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Bioregulatory Systems: Upper GI Tract > Lower GI Tract > Flashcards

Lower GI Tract Flashcards

1
Q

List the 7 main structures within the colon (large intestine)

A

Appendix

Caecum

Ascending colon

Transverse colon

Descending colon

Sigmoid colon

Rectum (—>anus)

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2
Q

List the 3 major organs supplied by the celiac artery

A

Stomach

Liver

Spleen

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3
Q

List the 3 major organs supplied by the superior mesenteric artery

A

Small intestine

Large intestine

Pancreas

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4
Q

Name the organ supplied by the inferior mesenteric artery

A

Colon

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5
Q

Name the major vein where the majority of organs in the gastrointestinal tract drains blood into.

A

Portal Vein

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6
Q

List the 4 major layers of the GI tract

A

Mucosa

Submucosa

Muscularis

Serosa

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7
Q

List the 3 components which make up the mucosa

A

From innermost to outermost:

Epithelium

Lamina propria

Muscularis mucosae

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8
Q

List the 2 components which make up the muscularis

A

From innermost to outermost:

Circular muscle

Longitudinal muscle

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9
Q

List the 2 components which make up the serosa

A

From innermost to outermost:

Areolar connective tissue

Epithelium

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10
Q

State the nerve responsible for parasympathetic innervation of the ascending and transverse colon.

A

Vagus nerve

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11
Q

State the nerve responsible for parasympathetic innervation of the distal portions of the colon (e.g descending, sigmoid)

A

Pelvic nerves

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12
Q

State vertebral regions of the spinal cord responsible for supplying sympathetic innervation of lower GI tract

A

Lower thoracic

Upper lumbar

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13
Q

External anal sphincter is supplied by which nerves and fibres?

A

Somatic motor fibres supplied by pudendal nerves

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14
Q

State what afferent sensory nerves of the lower GI tract are responsible for detecting.

A

Detects pressure

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15
Q

State the name of the plexus which innervates the submucosa of the GI tract

A

Meissner’s plexus

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16
Q

Define Hirchsprung’s Disease and its cause

A

Disorder of the lower GI tract in which there is difficulty in passing stool

Caused by lack of enteric intramural ganglia in most ditsal portions of the colon

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17
Q

State the region where myenteric ganglia is located

A

Taenia coli (The longitudinal ribbons of smooth muscle lining the colon)

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18
Q

State the 5 main types of lower GI tract disorders

A

Inflammatory

Infective

Structural

Functional

Neoplastic

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19
Q

Give 2 examples of inflammatory lower GI tract disorders

A

Inflammatory bowel disease

Microscopic colitis

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20
Q

Give 2 examples of infective lower GI tract disorders

A

E coli

C diff (Clostridium difficile)

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21
Q

Give 3 examples of structural lower GI tract disorders

A

Fissure

Haemorrhoids

Diverticular disease

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22
Q

Give an example of a functional lower GI tract disorders

A

Irritable bowel syndrome (IBS)

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23
Q

Give 2 examples of neoplastic lower GI tract disorders

A

Colon cancer

Colonic polyps

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24
Q

List 3 other causes for lower GI tract disorders besides those of the main divisions

A

Vascular causes

Metabolic causes

Neurological causes

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25
Q

State the incidence of inflammatory bowel disease in america and europe.

A
  1. 5 million americans
  2. 2 mil europeans
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26
Q

Which demographic of indiviudals are most affected by inflammatory bowel disease?

A

Young adults

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27
Q

List some socioeconomic complications for individuals suffering from IBS

A
  • Burden of therapy for patients
  • Hospitalisation
  • Surgery
  • Health-related quality of life
  • Economic productivity
  • Social functioning
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28
Q

State the 2 main conditions which fall under the umbrella term of inflammatory bowel disease

A

Crohn’s Disease

Ulcerative colitis

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29
Q

Define ulcerative colitis

A

A lower GI tract inflammatory disorder characterised by inflammation of the colonic mucosa

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30
Q

Define Crohn’s disease

A

An inflammatory disorder of the GI tract characterised by presentation of chronic transmural granulomatous inflammation

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31
Q

State 4 main ways Crohn’s disease differs to ulceratve colitis.

A

1) Can affect any part of the GI tract whereas in UC it is limitted to the colonic mucosa (hence superficial)
2) Crohn’s presents with granulomas whereas UC doesnt
3) Crohn’s affects more females versus males (5:1). UC affects both equally
4) UC extends in a continuous manner wheres in Crohn’s can affect different areas in a non continous way

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32
Q

Ulcerative Colitis always involves which part of the lower GI tracts?

A

Rectum

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33
Q

Describe the way inflammation presents itself in Crohn’s Disease

A

Patchy chronic transmural granulomatous inflammation

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34
Q

List the 5 main types of ulcerative colitis from least continous to most continuous and state the areas affected

A

Proctitis (Rectum)

Proctosigmoiditis (Rectum + sigmoid colon)

Distal colitits (rectum–>descending colon)

Extensive colitis (rectum –> transverse colon)

Pancolitis (Entirety of the colon)

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35
Q

List the 6 main types of Crohn’s Disease and state the areas affected.

A

Gastroduodenal Crohn’s Disease (Duoedenum [opening of SI])

Ileocolitis (Ileum [Distal portion of SI] and the LI)

Ileitis (Ileum)

Jejunoileitis (Jejunum [mid portion of SI])

Crohn’s colitis (Colon)

Perianal Crohn’s (Rectum and anus)

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36
Q

What is the most common type of Crohn’s Disease?

A

Ileocolitis

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37
Q

Inflammatory bowel disease has a variety of symptoms depending on which areas are affected. List 4 potential symptoms that may arise with individuals with colitis

A

Bleeding

Diarrhoea

Urgency to empty bowels

Mucus in stool/diarrhea

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38
Q

. List 3 potential symptoms that may arise in individuals with perianal inflammation in IBS

A

Anal pain

Difficulty passing stool

Leakage

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39
Q

. List 5 potential symptoms that may arise in individuals with small bowel disease

A

Abdominal pain

Abdominal mass

Weight loss

Fatigue/Lethargy

Diarrhoea

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40
Q

List 4 regions which may display extra-intestinal manifestaions of IBD

A

Arthritic regions

Skin

Eyes

Liver

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41
Q

List 2 types of arthiritis that can be caused by IBD

A

Ankylosis spondylitis (Arthiritis in the spinal region)

Peripheral arthritis (e.g. joints of arms and legs)

42
Q

List 2 skin manifestations in patients with IBD

A

Erythema nodosum

Pyoderma gangrenosum

43
Q

Name 2 manifestations of IBD that presents itself within the eyes

A

Anterior veitis (Inflammation of middle layer of eye suchs as iris and cilliary body)

Iritis/Episcleritis

44
Q

Name 2 manifestations of IBD that presents itself within the liver

A

Primary sclerosis cholangitis (PSC) [Scarring of the bile ducts]

Autoimmune hepatits

45
Q

Inflammatory disease can occur by a combination of which 3 main factors?

A

Genetics

Environmental factors such as luminal microbiota

Immune response

46
Q

Name 4 types of gene which can increase the risk of developing IBD

A

NOD2

HLA

ATP

IL23R

47
Q

Name 2 types of antibodies which can increase the risk of developing IBD

A

ASCA (Anti-saccaromyces cervisia)

pANCA

48
Q

Give 2 examples of environmental factors which can increase the risk of developing IBD

A

Luminal microbiota:

Mycobacterium paratuberculosi

MMR (Not definitive proof(

49
Q

Define dysbiosis

A

Reduced diversity in the microbiota

50
Q

List 3 main pathophysiologies that may arise from dysbiosis

A

Autoimmunity

Metabolic disorders

Allergy

51
Q

List 11 factors that may increase the risk of dysbiosis

A

Appendectomy

Stress

Smoking

Sleep hygeine

Hygeine

Diet

UV exposure/Vitamin D

Microbiome

Medications (e.g. ABs)

Physical activity

Genetic susceptibility

52
Q

Presence of which antibody increases risk of developing Crohn’s Disease?

Presence of which antibody increases risk of developing Ulcerative Colitis?

A

ASCA = CD

pANCA = UC

53
Q

State the 3 main management goals for individuals with IBD

A

Induce clinical remission

Maintain clinical remission

Improve quality of life

54
Q

State 3 other management goals for patients with IBD

A

Heal mucosa

Reduce hospitilisation/surgery and costs

Minimise IBD and therapy related complications

55
Q

What are the 5 main treatment options for managing IBD?

A

Steroids

5 ASA (Drugs used to treat IBD)

Immune suppresants

Biologic therapy

Other: Diet, Exercise, ABs, FMT [faecal micribiota transplants], probiotics

56
Q

Name 2 immune suppresants used when treating IBD

A

Azathioprine

Methotreaxate

57
Q

Explain the pharmacodynamics of steroids

A

Steroid diffuse and enter nucleus where it binds to GRE (Gluccocorticoid response element).

This results in an increase of anti-inflammatory gene produts and an inhibition of pro-flammatory gene expression

58
Q

State the 3 modes of delivery for steroids

A

Orally

IV

Rectal enemas (enemas are tools which inject of fluid/gas up the rectum)

59
Q

How should steroids be used when treating patients with IBD?

A

Should only be used short term and a bridge to other therapies and should be used in the acutely unwell

60
Q

List 3 psychiatric symptoms of steroid usage

A

Sleep disturbance

Sleepiness

Psychosis

61
Q

List 5 dermatological symptoms of steroid usage

A

Cushingoid appearance

Hirsutism

Oedema

Acne

Abdominal striae

62
Q

List 2 neurological symptoms of steroid usage

A

Pseudomotor cerebri

Neuropathy

63
Q

State the main cardiological symptom of steroid usage

A

Hypertension

64
Q

List 3 musculoskeletal symptoms of steroid usage

A

Myopathy

Osteoporosis

Aseptic necrosis of bone

65
Q

List 2 endocrine symptoms of steroid usage

A

Adrenal cortex suppresion

Diabetes mellitus

66
Q

List 2 immunological symptoms of steroid usage

A

Immunosupresion

Lymphocytopenia

67
Q

List 2 opthalmic symptoms of steroid usage

A

Acute-angle glaucoma

Cataracts

68
Q

State the main developmental complication of steroid usage

A

Growth retardation

69
Q

State the 4 main pharmacodynamic actions of 5 ASA

A

Inhibition of pro-inflammatory cytokines (IL-1 and TNF-a )

Inhibition of the lipo-oxygenase pathway i.e. prostaglandin and leukotrienes

Scavenging of free radicals

Inhibition of NF-kB/ TLR via PPAR-gamma induction (perioxisome proliferator activated

receptor-gamma)

70
Q

What are the 2 main overall effects of 5 ASA?

A

Some immunosuppresive activity – inhibiting T cell proliferation, activation and differentiation

Impairs neutrophil chemotaxis and activation

71
Q

State the 2 methods of delivery for 5 ASA

A

Orally

Rectal

72
Q

State 7 side effects of 5 ASA

A

Intolerance

Headache

Malaise

Pneumonitis (Inflammation of the lungs)

Pancreatitis

Diarrhoea

Renal impairment

73
Q

Explain the pathophysiological actions of Azathioprine

A

Reduces the production of guanine and adenine ribonucleotides

Results in reduction of T and B lymphocytes, immunoglobulins and interleukins.

Also increases T cell apoptosis

74
Q

Give 7 examples of side effects from azathioprine

A

Infections

Pancreatitis

Bone marrow suppresion

Malignancy/lymphoma

Allergic reactions (e.g. fever, malaise, rash)

GI disturbance

Hepatotoxicity (nodular regenerative hyperplasia)

75
Q

List 8 things that should be checked before and during administration of azathiroprone to a patient

A

TPMT (Low levels detected = dont give)

HIV

Hep B/C

Chickenpox (cant give if they never had)

TB

Vaccinations

During administration:

Take frequent blood tests intitally

Maintenance blood tests

76
Q

State the 2 ribonucleotides affected by azathioprine

A

Adenine

Guanine

77
Q

Describe the pharmacodynamics of methotrexate and state its 2 effects

A

Mechanisms unknown however it affects DNA synthesis and cell replication

Main effects:

Increases adnosine production which is an anti-inflammatory metabolite

Increases apoptosis of peripheral T cells

78
Q

How long does methotrexate take to start having effects?

A

3 months

79
Q

What 2 types of patients should not be administered methotrexate?

A

Patients with liver diseases

Patients who are pregnant or planning to become pregnant

80
Q

What should be monitored in patients taking methotrexate?

A

LFTs (Liver function tests)

FBCs (Detect abnormalities such from complications such as bone marrow suppresion)

81
Q

What should be given to patients alongside methotrexate to reduce the chance of developing side effects?

A

Folic acid supplemets

82
Q

How often should methotrexate be administered to patients?

A

Weekly

83
Q

State 8 potential side effects from methotrexate.

A

Rash

Nausea

Mucositis

Diarrhoea

Bone marrow suppresion

Hypersensitive pneumonitis

Cirrhosis

Liver fibrosis

(N.B. High levels of liver enzymes in circulation indicates liver damage)

84
Q

Why should methotrextae not be given to patients who are pregnant or are planning for pregnancy?

A

Methotrexate is a abortifacient so can early terminate pregnancies

85
Q

Define abortifacient

A

A substance that is capable of causing abortion during pregnacy

86
Q

How do methotrexate and azathioprine differ in terms of malignancy risks?

A

Unlike azathioprine, methotrexate has not been known to cause lymphomas

Also not know to attribute to development of skin cancers

87
Q

Define biologics

A

A type of drug that reduces inflammatory damage

88
Q

State the 5 effects of TNF-a

A

Increased inflammation

Increased cell infriltration

Increased CPR in serum (C-reactive protein)

Tissue remodelling

Compromised of barrier functioning

89
Q

Name 2 biologics that have an anti-TNF-a effect

A

Infliximab

Adalimumab

90
Q

Name a biologic that have an anti-a4ß7 effect

A

Vedolizumab

91
Q

Name a biologic that have an anti-IL12/IL23 effect

A

Ustekinumab

92
Q

State how infliximab is admnisitered and how frequent dosgaes should be given

A

IV administration

Dosages are given in a 0, 2, 6 weeks period

Maintenance dosage 8 weekly

93
Q

How does adalimumab compare in terms of administration and dosage frequency versus infliximab?

A

Subcutaneously (self-injected)

Can be taken at home versus in hospital and is taken more frequently

94
Q

Give 10 examples of potential side effects of biologics

A

Opportunistic infection

IV/site infections

Infections

Bone marrow suppresion (neutropenia)

Malignancy (Lymphoma)

Demyelinating diseases

Heart failure (congestive heart failure)

Autoimmunity

Hepatotoxicity

Cutaneous reactions such as psoriasis

95
Q

anti-TNF drugs such as infliximab and adalimumab work best alongside which two types of medication and why?

A

Azathioprine

6-MP (aka mercaptopurine)

Has a superior effect in maintaining response and remission

Reduces rate of antibody formation

96
Q

Dietary therapy for treating inflammatory bowel disease is most effective in which type of patients?

A

Young children

97
Q

Dietary therapy in children with IBD can be just as effective as which other alternative treatment method?

A

Steroids

98
Q

Dietary therapy is most effective for which disease?

A

Small bowel Crohn’s Disease

99
Q

How effective are the use of antibiotics for treating IBD?

A

No hard evidence suggesting effectiveness however can help in treating sepsis

100
Q
A

Bioregulatory Systems: Upper GI Tract (13 decks)

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