Anatomy
Azim comes to visit the GP, he has intermittent intestinal obstruction symptoms, primary around the transverse portion of duodenum. Which artery is most likely impacted?
Superior mesenteric artery
= Superior mesenteric artery syndromeD
Diminished mesenteric fat
A patient has recently returned from a trip through Eastern Europe where he spent a lot of time swimming. Since returning, has noticed the following:
What is his most likely diagnosis? How would you treat him?
Giardia
Antibiotic --> infectious diarrhoea
Metronidazole
Parthy can smell a HSP and is very hungry, which phase of the gastric acid secretion would be activated?
Describe 2 functions of gastrin
Cephalic --> anticipation of food
1. increase gastric motility
2. Stimulate ileal motility
3. Colon mass
What hormone initiates peristalsis?
Motilin
However, after a few weeks of this new diet, he starts to feel increasingly fatigue. He goes into see his doctor. What is his likely diagnosis?
Macrocytic Aneamia
- Vitamin B12 Deficiency
- The cell is unable to divide --> large cells
What is the blood supply to the gall bladder? What trunk does this come off?
Celiac trunk
Common Hepatic
Cystic
Daniel has been diagnosed with a spastic colon. This has led to the following symptoms:
- Diarrhoea
- Constipation
- Bloating
- Abdominal pain
He is prescribed with metoclopramide. What type of drug is this and how does it work?
Motility stimulant
- Accelerates gut transit time across the lower GIT
However, may cause diarrhea
What inhibits gastric secretions?
GIP, CCK and secretin (stimulated by chyme in the duodenum)
--> inhibit acid production and motility
Daniel has an issue with his motility of his small intestine. It takes longer for him than most people to move his food through the small intestine. Which type of cells would influence this?
Pacemaker cells : Interstitial Cells of Cajal
- Normal movement --> 3 waves/ min
Alex, has recently had strong, red and painful flare ups of his big toe. What is his most likely diagnosis and what is causing this?
Gout --> chronic disease of the joints
Disorder with purine metabolism --> hyperuriceamia
High concentrations of uric acid --> this
Where does femoral hernia protrude?
Protrudes below the inguinal ligament, through the femoral canal below and lateral to the pubic tubercle.
What type of drug is Hyoscine?
Antispasmodics
E.g. Travacalm
= antimuscarinic, reduces gut spasm and dries up secretions
Nithin is on a calcium inhibitor. He experiences excessive pain in his abdomen. What is most likely the cause of this?
Calcium Inhibitor ----> decreased contraction
Gall bladder is not able to contract ---> gall stones
Gall stones ---> pain
Coeliac Disease
He is later diagnosed to with Coal Workers Lung. What would you expect to find on a histological slide of this?
Fully fibroses lungs
Blue nuclei
Septa with fibrotic tissue
1. Posterior wall = transversals fascia, internal oblique and transverses abdominis
2. Anterior wall = exteternal oblique
3. Floor = Inguinal ligament (external oblique)
4. Roof = Internal oblieuw and Transverses abdominis
What is the mechanism of action of stimulants? Give an example of one.
Sessonsides
Bisacodyl
= irritates & stimulates the intestinal cells ---> contractions and water influx into the intestine which then stimulates bowel movement
What histological findings would be present with a patient who has chronic pancreatitis?
Ribrosis
Reduced Acini (relative sparing of islets of Langerhan)
Duct obstruction
Duct dilation
Chronic inflammatory infiltrate
A patient is vitamin D deficient. Which of his micro nutrients should be checked?
Zinc
SAD REACCS
Perform a hematological physical examination in under 8 mins. xoxox
praying 4 u
What is found within the portal triad?
Portal vein
Hepatic artery
Bile duct
A 59 year old woman is experiencing constipation. Her prescription options are wither metoclopramide or domperidone.
Discuss the possible impacts of these drugs.
Both = Dopamine (D2) antagonist
- Inhibits motility within the GIT, these result as there is a suppression of ACh release from the myenteric motor neurons (decreased parasympathetic activity)
- Inhibitory drugs --> pro kinetic effect
Main difference metoclopramide impacts the central nervous system --> drowsiness and confusion at high doses. Domperidone does not do this.
A patient is diagnosed with hemolytic uremic syndrome. He has E. coli.
With the management of this, which drug would you NOT give him?
Antibiotics, these break down the cell wall. Therefore, this would release toxins into the blood, therefore leading to further complications.
Treat: Hydration and Oxygen support
Matt tries to cook for Gabby on their date. However, Matt has no knowledge of how to cook and undercooks his chicken stir-fry.
After 4 days Gabby gets a severe headache, diarrhea and constipation.
What is most likely causing this?
Salmonella.
- Colonises within the intestines
- Cross contamination or undercooking of raw meats or poultry
- Long incubation period
The Jonas Brother's once released a song called Poison Ivy. They wish to know more about the type of reaction poison ivy and have come to you for help.
Type 4 Hypersensitivity
- Contact Dermititis
Develops hours ---> days after contact.
1. Contact and bind to self protein and taken up by Langerhan'scells
2. Langerhan's cells present self peptides and come in contact with Th1 cells which secrete cytokines
3. This activates keratinocytes which secrete cytokines
4. This leads to macrophage activation which secrete mediators of inflammation