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GASTROINTESTINAL > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What is the gastroileal reflex stimulated by and what does it involve?

A

Stimulated by gastric distension

Involves opening of the ileocaecal valve

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2
Q

What is absorbed and secreted by the large intestine?

A

Water, sodium and chloride ions are absorbed

Potassium, bicarbonate and mucus are secreted

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3
Q

Carbohydrates not absorbed in the S.I can be absorbed in the L.I but first must be converted. What does this involve?

A

Colonic flora ferment the carbohydrates to short-chain fatty acids which can then be absorbed

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4
Q

Is the internal anal sphincter under control of the brain or the spinal cord?

A

Spinal cord

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5
Q

What does RELAXATION of the skeletal muscle of the external anal sphincter cause?

A

Defecation

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6
Q

What does CONTRACTION of the skeletal muscle of the external anal sphincter cause?

A

Delays defecation

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7
Q

What are some of the roles of colonic bacteria within the bowel?

A

Increase intestinal immunity
Promote motility
Activate some drugs
Synthesis vitamin K2 and free fatty acids

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8
Q

What are the two main important drug classes used for IBD?

A

Steroids and immunosuppressants

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9
Q

What two conditions fall under IBD?

A

Crohn’s Disease and Ulcerative Colitis

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10
Q

What is a polyp?

A

A protrusion above an epithelial surface

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11
Q

What is an adenoma?

A

Benign tumours composed of epithelial cells

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12
Q

What is an adenocarcinoma?

A

A malignant epithelial tumour

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13
Q

Injecting what substance can prevent bleeding when removing a polyp?

A

Adrenaline

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14
Q

Why must all adenomas be removed?

A

They are dysplastic and are pre-malignant - it would only take a few more mutations for a cancer to develop and thus they need to be removed to prevent this from happening

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15
Q

Are left or right sided colorectal cancers more common?

A

Left- sided

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16
Q

Why can there be spread to the liver from a colorectal cancer?

A

The merging of the systemic with the portal venous system allows metastasis to be directed towards the liver

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17
Q

Name two types of inherited cancer syndromes

A

HNPCC (hereditary non polyposis coli)

FAP (familial adenomatous polyposis)

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18
Q

What are causes of diverticular disease?

A

Low fibre diet

Increased intraluminal pressure

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19
Q

What is diverticulitis?

A

Inflammation of the diverticulae

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20
Q

What are some of the complications of diverticular disease?

A 
Inflammation 
Rupture/ Perforation - peritonitis/ sepsis
Abscess 
Fistula 
Stricture 
Massive bleeding
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21
Q

What is the most common fistula that can occur from the large intestine? What can this cause?

A 
Colovesical fistula (bladder and L.I communicate) 
- Can cause recurrent UTI's and flatus (bubbles) in the urine
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22
Q

What is a fistula?

A

A pathological communication between two epithelial surfaces

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23
Q

What classification is used to stage acute diverticulitis?

A

Hinchey Classification

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24
Q

What is the name of the surgery used in the management of complex diverticulitis?

A

Hartmann’s procedure

25
Who gets ischaemic colitis?
Elderly patients | Arteriopaths (patients with artery disease)
26
What are some of the causes of rectal bleeding?
Haemorrhoids Diverticular disease Cancer Large polyps
27
What are some of the possible causes of large bowel obstruction?
Colorectal cancer Hernias Volvulus Strictures
28
What are the symptoms of large bowel obstruction?
Constipation Distension Pain Vomiting
29
What is a sigmoid volvulus?
When the sigmoid colon twists on its mesentery causing the lumen to be blocked off and the vasculature to be pinched off - can cause infarction and gangrene
30
What is meant by a 'pseudo obstruction'?
When there is no real mechanical/ physical obstruction - can be due to hypoxia/ biochemistry
31
What are the histopathological clues of ischaemia?
Withering of crypts Pink, smudgy lamina propria Few chronic inflammatory cells
32
What are the histopathological clues of antibiotic-induced pseudomembranous colitis?
Patchy yellow membrane exudates on the mucosal surfaces
33
What are the histopathological clues of collagenous colitis?
Increased thickness of sub epithelial collagen | thickened basement membrane
34
What are the histopathological clues of lymphocytic colitis?
Increased intraepithelial lymphocytes | No thickening of the basement membrane
35
What two conditions come under the term 'Microscopic Colitis'?
Collagenous Colitis and Lymphocytic Colitis
36
What kind of history would be important in considering a diagnosis of radiation colitis?
History of prostate/cervical cancer, treated with radiotherapy
37
What are two causes of irritable bowel syndrome?
Disorders of intestinal motility | Visceral hypersensitivity
38
What can exaggerate the symptoms of IBS?
Stress Menstruation Gastroenteritis
39
What investigations are done for IBS?
``` FBC ESR/ plasma viscosity CRP Antibody testing for coeliac disease Lower GI tests if >50 years or there is a FH of colorectal cancer ```
40
What classes of drugs can be used for the treatment of IBS?
Anti-diarrhoeals Anti-spasmodics Anti-depressants Laxatives
41
Which disease has a higher risk of malnourishment - Crohn's or Ulcerative colitis?
Crohn's | - As the disease can affect anywhere in the GI tract from the mouth to the anus
42
A BMI of 30 - 35kg/m2 reduces life expectancy by how many years? A BMI of >40kg/m2 reduces life expectancy by how many years?
2-4 years 10 years
43
What are the alarm symptoms for dyspepsia which require urgent referral for endoscopy?
``` Chronic GI bleeding Weight loss (unintentional) Persistent vomiting Dysphagia Iron deficiency anaemia Epigastric mass Patient >50 years with persistent dyspepsia ```
44
List 3 medications which can cause dyspepsia
NSAIDs Aspirin Corticosteroids
45
What are the three types of jaundice?
Prehepatic Intrahepatic Posthepatic
46
List some possibilities to include in the differential diagnosis of dysphagia
``` Cancer Ulcers GORD Achalasia Oesophagitis Extrinsic pressure Oesophageal spasm Benign strictures and tumours ```
47
What are the investigations for dysphagia?
History and examination | Endoscopy (OGD)
48
Bacillus Serus can cause food poisoning. What food is it usually associated with?
Starchy foods - particularly poorly temperature controlled rice
49
What is the most common organism to cause food poisoning?
Campylobacter
50
Which organisms which cause food poisoning can cause bacteraemia in immunosuprressed patients?
Campylobacter and Salmonella
51
What organism which can cause food poisoning do reptiles carry a lot of?
Salmonella Enteritidis
52
What organism which is a cause of food poisoning can cause cell death of red blood cells and renal cells?
E.Coli 0157
53
What substance does E.coli 0157 produce?
Verotoxins
54
What can cause Haemolytic Ureamic Syndrome (HUS)?
E.Coli 0157
55
What are the symptoms of HUS?
``` Anaemia signs and symptoms Fever Vomiting and diarrhoea Abdominal pain Blod in stools Low/ no urine output ```
56
Why must antibiotics not be given to patients with suspected E.coli/ HUS?
As antibiotics can actually cause E.coli to produce more verotoxins, which worsens the condition
57
Which virus is the most common cause of vomiting and diarrhoea in children under 3 years old?
Rotavirus
58
Which virus involves sudden onset of explosive diarrhoea and vomiting, is highly infectious and causes large outbreaks?
Norovirus

GASTROINTESTINAL (13 decks)

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