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GIHEP > 20. Large Bowel Disease > Flashcards

20. Large Bowel Disease Flashcards

(45 cards)

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1
Q

Where is the plexus of meissner located?

A

Submucosa

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2
Q

Where is the plexus of auerback located?

A

Muscle

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3
Q

What is Hirschsprung’s disease?

A

Congenital megacolon due to arrested migration of neural crest cells: no meissner or auerbach plexuses so no peristalsis, causing a functional obstruction

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4
Q

What patient group is more likely to have Hirschsprung’s disease?

A

Male

Downes syndrome

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5
Q

What parts of the bowel are susceptible to Hirschsprung’s disease?

A

Rectum and sigmoid

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6
Q

What gene is associated with Hirschsprung’s disease?

A

RET gene

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7
Q

What are the clinical features of Hirschsprung’s disease?

A

Failure to pass meconium

Constipation, vomiting and abdominal distension

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8
Q

What are the complications of Hirschsprung’s disease?

A

Massive dilatation and perforation

Infection

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9
Q

What is the treatment for Hirschsprung’s disease?

A

Resect the part without ganglion cells

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10
Q

What part of the enteric tract is supplied by the superior mesenteric artery?

A

Caecum to splenic flexure

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11
Q

What part of the GIT is supplied by the inferior mesenteric artery?

A

Colon to rectum

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12
Q

What arteries supply the lower rectum?

A

Internal iliac and internal pudendal

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13
Q

What is a transmural infarction caused by?

A

Sudden occlusion of a major vessel causing infarction of all layers

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14
Q

What are the other types of infarction of the bowel?

A

Mural: mucosa and submucosa

Mucosal

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15
Q

What are the clinical features of transmural bowel infarction?

A

Severe abdominal pain
Bloody diarrhoea
Reduced peristaltic sounds
Rigidity

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16
Q

What are the clinical features of mucosal and mural infarcts?

A

Intermittent bloody diarrhoea

Non-specific abdominal complaints

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17
Q

What is angiodysplasia?

A

Dilatation of blood vessels in caecum and right colon

Seen in elderly as a result of wear and tear

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18
Q

What is hereditary haemorrhagic telangiectasia?

A

AD

Thin walled blood vessels in mouth and GIT which can rupture

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19
Q

What are risk factors for haemorrhoids?

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A

Constipation
Pregnancy
Portal hypertension

20
Q

What patient group gets necrotising enterocolitis?

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A

Premature or low birth weight infants

Any time in first 3 months of life

21
Q

What are the features of necrotising enterocolitis?

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A

Ischaemia
Bacterial colonisation
Excess protein in lumen
Functional immaturity

22
Q

What patient groups have higher risks of Crohn’s disease?

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A

Females
White, Jewish
Peak in teens and 20s, minor peak in 50-60

23
Q

Where is the most common area affected by Crohn’s disease?

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A

Terminal ileum

24
Q

What are the features of Crohn’s disease?

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A

Segmental: affected areas are separated by normal

Transmural, affects all layers

25
Give examples of the transmural effects of Crohn's disease?
Creeping fat Dull serosa Thickening of wall
26
What causes thickening of the bowel wall in Crohn's disease?
Oedema, inflammation and fibrosis
27
What types of ulcers are seen in Crohn's disease?
Aphthous Serpentine/linear: 'cobblestones' Fissures
28
What are the microscopic features of Crohn's disease?
Crypt architectural distortion Inflammatory cells in all layers Cryptitis and crypt abscesses Non caseating granulomas
29
What is the difference between cryptitis and crypt abscesses?
Cryptitis is neutrophils in the wall of the crypt | Crypt abscesses are collections of neutrophils in the lumen
30
What are the clinical features of Crohn's disease?
Relapsing and remitting abdominal pain, fever, bloody diarrhoea Malabsorption
31
What types of anaemia are associated with Crohn's disease?
Iron deficiency due to ulceration and bleeding | B12 deficiency due to involvement of terminal ileum
32
What are the complications of Crohn's disease?
``` Obstruction Adhesions Fistula Malabsorption Increased risk of carcinoma ```
33
What structures can be fistulated in Crohn's disease?
Small bowel and colon Bladder Vagina Skin
34
What are the systemic manifestations of Crohn's disease?
Arthritis Uveitis Erythema nodosum Clubbing
35
What is the gross pathology of ulcerative colitis?
Begins in the rectum and spreads upwards continuously Red mucosa Broad ulcers
36
What are the microscopic features of ulcerative colitis?
Cryptitis and crypt abscesses Architectural distortion of crypts Epithelial dysplasia No granulomas
37
What are the clinical features of ulcerative colitis?
Relapsing and remitting bloody mucoid diarrhoea, abdominal pain and tenesmus Fever, weight loss, anaemia
38
What type of anaemia is seen in ulcerative colitis?
Only iron deficiency
39
What are the complications of ulcerative colitis?
Toxic megacolon caused by damage to the muscularis propia by inflammatory cells, destroying neuromuscular function Neoplasia
40
What are the systemic manifestations of ulcerative colitis?
Arthritis, erythema nodosum, clubbing Pyoderma gangrenosum PSC Uveitis
41
How does a low fibre diet cause diverticular disease?
Low fibre > low stool bulk > increased peristalsis > increased pressure
42
What are the clinical features of diverticular disease?
Normally asymptomatic | Cramping, lower abdominal pain, tenesmus
43
What complications are associated with diverticular disease?
``` Diverticulitis Perforation Adhesions Fistula with bladder Pericolic abscess formation Haemorrhage Obstruction ```
44
What is the cause of intussusception in the elderly?
Tumour at the leading edge
45
Which part of the GIT is involved in volvulus in the elderly and young adults?
Elderly: sigmoid | Young adults: caecum

GIHEP (30 decks)

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