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Gastrointestinal > Week 4 > Flashcards

Week 4 Flashcards

1
Q

The large GI tract from proximal to distal runs…

A

Caecum, appendix, ascending, transverse, descending, sigmoid, rectum, anus

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2
Q

The ______ gutters are where fluid may accumulate in the gut

A

Paracolic

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3
Q

Paracolic gutters are located

A

On the lateral aspects of the ascending/descending colon along the abdominal wall

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4
Q

The transverse colon is retro/intra-peritoneal

A

Intraperitoneal

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5
Q

Gross distinguishing features of the colon include

A

Omental appendages, teniae coli, haustra.

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6
Q

The teniae coli form how many bands of longitudal muscle?

A

3

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7
Q

What is the clinical use of teniae coli?

A

They all converge on the appendix and can be used to locate it in surgery

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8
Q

In non-contrast AXR, it is pathological to see gas in the ascending colon. True/false?

A

False

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9
Q

What is the appearance of faeces in the rectum on AXR?

A

Mottled

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10
Q

Name the orifices of the caecum

A

Ileocaecal and appendiceal

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11
Q

The most common position of the appendix is

A

Retrocaecal

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12
Q

The many different locations of the appendix anatomically gives rise to the difference in

A

Presentation of appendicitis pain

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13
Q

The passageway through which the SI enters the LI is called the ____

A

Ileocaecal orifice.

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14
Q

McBurney’s point is

A

The point at which the appendiceal orifice enters the caecum - usually on the posteriomedial surface. Point of greatest tenderness in appendicitis.

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15
Q

The anatomical locaiton of McBurney’s point is usually

A

1/3rd of the way between the right ASIS and umbilicus

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16
Q

The sigmoid colon lies in which fossa?

A

Left iliac fossa

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17
Q

The sigmoid colon’s mesentry is called

A

Sigmoid mesocolon

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18
Q

Obstruction of the descending colon due to twisting is termed

A

Sigmoid volvulus

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19
Q

The 3 midline branches of the abdominal aorta are (3)

A
  • Coeliac trunk
  • Superior mesenteric
  • Inferior mesenteric
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20
Q

The coeliac trunk supplies which region of gut and which organs?

A

Foregut - liver/gallbladder/proximal duodenum/stomach

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21
Q

The SMA supplies which region of gut and which organs?

A

Midgut - distal duodenum, jejunum, ileum, caecum, appendix, transverse colon

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22
Q

The IMA supplies which region of the guy and which organs?

A

Hindgut - descending/sigmoid colon

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23
Q

The abdominal aorta bifurcates at which vertebra level?

A

L4

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24
Q

The abdominal aorta bifurcates into which structure? What does this split into?

A

Common iliacs, internal and external iliac arteries.

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25
Q

Coeliac trunk emerges from AA at which vertebral level?

A

T12

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26
Q

SMA emerges from AA at which vertebral level?

A

L1

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27
Q

IMA emerges from the AA at which vertebral level?

A

L3

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28
Q

Gonadal arteries emerge from the AA at which vertebral level?

A

L2

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29
Q

The SMA divides into which arteries

A

Inferior pancreaticoduodenal, middle colic, right colic, ileocolic, appendicular branch.

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30
Q

The SMA runs anterior/posterior to the ucinate process of the pancreas?

A

Anterior

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31
Q

The jejunum vasa rectae arteries are longer/shorter than the ileum’s

A

Longer

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32
Q

The ileum has more/less arterial arcades than the jejunum

A

More

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33
Q

The IMA gives rise to the… (3)

A

Left colic artery, sigmoid arteries, superior rectal artery.

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34
Q

The Marginal Artery of Drummond is an anastamosis between

A

SMA and IMA

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35
Q

The Marginal Artery of Drummond is important as

A

It will protect the descending colon if the sigmoid / left colic arteries are blocked

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36
Q

The rectum and anal canal receive blood from the

A

Superior rectal artery

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37
Q

Describe the 3 clinically important systemic-portal anastamoses in humans

A

Skin around the umbilicus, distal end of oesophagus, anal canal.

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38
Q

Portal hypertension will present with what sign in the umbilical region

A

Caput medusae

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39
Q

Portal hypertension will present with what sign in the oesophagus/anal canal

A

Varices

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40
Q

The superior part of the oesophagus drains into which vein

A

Azygous

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41
Q

The coeliac trunk supplies which gut structures?

A

Foregut (liver, gallbladder, duodenum, first half pancreas)

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42
Q

The SMA supplies which gut structures?

A

Midgut (distal duodenum, jejunum, ileum, caecum, appendix)

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43
Q

The IMA supplies which gut structures?

A

Hindgut (desceding/sigmoid colon)

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44
Q

Abdominal aorta bifurcates into common iliacs at which vertebral level?

A

L4

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45
Q

The external iliac supplies which structure?

A

Lower limbs

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46
Q

Coeliac trunk emerges at which vertebral level?

A

T12

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47
Q

SMA emerges at which vertebral level?

A

L1

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48
Q

Renal arteries emerge at which level?

A

L1

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49
Q

Gonadal arteries emerge at which level?

A

L2

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50
Q

IMA emerges at which level?

A

L3

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51
Q

The SMA separates into which arteries (5)

A
  • Inferior pancreatioduodenal
  • Middle colic
  • Right colic
  • Ileocolic
  • Appendicular branch
  • jejunal and ileal
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52
Q

The jejunum has longer/shorter vasa rectae thna the ileum?

A

Longer

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53
Q

The jejunum vasa rectae are larger/smaller than the ileum?

A

Larger

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54
Q

The jejunum has more/less vasa rectae than the ileum?

A

Less

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55
Q

IMA gives off which arteries (3)

A
  • left colic
  • sigmoid
  • superior rectal
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56
Q

The Marginal Artery of Drummond is important as

A

It is an anastamosis between SMA and IMA, collateral blood flow can protect against ischaemia

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57
Q

Blood supply to rectum and anal canal is through which artery?

A

Superior rectal

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58
Q

Remainder of GI tract not supplied by rectal artery is supplied by

A

Internal iliac

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59
Q

Splenic vein drains which gut area

A

Foregut

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60
Q

SM vein drains which gut area

A

Midgut

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61
Q

IM vein drains which gut area

A

Hindgut

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62
Q

3 clinically important portal-systemic anastamoses (3)

A
  • oesophagus
  • skin around umbilicus
  • rectum/anal canal
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63
Q

Superior part of oesophagus drains into the (venous)

A

Azygous vein

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64
Q

Para-umbilical veins drain into the

A

Hepatic portal vein around the round ligament of liver

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65
Q

The clinical sign of liver failure around the umbilicus is

A

Caput medusae

66
Q

Which criteria is used to stage colorectal cancer?

A

Dukes

67
Q

What proportion of colorectal cancers are left-sided (rectum/sigmoid/descending)?

A

75%

68
Q

What proportion of CRC is right sided?

A

25%

69
Q

HNPCC is late/early onset. It typically presents with . It is autosomal dominant/recessive defect in ____

A

Late, 100 polyps, autosomal dominant, defect in DNA mismatch repair

70
Q

FAP is late/early onset. It typically presents with . It is a mutation _______ and is associated with _____ cancer.

A

early onset, >100 polyps, defect in tumour suppression, thyroid carcinoma

71
Q

HNPCC gives predominately left/right sided tumours?

A

Right sided

72
Q

The LI recieves approximately of matter per day

A

1000mL

73
Q

Passage through the LI takes approximately

A

18-24hours

74
Q

The ascending/transverse colon function is mainly

A

Fluid reabsorption

75
Q

The sigmoid/descending colon function is mainly

A

Drying

76
Q

Haustration is propulsive/non-propulsive

A

Non-propulsive

77
Q

Bacteria in the gut are useful because (4)

A
  • Vit K
  • Competition
  • Fatty acid
  • Drug activation
78
Q

Long term remission maintaining drug in UC

A

Aminosalicylates (e.g. sulfasalazine)

79
Q

How do aminosalicylates work?

A

Reduce activity of COX and LOX

80
Q

Side effects of aminosalicylates

A

Dysarthria, rash

81
Q

Drug which may be used in acute flare up of UC or CD

A

Glucocorticoid

82
Q

Newer drug which may replace steroids in acute flareup of IBD

A

Azathioprine

83
Q

Side effect of azathioprine

A

Hepatotoxicity

84
Q

Other immunosuppresants used in IBD

A

Ciclosporin (renal toxicity), 6-mercaptopurine, methotrexate, infliximab

85
Q

IBS often presents with sensitivity

A

Visceral

86
Q

Visceral sensitivity in IBS may be treated with what type of drug

A

Tricyclic antidepressants

87
Q

Drug treatment is primary/secondary to lifestyle in treatment of IBS

A

Secondary

88
Q

Diverticular disease often occurs at which part of colon?

A

Sigmoid

89
Q

Diverticular disease is more common in which type of diet?

A

Low-fibre

90
Q

Diverticulitis presents with pain in which area?

A

LIF

91
Q

Commonest fistula in diveriticular disease?

A

Colovesical (colon and bladder); CPC with pneumoturia and recurrent UTIs

92
Q

Diverticulitis is classified by which system?

A

Hinchey 0 = mild 4 = severe peritonitis

93
Q

Name of surgery which may be done to treat complex diverticulitis

A

Hartmann’s Procedure

94
Q

Are IV fluids indicated in uncomplicated diverticulitis?

A

No

95
Q

Causes of acute colitis include (4)

A
  • Infective (Food)
  • Ulcerative (Can)
  • Crohn’s (Cause)
  • Ischaemic (Illnesses)
96
Q

What is the radiological sign of of acute colitis on AXR?

A

Lead piping

97
Q

IV fluids are used to treat CD/UC. True or false?

A

True

98
Q

Colonic angiodysplasia gives the macroscopic appearance of

A

Lakes of blood under tissue

99
Q

On sigmoid volvulus AXR, what is the buzzword for the appearance of the sigmoid colon?

A

Coffee bean

100
Q

IBD is a condition/characterised by (1)

A

Visceral hypersensitivity

101
Q

IBS pain gets worse / improves with defecation?

A

Improves

102
Q

IBS is associated with which conditions? (4)

A
  • CFS
  • Fibromyalgia
  • TMJ joint dysfunction
  • Chronic pelvic pain
103
Q

Alarm features for development of IBS? (6)

A
  • > 50yo
  • woken from sleep by bowel habits
  • rectal bleeding
  • weight loss
  • anaemia
104
Q

First line treatment of IBS?

A

Regular meal times, restrict coffee, stop opioids, begin anti-diarrhoeals.

105
Q

Example of a drug which can be used to treat IBS?

A

Tricyclics antidepressants

106
Q

From proximal to distal, the colon runs as….

A

Caecum, appendix, ascending, transverse, descending, rectum, anal canal, anus

107
Q

The pelvic floor is formed by what

A

Levator anii muscle

108
Q

Sigmoid colon becomes rectum at which vertebral level?

A

S3

109
Q

Rectal ampulla lies immediately ____ to levator ani muscle.

A

Superior

110
Q

Pouches in females

A

Vesicouterine, rectouterine (Douglas)

111
Q

Levator anii is composed of which muscles (3)

A

Puborectalis, pubboccygeus, ilioccygeus

112
Q

Which nerves supply rectum?

A

Pudenal and sacral plexus

113
Q

The levator anii is relaxed most times. True or false?

A

False - tonically contracted

114
Q

Pudenal nerve plugs into spine where

A

Anterior ramii of S2, S3, S4.

115
Q

Name of the muscular half moon aiding with continence

A

Levator anii

116
Q

Contraction of puborectalis does what to anal angle?

A

Decreases, locking the anus up tight

117
Q

The levator ani nerve supply is from….

A

Pudenal nerve (anterior rami of S2 S3 S4) and sacral plexus levator ani branch

118
Q

The shape of the puborectalis?

A

Half moon

119
Q

The internal sphincter is which proportion of the anal canal?

A

2/3rds

120
Q

Contraction of the external sphincter is carried along which nerve

A

Pudenal

121
Q

Sympathetic control fibres to rectum come from which spinal level

A

T12-L2

122
Q

Parasympathetic nerves to rectum come off which spine level?

A

S2-S4

123
Q

Pectinate line marks what?

A

Junction between endoderm (gut) and skin (ectoderm)

124
Q

Above pectinate line, rectal blood supply comes from which artery

A

Superior rectal of IMA

125
Q

Below pectinate line, which artery supplies blood

A

Common iliac

126
Q

Above pectinate line, where does lymph drain?

A

Inferior mesenteric nodes

127
Q

Above pectinate line, where do veins drain to?

A

Hepatic portal system

128
Q

Key difference between rectal varices and haemorrhoids?

A

Varices are portal hypertension caused, haemorrhoids are pressure caused

129
Q

What is the name for the area of fat lying lateral to anus?

A

Ishcio-anal fossae

130
Q

Diarrhoea is roughly defined as

A

Unformed stools which hold shape of container

131
Q

Short-onset gut pathogens include

A

B. Cereus and S. Aureus

132
Q

Most common cause of food poisoning in Scotland

A

C. Jejuni

133
Q

Medium length incubation gut pathogens (12-48hrs)

A

Salmonella, C. Perfringens.

134
Q

Long-term incubation gut pathogens (2-14days)

A

Campylobacter, O157 E. coli

135
Q

Antibiotic class of type in Campylobacter infection

A

Macrolides

136
Q

Many/small number of campylobacter needed for infection

A

Small

137
Q

Salmonella is associated with what?

A

Raw poultry, eggs, reptiles

138
Q

Serogrouping of salmonella works off which antigen

A

O antigen (B, C, D most common serogroup)

139
Q

Agar used to identify E. coli

A

MAC or SMAC

140
Q

Potential complications of EHEC

A

HUS, DIC

141
Q

Presentation of HUS

A

Low WBC, platelets, HB, red cell fragments, LDH raised

142
Q

Drug treatment of choice in EHEC?

A

None - no ABX or NSAIDs or antimotility agents

143
Q

Rotavirus is commonest in which age group

A

<3years old

144
Q

Rotavirus stools are bloody, true or false?

A

False

145
Q

Approximate dose for an infection of rotavirus?

A

100-1000 virions

146
Q

How to diagnose rotavirus?

A

PCR on faeces

147
Q

Treatment of choice in rotavirus?

A

Hydration

148
Q

Norovirus sheds for how long post symptoms

A

48 hours

149
Q

Diagnosis of norovirus is by

A

PCR of stool

150
Q

Rotavirus is typically _______ in adults

A

Subclinical or mild

151
Q

CPC of UC

A

Bloody diarrhoea, urgency, colicky abdominal pain

152
Q

UC may occur where along the GI tract?

A

Colon

153
Q

CD may occur where along the GI tract?

A

Anywhere

154
Q

Common deficiencies in CD and UC include

A

Iron and B12

155
Q

Enteral nutrition has which role in treatment of UC?

A

None, no established evidence for implication of diet

156
Q

In times of CD flare up, it may be necessary to induce exclusive EN for 3-6 weeks to induce a remission, true or false?

A

True

157
Q

Example nutritional supplement used in IBD

A

Modulen IBD

158
Q

IBS is more or less common in females?

A

More, about 2:1 ratio

159
Q

First line therapy in treatment of IBS

A

Diet: regularity, avoid irritants, cut down on fatty foods, hydration, limit fizzy drinks

160
Q

Second line treatment in therapy of IBS

A

Low food map diet (Fermentable, Oligosaccharidoes, Disaccharides, Monosaccharides and Polyols)

161
Q

In Scotland gluten free food can be prescribed on which service

A

Scottish gluten free food service

Gastrointestinal (7 decks)

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