describe the digestion of fats
mainly in duodenum emulsified by bile salts and lecithin from gallbladder co-lipase overcomes lipase inhibition by bile salts Pancreatic lipase breaks down emulsified fats into fatty acids and monoglycerides
40
Describe the absorption of fats
bile salt and fatty acids/ monoglycerides form tiny miscellses which transport fatty acids into cells fatty acids immediately diffuse out of micelles, enter smooth ER and form triglycerides and are released as chylomicrons into the portal blood A small amount of short chain fatty acids can be absorbed directly into portal blood without being in chylomicrons
41
What are the causes of chronic pacreatitis?
70% alcohol | others idiopathic
42
What are the risk factors for chronic pancreatitis?
``` alcohol smoking family history coeliac disease haemochromatosis ```
43
What are the key features presenting in chronic pancreatitis?
``` risk factors abdominal pain steatorrhoea jaundice weight loss and malnutrition nausea and vomiting ```
44
What diagnostic techniques are used for chronic pancreatitis?
``` ultrasound ERCP MRCP faecal elastase faecal fat ```
45
What is the management of chronic pancreatitis?
``` alcohol and cigarette smoking cessation analgesia pancreatic enzymes and PPis dietary modifications and enteral feeding antioxidants ```
46
Describe the pathophysiology of toxin mediated diarrhoea
produced prior to consumption produced after consumption damage to endothelial surface invasion across intestinal epithelial barrier
47
Describe small intestine diarrhoea
large volume watery diarrhoea. Cramps, bloating, wind, weight loss
48
Describe large intestine diarrhoea
frequent small volumes, painful stool, fever and blood
49
Give examples of bacteria that commonly cause diarrhoea
``` campylobacter salmonella Shigella (travellers) E.coli 157H7 clostridium difficile ```
50
Give examples of viruses that commonly cause diarrhoea
norovirus rotavirus adenoviruses
51
Give examples of parasites that commonly cause diarrhoea
cryptospordium guardians cyclospora
52
What is the clinical approach to to infectious diarrhoea?
history stool examination / culture endoscopy
53
Describe what should be included in history taking of a patient with infectious diarrhoea
``` food onset and nature of symptoms residence travel pets hobbies recent hospitalisations / antibiotics co-morbidity ```

Gastrointestinal (4 decks)

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