The Gastrointestinal And Hepatobiliary System

Front 1

What are the organs in the right upper quadrant?

Back 1

- liver
- gallbladder
- duodenum
- head of the pancreas
- right adrenal gland
- upper lobe of the right kidney
- hepatic flexure of the colon
- section of ascending colon
- section of transverse colon

Front 2

What are the organs in the left upper quadrant?

Back 2

- left lower part of liver
- upper lobe of left kidney
- splenic flexure of colon
- section of transverse colon
- section of descending colon
- stomach
- spleen
- pancreas
- left adrenal gland

Front 3

What are the organs in the right lower quadrant?

Back 3

- lower lobe of right kidney
- section of ascending colon
- right fallopian tube (female)
- right ovary (female)
- part of uterus (if enlarged)
- right spermatic cord (male)
- cecum
- appendix
- right ureter

Front 4

What are the organs in the left lower quadrant?

Back 4

- lower lobe of left kidney
- section of descending colon
- left spermatic cord (male)
- part of uterus (if enlarged)
- sigmoid colon
- left ureter
- left ovary (female)
- left fallopian tube (female)

Front 5

What is peritonitis?

Back 5

Inflammation of the peritoneum

Front 6

What is peritonitis typically caused by?

Back 6

Bacterial infection either via the blood or rupture of an organ in the peritoneal cavity

Front 7

What are specific disorders that can result in peritonitis?

Back 7

- appendicitis
- diverticulitis
- acute pancreatitis

Front 8

What are disorders that result in peritonitis manifested by?

Back 8

- rapid proliferation of bacteria which increases immune response
- release of inflammatory cytokines
- fever
- vomitting (gut sends signals to the brain centres that cause sickness)
- pain

Front 9

Can necrosis of the kidney progress to peritonitis?

Back 9

No, as it is not located in the peritoneum

Front 10

Can bacterial related necrosis of the fallopian tubes progress to peritonitis?

Back 10

Yes, as they are located in the peritoneum

Front 11

What is liver cirrhosis?

Back 11

Liver cirrhosis is where the portal venous system becomes blocked up by fibrous tissue which prevents free flow of blood, causing congestion of the liver; the pressure causes portal venous hypertension and the blood backs up into the GIT

Front 12

What is Ascites?

Back 12

Abnormal accumulation of fluid in the peritoneal cavity

Front 13

Why does liver cirrhosis result in Ascites?

Back 13

Cirrhosis results in Ascites to relieve the pressure that is by cirrhosis. The fluid that is backed up into the GIT escapes into the peritoneum as it is not easily able to go trough the liver and on to the right side of the heart

Front 14

Why does liver cirrhosis result in oesophageal varices and internal haemorrhoids?

Back 14

The pressure created from the blocked portal venous system causes the body to create collateral channels by angiogenesis in attempt to go straight back to the heart; these new blood vessels are not yet ready to withstand the high amount of pressure so they start popping which results in bleeding

Front 15

Why does cirrhosis cause excess overall bleeding?

Back 15

- Because there is a lot of damage to the blood cells; decreased function of the liver results in the build-up of ammonia as the liver is not able to break it down - this is damaging to platelets and blood cells.
- the function of the coagulation cascade is also decreased as the proteins that are needed for coagulation is produced in the liver - decreased coagulation results in more bleeding

Front 16

Why does cirrhosis cause mental confusion?

Back 16

- mainly due to the lack of breaking down of ammonia which is damaging to neurons
- other toxins that are not able to be metabolised by the liver also build-up and become neurotoxic

Front 17

What are two distinctly different forms of oedema (formed by two distinctly different mechanisms), in patients with hepatitis?

Back 17

1. increased capillary pressure due to congestion in the liver
2. osmosis

Front 18

Explain how increased capillary pressure due to congestion in the liver causes oedema in hepatitis patients.

Back 18

- increased capillary pressure due to congestion of the liver causes portal hypertension and ascides
- results in the portal vein having so much pressure on it that it forces fluid through the blood vessels and into the area of the peritoneum

Front 19

Explain how osmosis causes oedema in hepatitis patients.

Back 19

- in hepatitis, the protein production is going to decrease severely which causes a lack of albumin
- this creates an osmotic imbalance and causes fluid to be transferred into the interstitial space

Front 20

What does vomitting a coffee-ground emesis suggest?

Back 20

- Vomitting an emesis with ground coffee like appearance suggests that there is blood in the GIT, usually the upper portion of the duodenum.
- when the blood is churned up it oxidises and solidifies to create a substance that looks like coffee grounds in the emesis

Front 21

What are three things that break the "impenetrable" barrier of the stomach and predispose to peptic ulcer?

Back 21

1. alcohol
2. non-steroid anti-inflammatory drugs, e.g. aspirin
3. helicobacter pylori

Front 22

What could blood in the stomach be caused by?

Back 22

Blood in the stomach could be caused by things such as stomach fissures (Mallory-Weiss), peptic ulcers and a number of other factors

Front 23

Why does bleeding wind up with iron deficient anaemia?

Back 23

- bleeding end up in iron-deficiency as bleeds that last a long time end up in a higher loss of iron that what we are able to absorb (iron levels come from the amount we are able to absorb)

Front 24

Why doesn't normal red blood cell destruction cause iron deficient anaemia?

Back 24

- RBC destruction does not cause anaemia as the iron is reused
- the RBC's go through the spleen and old RBC's are engulfed and broken up by macrophages
- bilirubin is excreted and the proteins and iron are reused

Front 25

Name several disorders that cause upper GIT bleeding and the expected appearance of the faeces (and vomitus) in each case.

Back 25

1. Mallory-Weiss disorder (stomach fissures)
2. Peptic ulcer disease
3. Gastritis

- bleeding from the upper GIT mix in with the faeces resulting in a dark and black stool - the dark colour is due to the oxidised blood and is termed melana

Front 26

Name several disorders that cause lower GIT bleeding and the expected apperance of the faeces (and vomitus) in each case.

Back 26

1. Diverticulosis
2. Anal fissures
3. Haemorrhoids

- bleeding from the lower GIt, blood will usually be on the outside of the stool rather than mixed in, also fresh blood may be seen on the toilet paper

Front 27

What are diverticula?

Back 27

Diverticula are out pouches which commonly develop in the lower portion of the colon due to increased pressure on the descending colon from the straining of a low-bulk stool

Front 28

Why does diverticula sometimes result in diverticulitis?

Back 28

Inflammation from bacteria of faeces that invade the protrusions and the bleeding that they cause

Front 29

How do diverticula differ from adenomatous polyps?

Back 29

adenomatous polyps differ from diverticula in that they develop inwards and into the lumen of the GIT; they also arise most commonly in the lower portion of the colon

Front 30

What is the significance of adenomatous polys in the colon?

Back 30

- they are capable of progressing to bowel cancer which can then metastisise to the liver
- normal epithelium of the colon undergoes genetic mutation resulting in a hyper-proliferation of cells that stack up on top of one another; the bottom cells then atrophy leaving a kind of pouch - this is an adenoma
- the adenoma constantly undergoes damage and exposure to faecal toxins which cause more mutations eventually forming a carcinoma

Front 31

What is the main thing that you might see in early stages of adenoma and carcinoma?

Back 31

- a change in bowel movements
- blood present in stool