Small Bowel

Front 1

3 small bowel diseases which show dysregulation in their immune system

Back 1

IBD
coeliac
primary immune def

Front 2

name some mucosal tissues of the human body

Back 2

GI tract (salivary gglands- anal canal), resp tract, uro-genital tract, mammary glands

Front 3

name some secondary lymphoid tissues

Back 3

remember: peyer's patches in small intestine (ileum)

Front 4

what specialised epithelial cells are present in Peyer-s patches (ileum)
- what are their characteristics

Back 4

Front 5

what are the function of M cells at the epithelial surfaces of Peyer's patches?
- by what transport mechanism
- what happen's on the lamina propria side?

Back 5

M cells in close proximity to underlying immune cells.
TRANSPORT ANTIGENS--->lamina propria side: co-stimulatory signals

Front 6

apart from M cells in Peyer's patches of the ileum, what other cells in the epithelium are important for the gut's immune defence

Back 6

& CD8 killer T cells

Front 7

villi (in addition to peyer's patches) also contain immune cells.
- which are in the lamina propria

Back 7

CD4, mac, mast, dendritic, plasma cells

Front 8

how are activated effector T cells sent to their destined place in the lamina propria of the small intestine?

Back 8

T cells 'homed' to peyer's patched → dendritic cells present antigen → T cells activated → lymph →blood → appropriate chemokines & receptors attract effector T cells to gut.

Front 9

which receptor do activated effector cells bind to on the endothelium of gut capillaries to enter the villi where they will act

Back 9

MadCAM-1

Front 10

which Ig predominates in the humoral intestinal response produced by plasma B cells
- role

Back 10

80% IgA- AGGLUTINATION & NEUTRALISATION at mucosal sites (also at other mucosal tissues)

Front 11

Intraepithelial Lymphocytes (IELs): T cell (CD8) expression of which integrin anchors them in the epithelium

Back 11

αE:β7

Front 12

what cell type are the majority of IELs? (intraepithelial lymphocytes)
- how do they respond to epithelial cell infection

Back 12

CD8+ Killer T cells
- kill infected cell via perforin/granzyme & Fas-dependent pathways

Front 13

in mucosal hyperresponsiveness, T cells show a higher level of activation & a stronger response where there shouldn't be.
- what molecules are absent to prevent dendritic and T cell maturation?

Back 13

chemokines

Front 14

IgA def is a primary immunodef, what disease does is predispose to

Back 14

coeliac's disease

Front 15

food allergy demonstrates what type of hypersensitivty
- cells involved?
- common symptoms

Back 15

IMMEDIATE type 1 IgE-mediated
cross-link on MAST cells

- vomiting (intestinal contraction)
- diarrhoea
- puritis (itching_, urticaria (itching), anaphylaxis (rare) : from wide haematogenous dissemination

Front 16

which enzyme is present in coeliac's disease that modifies gluten so it can be presented to CD4 T cells (MHCII) causing an autoimmune response?

- what type of hypersensitivity reaction does it show

Back 16

tTG (tissue transglutaminse)
can be used for dx

- DELAYED type 4 hypersensitivity: Tcells & macrophages

Front 17

how to dx (Ix's) for coeliac's disease

Back 17

BIOPSY
serology: IgA & tTG

Front 18

2 types of autoimmune inflammatory hepatobiliary cirrhosis

Back 18

autoimmune hepatitis
primary biliary cirrhosis
(? primary sclerosing cholangitis- suggested)

Front 19

autoimmune hepatitis is a type of autoimmune inflammatory hepatobiliary cirrhosis...which shows loss tolerance against liver tissues
- which 3 serum antibodies can be detected on Ix

Back 19

antibodies to:
- nuclear antigens (ANA)
- smooth muscle (ASM)
- liver kidney microsomala antigens (LKM1)

Front 20

PBC (primary biliary cirrhosis) is a type of autoimmune inflammatory hepatobiliary cirrhosis...showing chronic cholestatic LIVER disease with small & medium INTRAhepatic duct destruction.
- which serum antibody can be detected in high concs?

Back 20

IgG AMA (antimitochondrial ab's) 98% - M2 subtype

Front 21

only therapy for PBC

Back 21

UDCA (ursodeoxycholic acid)

Front 22

where's the control centre for energy homeostasis ( integrates neural & hormonal)

Back 22

hypothalamus

Front 23

what controls short-term satiation

Back 23

PEPTIDES produced in the STOMACH & GI tract

Front 24

what controls long-term body weight

Back 24

HORMONES

Front 25

which peptides controlling short-term satiation is released from the I-cells of the duodenum & jejunum
- in response to what
- effect

Back 25

CCK in response to FAT & PROTEIN
seonsory --> hindbrain

Front 26

which2 peptides controlling short-term satiation is released from the L-cells of the GI tract
- in response to what
- effect

Back 26

1) PeptideYY (PYY) AFTER meals
-inhibits gastric emptying
- satiation

2) GLUCAGON-LIKE peptide-1 (GIP-1) on INDEIGESTION
- inhibits gastric emptying
- satiation

Front 27

which 2 peptides controlling short-term satiation is released from the OXYTINIC cells of the duodenum & jejunum
- in response to what
- effects

Back 27

1) OXM- AFTER meal
- reduces appetite

2) GHRELIN - BEFORE meals
- increases lipogenesis
- hunger

Front 28

2 hormones that communicate to hypothalamus to alter energy balance (increase energy burn)
- which cells release them
- which malfunctions in obesity

Back 28

LEPTIN- adipose

INSULIN- pancreatic ISLET's of Langerhan's (endocrine)

Front 29

what's the effect of reduced leptin levels (normally produced from adipose cells)

Back 29

mimics STARVATION = unrestrained appetite, increased fat deposition, reduced energy burn

Front 30

how does ORLISTAT work to reduce obesity

SE's

Back 30

inhibits pancreatic lipase
decreases triglyceride dig & absorption
SHORT-term

x. cramping, severe, diarrhoea

Front 31

LORCASERIN is a new anti-obesity drug. which receptor does it antagonise

Back 31

5-HTc receptor antagonists

Front 32

histology of normal small bowel

Back 32

JEJUNUM- tallest villi, plicae circularis, goblet cells and crypts of Lieberkuhn

ILEUM- Peyer's patches, smaller villi & crypts, less prominent plicae, goblet cells

Front 33

2 reasons why the bowel can become ischaemic

Back 33

OCCLUSION in mesenteric arteries:
- thromboembolism
- atherosclerosis

PERFUSION insufficiency:
- shock
- strangulation
- drugs
- hyperviscosity

Front 34

which part of the GI wall suffers from ischaemia first (i.e. the most metabolically active)

Back 34

mucosa- can replace quickly

(muscle damage cannot replace quickly)

Front 35

3 outcomes of ischaemic bowel

Back 35

- RESOLUTION
- FIBROSIS, stricture, chronic ischaemia, 'mesenteric angina'
- GANGRENE, perforation, peritonitis, sepsis, death

Front 36

what's Meckel's diverticulum
what ar ethe complications

Back 36

incomplete regression of vitello-intestinal duct, outpouching connected to umbilicus 2ft above ileocaecal valve:
X. bleeding, pain, perforation, divertilculitis

Front 37

primary tumours of small bowel are rare:
- 3 types

Back 37

LYMPHOMOA- (MALTomo- Bcell derived)

CARCINOID- locally invasve, produce hormones

CARCINOMAS- Chron's & coeliac disease, presents late.

Front 38

secondary mets to small bowel are common:
from which 3 cancers

Back 38

ovarian
colorectal
stomach

Front 39

S&Ss appendicitis

Back 39

umbilical colic --> constant RIF
vomiting, constipation (or diarrhoea)
tachycardic, shallow breaths, fever
guarding

peritonitis: wash-board rigidity, lay still

↑WCC & CRP

Front 40

pathology of acute appendicitis
- specific loc of wall?

Back 40

acute inflammation- neutrophils, eosinophils...
MUCOSAL ulceration
exudate, pus

Front 41

3 complications of acute appendicitis

Back 41

perforation/ rupture --> peritonitis --> sepsis
abscess
fistula

Front 42

associations with coeliac disease

Back 42

HLA-B8
dermatitis herpetiformis
childhood DM

Front 43

pathological features of coeliac disease biopsy

Back 43

IELs (CD8) damage epithlial cells = villous ATROPHY
MALABSORPTION
↑IELs & ↑inflam cells in lamina propria
PROXIMAL bowel worse

Front 44

S&Ss coeliac disease
- intestinal
- extra-intestinal
-general

Back 44

STEATORRHOEA
abdo pain & bloating
N&V
mouth ulcers & angular stomatitis, glossitis (B12 def)
↓weight, fatigue, weak, anaemia, osteomalacia
failure to thrive

asymp!

Front 45

5 complications of coeliac disease

Back 45

anaemia
GI T-cell lymphomas (rare)
small bowel carcinoma
gall stones
ulceration & strictures

Front 46

surgical criteria for bariatric surgery

Back 46

BMI>35 + co-morbidities
or
BMI>40

achieved 5% weight loss
tried ALL non-surgical Rx
medically & psychologically stable
non-smoker

Front 47

3 types bariatric surgery

Back 47

BYPASS - reversible
BAND
SLEEVE

Front 48

common diseases causing malabsorption 6: CCCCBP

Back 48

COELIAC
CHRON's
Chronic PANCREATITIS
CIRRHOSIS
Biliary obstruction/ cirrhosis = ↓bile
Post-infection

uncommon: (pancreatic ca, drugs, Short bowel syndrome)

Front 49

S&Ss malabsorption

Back 49

diarrhoea, steatorrhoea
↓weight, faitgue
anaemia (pallor, conjunctivae, ulcers, stomatitis, koilonychia)
glossitis
bleeding/ bruising (VitK def)
oedema (↓protein)

Front 50

Ix's for ?malabsorption

Back 50

FBC, coagulation (vit K), U&Es (hydration), LFTs (albumin), Ca (vit D def), COELIAC serology (IgA, tTG)

STOOL (fat, infection)
ENDOSCOPY + BIOPSY
RADIOGRAPHY- X-ray, USS, ERCP, CT, MRI

Front 51

contraindications for artificial enteral feedin gsupport via NG/NG/PEG/PEJ

Back 51

ulcers
obstruction
perforation
fistulas
facial injury

Front 52

define acute and chronic intestinal failure

Back 52

gut not able to supply nutritional & hydrational needs

ACUTE <2wks: mucositis, post-chemo

CHRONIC- short gut syndrome

Front 53

causes of chronic intestinal failure

Back 53

SHORT BOWEL SYNDROME- iatrogenic or congenital
Vascular (ischmia)
Neoplasia
Dysmotility
Severe CIRRHOSIS
Iatrogenic

Front 54

management of short bowel syndrome

Back 54

supportive/ symptom control -Rx: PPIs, loperamide, codeine

PARENTERAL feeding (long-term)

TRANSPLANT (last resort)

Front 55

some complications of parenteral feeding

Back 55

!!!PNEUMOTHORAX, puncture ARTERY, THROMBOSIS, SEPSIS!!!!
inappropriate use
liver disease
bone disease
line fracture/ break
psychosocial

Front 56

clinical features of refeeding syndrome

Back 56

CV & resp FAILURE
bone marrow suppression- immunosuppression
SEIZURES
Metabolic disturbances: ↓K, ↓Mg, oedema, glucose metabolism shift, ↓vits

Front 57

commonest western cause small intestinal obstruction

Back 57

adhesion (eg after surgery, prev intraperitoneal inflam)
or
hernia