Week 5 Flashcards
(115 cards)
1
Q
iron, fat, and monosaccharides is only absorbed where?
A
Duodenum
2
Q
Which vitamins are ONLy absorbed in the jejunum?
A
Vitamin c and B6
3
Q
Vitamin B12 is absorbed where?
A
Ileum
Same as bile acid
4
Q
Where is magnesium absorbed?
A
Whole SB
5
Q
Ileum is mainly water soluble vitamins absorbed, true or false
A
True
6
Q
Cause of malnutrition in GI diseases?
A
Oesophageal structures/ malignancy
Gastric pathology- eg maybe stomach doesn’t empty?- malignancy/ gastroparesis
7
Q
Biggest cause of malabsorption in the biggest world?
A
Coeliac disease
8
Q
What’s happening in coeliac disease?
A
Trying to kill gliadin, but kills enterocytes instead ????
9
Q
Biggest sign of coeliac disease
A
Iron deficiency
10
Q
Complications of coeliac disease?
A
Refractory coeliac
Ulcerative jejunitis
Bone disease
Colon/ oesophagus/ adenoma lymphoma cancers
11
Q
4 infections related to coeliac disease?
A
Giardia
Tropical sprue
HIV
Whipples
12
Q
4 treatments of IBD?
A
5ASA
Steroids
Biologics
Surgery
13
Q
Pancreatic enzyme insufficiency affects which enzymes?
A
Protease
Lipase
Amylase
14
Q
Diagnosis for pancreatic insufficiency?
A
Faecal elastase
Cross sectional imagez
15
Q
Could cystic fibrosis affect the pancreas?
A
Yes
Pancreatic insufficiency
16
Q
Commonest reasons for surgery for small bowel disease?
A
Crohns/ ischaemia
Reducing length of SB
17
Q
For IBD why does malabsorption only occur in crohns Vs uc?
A
Because absorption happens in small bowel. Uc is only large bowel. However both result in diarrhoea because water absorption occurs in the large colon
18
Q
Diagnosis/ differential necessary for diagnosing between IBS Vs IBD?
A
For IBD need inflammatory markers
19
Q
Why would a fart relieve pain with bloating?
A
Because bloating stretches smooth muscle, fart stops distension
20
Q
What imaging for gall stones?
A
Ultrasound
21
Q
Definition of re-feeding syndrome?
A
22
Q
Enteral Vs parental nutrition?
A
Parental - when gut is inaccessible
23
Q
What’s a gastrostomy
A
Dk
24
Q
Definition of intestinal failure?
A
State in which the absorptive function of the gut cannot meet the minimum needed to maintain macronutrients and or water and electrolytes necessary for organism survival
25
How many types of intestinal failure is there?
3
Type 1) acute and short lasting
Type 2) acute but requiring nutritional support for weeks or months
Type 3) chronic
26
27
Drugs treating alimentary disease are mainly administered which way?
Orally
28
Parasympathetic Vs Sympa, mainly post or pre ganglionuc?
Para = very long pre
Sympa = mainly post
29
Which diseases need drugs that protect against acid damage to mucosa?
GORD, Barrett’s, peptic ulcer disease
30
What do prostaglandins do
Inhibit acid, and increase mucus production
31
Which infection causes acid damage to mucous layer
H pylori
32
What pharmacological option for h pylori
Triple therapy (PPI and two antibacterial- amoxicillin and meth something)
33
H2 receptor antagonist drugs do what
Inhibit activation of proton pump so decrease acid secretion
34
Biggest proton pump inhibitor?
Omeprazole - oral or IV
35
When are H2-RA and PPIs indicated?
GORD/peptic ulcer disease and h pylori
36
Adverse affects of drugs that raise pH/ lower gastric acid secretion, eg h2-RA and PPIs?
Vitamin b12 deficiency
More chance of infection eg C. difficile
Tumour?
37
What’s happening in vomiting?
Contraction and distal end, relaxation in proximal end
38
Why nausea when dizzy?
Body thinks dizzy = poisoned. Poison often causes dizziness you see
39
Is the cause of nausea known?
No
NB you can actually be nauseous without vomit and vice versa
40
What’s chronic functional nausea? What might it respond to?
Low dose antidepressants
No known cause
41
Drugs that affect the motility of the GI tract?
Purgatives (accelerate passage of food)
Anti-diarrhoeal drugs that decelerate passage of food
42
Example of purgative?
Laxatives eg osmotic (poorly absorbed solutes- to encourage water to come in)
43
What’s a stimulant purgative?
Increase electrolyte secretion by the gut mucosa
Therefore increase water secretion
44
Side effect of stimulant purgative laxative (given as suppository)
Cramps
Very effective
Act on myenteric plexus
45
Drugs which directly affect drug motility?
Domperidone (D2 antagonist)
= lowers oesophageal sphincter pressure (GORD)- increases gastric emptying
46
Anti depressants could treat IBS?
Yes
47
Clinical management of inflammation of IBD?
Corticosteroids especially when acute
Given orally IV or rectallt
48
Concerns of corticosteroid use in IBD
Osteoporosis and increased susceptibility to infection
also crises when you take drug away (look at this for more notes)
49
Chronic treatment of IBD?
Aminosalicylates
50
Drugs for GI system target what?
Gastric secretion
Vomiting and nausea
Gut motility and defecation
Formation and defecation of bile
51
Anti muscarinics affect what?
Motility
52
Sympathetic , which is mainly post-ganglionic- is it excitatory or is it inhibitory
Inhibitory
53
Which cells in particular do H2-RAs and PPIs target?
Parietal cells
Because that’s where gastric acid production/secretion comes from
(Nb G cells are where gastrin comes from, that enzyme)
54
Why do PPIs and H2-RAs cause a side effect of B12 deficiency?
Because they target parietal cells, that secrete acid. But they also secret intrinsic factor
55
Treatment of diarrhoea?
Anti-infective agents
Anti-diarrhoeal drugs that decrease motility
Anti-spasmodic agents that decrease muscle tone
56
The main agents for treatment of diarrhoea are?
Opioids
Main one is loperamide
Constipation is a problem with these
57
How does the opiate loperamide work?
Opiate receptors decrease ACh release
58
What do opioids do for smooth muscle contraction,
And
Anal sphincter tone
Reduces smooth muscle contraction
Increases anal sphincter tone
59
Opioids inhibit ACh release. What does this do
Related to vagus nerve. It’s parasympathetic so ACh would normally increase gut motility
60
Gall bladder pain can be referred where?
To the shoulders
61
Diverticulitis results from what
Stagnation of faecal material
62
L2,3,4 keeps…
Your bowels off the flood
63
Pernicious anaemia and IBD?
64
Gastric emptying is controlled by which nervous systems
Vagus and enteric nervous system
65
State where each of the cells are produced?
Gastrin
CCK
Secretin
Motilin
Gastrin = G cells in the stomach
CCK = in duodenum
Secretin = duodenum
Motilin = intestine
66
What does CCK do?
Delays gastric emptying?
Also it basically causes the gall bladder to contract
67
Is a small bowel obstruction further up or down, if it's a very high volume of vomit?
Further down. Might suggest its as far down as most of the duodenum.
68
Green vomit meaning, related to obstruction
Green undigested bile typically comes from the upper duodenum (the first part of the small intestine). If a person vomits this substance, it may mean that there is an obstruction or other potential issue
69
Out of:
Gastrin
HCL
Pepsin
Mucus
Secretin
CCK
Digestive enzymes
which come from where? (3)
Stomach =
gastrin (encourages HCL release)
HCL
Pepsin (protiens)
Mucus
Duodenum =
CCK
Secretin
(both inhibits gastrin and encourages release of digestive enzymes from pancreas)
Digestive enzymes = from pancreas
70
Patient with history of recurrent pneumonia due to aspiration of food at night. What is this?
achalasia
relaxation of oesophageal sphincter, so oesophagus becomes dilated and filled with food over time.
71
Why do we look for mouth ulcers in abdominal exam?
mouth ulcers occur in crohns and B12 deficiency
72
Anemia affects the tongue how?
Affects the colour of the tongue
73
What imaging for checking position of a nasogastric tube?
X-Ray
74
When would an x ray be useful for a GI disease???
Exclusion of perforation, as you could see free gas in it
75
X rays would be useful for exclusion of perforation, give some examples of what might be perforated?
Perforated duodenal ulcer, or perforated colonic diverticula
76
Big three causes of bowel obstruction?
Adhesions (small bowel)
Hernias (small bowel)
Malignancy (large bowel)
Need to learn these without hesitation.
77
Patient has an obstruction. You know the three biggest causes of obstruction. You find out part of the patient history is a previous abdominal surgery. What’s the most likely cause therefore?
Adhesion
78
What are adhesions
Scar tissues that can bind abdominal content together
79
What’s a closed loop obstruction? And therefore how might this lead to ischaemia and perforation?
Two points of obstruction.
Contents of middle section = don’t have an open end where they can drain and decompress- the closed-loop section will inevitably continue to expand, leading to:
ischaemia and perforation!!!!
Requires emergency surgery.
80
Lack of flatulence, with absolute constipation- alongside green vomit and diffuse abdominal pain and distension?
Bowel obstruction
81
When might NG tube be used for management of bowel obstruction?
Initially. With free drainage to allow stomach contents to freely drain and reduce the risk of vomiting and aspiration.
82
Initial management of bowel obstruction ?
“Drip and suck”
#Nil by mouth
#IV fluids - hydrate patient and correct electrolyte imbalances
#NG tube with free drainage
83
Why does iron deficiency anaemia and coeliac disease go together?
In celiac disease, due to the atrophy of the intestinal mucosa, there is a reduced intestinal absorption of iron and therefore reduced iron delivery to developing red cells.
84
Peaks for diagnosing coeliac disease?
Infancy when first exposed to gluten
And then also
At age 40-50 years
Good to know this for thinking about diseases
85
So investigations for coeliac disease- I know I’ll looks at bloods for anaemia. But most coeliacs are often positive in what?
HCL DQ8 - most coeliacs
But also DQ8
86
Why does chronic inflammation occur in coeliac disease?
Basically gliadin isn’t broken down, and instead it goes through the withekium and causes an immune response. This immune response causes the chronic inflammation.
87
What does the chronic inflammation in coeliac disease lead to?
Damages the epithelium and ultimately leads to malabsorption
88
Could there be fistulas in crohns?
Yes
89
Which IBD has inflammation that leads to non-caseating Granulomas?
Crohns
90
A nasogastric tube would be used in obstructions. (Also for feeding and draining). What are the three biggest causes of obstructions?
Hernias
Malignancy
Adhesion
91
Someone with a bowel obstruction, with PR bleeding. Knowing the three biggest causes of bowel obstruction, what is the likeliest cause?
Bowel cancer
92
How do we check that a nasogastric tube has actually been inserted into the stomach?
A pH test
93
A gas filled small bowel would show as what sign?
Abdominal distension
94
Oesophageal cancer- what’s out imaging modality of choice?
Endoscopy to obtain biopsy
95
Would you ever do a barium swallow study with x rays for study of small bowel? Give example.
Yes
Eg with crohns to visualise cobblestones.
96
What imaging modality am I describing? Adding contrast to the biliary tree distally, using an endoscope, through the stomach into the duodenum.
ERCP
Endoscopic retrograde cholangio-pancreatograpgy
97
When would you do ERCP for a patient with jaundice?
Imagine you think the reason is obstruction of the bile duct. We do the ERCP- contrast injected through into biliary tree, the x rays taken- and we can therefore see a dilated bike duct- confirms a big stone is blocking.
98
What’s a PTC test?
Percutaneous transhepatic cholangiography
Long thin needle through skin into bile ducts. Inject contract. Look at pancreas, gallbladder and bile ducts (can also take biopsies)
99
When would you have a PTC Vs an ERCP?
PTC if can’t have ERCP or if your ERCP didn’t work e.g. could t get biopsies or couldn’t unblock ducts
100
ERCP is used for diagnosing and treating problems with the liver, gallbladder, bile ducts, and pancreas. What might it do to treat blockages in the bile ducts?
Remove stones
Bypass obstructions eg due to inflammation, tumour, infection
101
Endoscopy Vs endoscopic ultrasound Vs ERCP??
Endoscopy = a thin, flexible tube with camera and light on the end
EUS = endoscopy *with* Ultrasound probe on the tube at the end to generate virtual image ( better than normal US cuz not from outside the body, but inside!)
ERCP = endoscopy with video camera, X-ray not ultrasound, and contrast
102
Pain where would indicate specifically EUS image modality?
Pain in upper right quadrant e.g. clinician might think it’s gallstones
103
If a tumour invaded the portal vein, can it be resected successfully?
No
104
Why endoscopic ultrasound Vs normal ultrasound
Allows us to get closer to internal structures, which improves image resolution
105
Why is CT good in an emergency situation?
Because it is very quick, and it’s accessible.
106
CT’s are often used for acute emergency situations. When else might they be used?
Diagnosis and staging of cancer
107
Put CO2 up the rectum, to distend colon. What do we do before and after
Bowel prep to clear the colon
Do a CT colonography
108
Fresh blood in the stool or on wiping, with no pain during defecation, is classical for what
Haemorrhoids
109
Fresh blood in the stool or on wiping with severe pain on defecation =
Anal fissure
110
How does diverticulitis present?
Localised abdominal pain due to inflammation of the diverticula, along with fever nausea and decreased appetite
111
Bloody diarrhoea and weight loss- is this is present in ulcerative colitis?
Yeah
112
ALARMS symptoms of gastro oesophageal reflux disease ie GORD?
Anaemic, loss of weight, anorexia, recent onset of progressive symptoms, masses and malaena, swallowing difficulty
113
Golden operative standard got gallstones?
Laparoscopic cholecystectomy
114
Two day history of heartburn and epigastric pain, after excessive alcohol and smoking is what
GORD
115
Immunosuppressives and they have a sore throat? = what (eg azathioprine)
Urgent full blood count
