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GASTRO > 7: Intestines > Flashcards

7: Intestines Flashcards

1
Q

What is the difference in MOBILITY between the Small and Large intestines?

A

Small

  • Duodenum NOT mobile
  • Jejunum / Ileum mobile

Large

  • Ascending & Descending colon NOT mobile
  • Caecum NOT mobile
  • Transverse colon mobile
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2
Q

What is the difference in Lumen Diameter between the Small and Large intestines?

A

Small: Smaller

Large: Larger

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3
Q

What is the difference in Logitudinal Muscle between the Small and Large intestines?

A

Small: Continuous layer

Large: 3 bands: teniae coli

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4
Q

What is the difference in FATTY TAGS between the Small and Large intestines?

A

Small: NONE

Large: Attached to wall

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5
Q

What is the difference in the WALLS between the Small and Large intestines?

A

Small: Smooth

Large: Sacculated (sac formation), forms Haustra (small pouches)

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6
Q

What is the difference in the Mucous Membrane between the Small and Large intestines?

A

Small: Permanent folds = plicae circularis

Large: Incomplete folds may be present

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7
Q

What is the difference in LYMPHATIC TISSUE between the Small and Large intestines?

A

Small: = lymphatic tissue

Large: NONE

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8
Q

What is the blood supply of the DUODENUM? (2 things)

A

Duodenum derived from Foregut & Midgut

  1. Foregut supplied by Coeliac Trunk

Coeliac Trunk → Gastroduodenal Artery → Sup Pancreaticoduodenal Artery

  1. Midgut supplied by Sup Mesenteric Artery (SMA)

Abd. Aorta → SMA → Inf Pancreaticoduodenal Artery

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9
Q

What is the blood supply of the Jejunum and Ileum?

A

Jejunum & Ileum derived from Midgut

Midgut supplied by Sup Mesenteric Artery (SMA)

  • Abd Aorta → SMA → Jejunal Arteries
  • Abd Aorta → SMA → Ileal Arteries

Jejunal Arteries unite → form Arterial Arcades (loops)

Arterial Arcades give rise to Vasa Recta (straight arteries)

(Ileal arteries do same thing)

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10
Q

What is the venous drainage of the Duodenum? (2 points)

A
  1. Veins of duodenum follow arteries
  2. Drain → Hepatic Portal Vein:
  • Directly
  • Through Sup Mesenteric & Splenic Veins
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11
Q

What is the difference in COLOUR between the Jejunum and Ileum?

A

Jejunum: Deep red

Ileum: Paler pink

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12
Q

What is the difference in VASA RECTA between the Jejunum and Ileum?

A

Jejunum: Long

Ileum: Short

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13
Q

What is the difference in PLICAE CIRCULARIS FOLDS between the Jejunum and Ileum?

A

Jejunum: Large + Tall + Closely packed

Ileum: Low + Sparse + Absent in distal part

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14
Q

What is the difference in LYMPHOID NODULES (PEYERS PATCHES) between the Jejunum and Ileum?

A

Jejunum: Few

Ileum: Many

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15
Q

What is the difference in FAT IN MESENTRY between the Jejunum and Ileum?

A

Jejunum: Less

Ileum: More

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16
Q

What is the difference in LOOPS between the Jejunum and Ileum?

A

Jejunum: Few LARGE loops

Ileum: Many SHORT loops

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17
Q

What is the difference in VASCULARITY between the Jejunum and Ileum?

A

Jejunum: Greater

Ileum: Less

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18
Q

What is the difference in DIAMETER between the Jejunum and Ileum?

A

Jejunum: Thick and heavy

Ileum: Thin and light

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19
Q

What are the 8 parts of the large intestine?

A
  1. Caecum
  2. Appendix
  3. Ascending Colon
  4. Transverse Colon
  5. Descending Colon
  6. Sigmoid Colon
  7. Recum
  8. Anal Canal
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20
Q

What is the blood supply of the Caecum?

A

Caecum is Midgut derived

Midgut supplied by Sup Mesenteric Artery (SMA)

Abd Aorta → SMA → Ileocolic Artery

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21
Q

What is the blood supply of the Appendix?

A

Appendix is Midgut derived

Midgut supplied by Sup Mesenteric Artery (SMA)

Abd Aorta → SMA → Ileocolic Artery → Appendicular Artery

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22
Q

What is the venous drainage of the Caecum and Appendix?

A

Through Ileocolic Vein → Sup Mesenteric Vein (SMV) → Portal Vein

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23
Q

What is the blood supply of the Ascending Colon and Right Colic Flexture?

A

Ascending Colon and RCF derived from Midgut

Midgut supplied by Sup Mesenteric Artery (SMA)

  • Abd Aorta → SMA → Ileocolic Artery (AC)
  • Abd Aorta → SMA → Right Colic Artery (RCF)
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24
Q

How is the Marginal Artery of the large intestine formed?

A

3 arteries:

  • Ileocolic Artery (supplies AC)
  • Right Colic Artery (supplies RCF)
  • Right branch of Middle Colic Artery (supplies TC)

Arteries anastamose with each other → Anastomotic Arcade

Asatomotic Arcade continues round large intestine to form a continuous arterial channel: Marginal Artery

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25
What is the venous drainage of the Ascending Colon and Right Colic Flexture?
Ileocolic + Right Colic Veis → drain into Sup Mesenteric Vein (SMV) → Portal Vein
26
What is the blood supply of the Transverse Colon?
Transverse Colon is **Midgut** & _Hindgut_ derived **Midgut** supplied by **Sup Mesenteric Artery (SMA)** Abd Aorta → SMA → **Middle Colic** Abd Aorta → SMA → **Right Colic** _Hindgut_ supplied by _Inf Mesenteric Artery (IMA)_ Abd Aorta → IMA → _Left Colic_
27
What is the venous drainage of the Transverse Colon?
Middle colic vein → SMV → Portal vein
28
What is the blood supply of the Descending and Sigmoidal colons?
Descending and Sigmoidal colons are Hindgut derived Hindgut supplied by Inf Mesenterc Artery (IMA) Abd Aorta → IMA → Left Colic Artery (Desc) Abd Aorta → IMA → Sigmoid Arteries (Sigmoid)
29
What is the venous drainage of the Descending and Sigmoid Colons?
Left Colic + Sigmoid Veins → Inf Mesenteric Vein (IMV) → Splenic & Portal Veins
30
What is the blood supply of the Rectum & Anal Canal?
_Proximally_: Rectum & Anal Canal are _Hindgut_ derived (IMA) _Hindgut_ supplied by _Inf Mesenteric Artery_ (IMA) Abd Aorta → IMA → _R & L Sup Rectal_ **Distally**: Common Iliac Artery (**CIA**) Abd Aorta → **CIA** → R & L Internal Iliac * R & L Internal Iliac → **R & L Middle Rectal** * R & L Internal Iliac → Inf Pudendal → **R & L Inf Rectal**
31
What is the venous drainage of the Rectum and Anal canal?
Sup + Middle + Inf Rectal Veins * Sup Rectal Vein → Inf Mesenteric Vein (IMV) → Splenic + Portal Veins * Middle + Inf Rectal Veins → Systemic System
32
What are the paracolic gutters?
Spaces between colon and abdominal wall
33
What does the Duodenum secrete? (5 things)
1. HCO3- 2. Water 3. Bile 4. Protease / Carbohydrase 5. Secretin / Gastrin / Cholecystokin (CCK)
34
What does the Duodenum absorb?
Iron
35
What does the Jejunum secrete? (2 things)
1. Protease / carbohydrase 2. Secretin, Gastrin, Cholecystokinin (CCK)
36
What does the Jejunum absorb? (6 things)
1. Carbs 2. A.a 3. F.A 4. Vitamins & Minerals 5. Electrolytes 6. Water
37
What does the Ileum secrete? (2 things)
1. Protease / carbohydrase 2. Secretin / Gastrin / Cholecystokinin
38
What does the Ileum absorb? (2 things)
1. Vitamin B12 2. Bile
39
What does the Large Intestine secrete?
NOTHING
40
What does the Large Intestine absorb? (2 things)
1. Water 2. Vitamin K, B12, Thiamine, Riboflavin
41
What form are Carbs ingested in?
1. Amylose = straight chain with alpha 1-4 bonds 2. Amylopectin = branched with alpha 1-6 bonds
42
What enzyme is in the saliva and pancreas?
Alpha-amylase
43
What does alpha-amylase breakdown?
alpha 1-4 bonds Amylose → Glucose / Maltose
44
What enzymes are on the Intestinal Brush Border? (4 things)
1. Isomaltase 2. Maltase 3. Sucrase 4. Lactase
45
What does Isomaltase breakdown?
alpha 1-6 bonds
46
What does maltase breakdown?
Maltose → Glucose
47
What does sucrase breakdown?
Sucrose → glucose / fructose
48
What does lactase breakdown?
Lactose → glucose / galactose
49
How is glucose absorbed in the intestines? (3 steps)
1. Na concentratient gradient formed using Na/K-ATPase in basolateral membrane 2. Na enters Epithelial cell down concentration gradient WITH GLUCOSE through Na-Glucose Symporter 3. Glucose leaves Epithelial cell into BLOOD through GLUT2 transporter (facilitated diffusion)
50
How are Amino Acids absorbed in the intestines? (2 things)
1. 5 active transport Na/A.A cotransporters 2. Facilitated diffusion
51
How are fats absorbed in the intestines? (3 steps)
1. Bile acids (in duodenum) incorporate fats → micelles (fat inside, bile acids outside) 2. Micelles carry fats into "unstirred layer" next to mucosa 3. F.A released and slowly diffuse into epithelial cells
52
How are sat and water absorbed in the intestines?
1. Na → diffuses into cell → actively transported across basolateral membrane 2. Cl- follows Na+ movement (down electrical gradient) 3. Ion movement forms osmotic gradient → water uptake
53
What is Oral Rehydration Therapy?
Give patient mixture of glucose and NaCl * Na uptake = generates osmotic gradient → water follows * Glucose uptake = stimulates Na uptake + generates own osmotic gradient → water follows
54
What is Segmenting of small intestine? (4 points)
1. NOT peristalsis 2. Contents moved very slowly 3. Gently agitated 4. Ensures: effective absorbtion
55
What is the intestinal gradient?
Small intestine divided into sections: each section has own pacemaker Intestinal gradient: frequency of pacemakers get less from Duodenum (12 / min) → Terminal Ileum (8 / min)
56
What do pacemakers in the sections of the intestine cause?
Intermittent contraction of SM in that section
57
What are the different types of motility in the intestines? (3 things)
_Small Intestine_ 1. Segmenting _Large Intestine_ 1. Haustral Shuffling 2. Mass Movement
58
What is Haustral Shuffling of the large intestine? (3 points)
1. Large intestine divided into segments called Haustra 2. Contractions of SM in Haustra walls shuffle contents _back & forth_ 3. Causes slow absorbtion of remaining water → forms faeces
59
What is Mass Movement of the large intestines?
1. Perstaltic pattern from Transverse colon → Descending colon 2. Forces faeces rapidly → Rectum 3. Faeces in Rectum induces urge to defecate via Pressure Receptors Happens 1 or 2 times a day
60
What is Mass Movement of the large intestine triggered by?
Gastro-colic reflex
61
What is the mechanism of defecation? (4 steps)
1. Mass Movement fills rectum + induces urge to defecate 2. PS control → relaxes Internal Anal Sphincter (SM) 3. Voluntary control → relaxes External Anal Sphincter (voluntary straited muscle) 4. Once both sphincters relax → intra-abdominal pressure increases → faeces expelled
62
What are the types of Inflammatory Bowel Disease? (5 causes)
1. Ulcerative Colitis 2. Crohn's Disease 3. Diversion Colitis 4. Diverticular Colitis 5. Radiation / Drugs / Infectious / Ischaemic Colitis
63
What are the clinical features of Ulcerative Colitis? (3 things)
1. Rectal bleeding 2. Diarrhoea 3. Abdominal pain
64
What are the clinical features of Upper GI Crohn's disease? (3 things)
1. Nausea & vomiting 2. Dyspepsia (indigestion) 3. Loose stools
65
What are the clinical features of Colonic Disease Crohn's? (2 things)
1. Diarrhoea 2. Passing blood
66
What things trigger Inflammatory Bowel Diseases?
1. Abx → Gets rid of normal flora 2. Diet 3. Acute infammation 4. NSAIDs 5. Smoking (Increases Crohn's risk) 6. Stress
67
What are the investigations for Inflammatory Bowel Disease? (6 things)
1. Colonoscopy * Biopsy of involved mucosa * Check for ulceration 2. Stool analysis * Parasites * Clostridium difficile * Culture 3. Barium radiography 4. CT scan 5. Capsule endoscopy 6. X-Ray
68
What are the MACROSCOPIC changes of Ulcerative Colitis? (3 things)
1. Red + inflammed mucosa 2. Mucosa bleeds easily 3. Ulceration (if severe)
69
What are the MICROSCOPIC changes of Ulcerative Colitis? (4 things)
1. Superficial inflammation 2. Chronic inflammatory cells infiltrate Lamina Propria 3. Crypt abcess 4. Goblet cell depletion
70
What are the MACROSCOPIC changes of Crohn's Disease? (3 things)
1. Thickened + Narrowed bowel 2. Deep ulcers + fissures (tears) in mucosa (Cobblestone appearance) 3. Fistulae + Abcesses (if penetrating disease) Pic is Crohn's Cobblestones
71
What are the MICROSCOPIC changes of Crohn's Disease? (4 things)
1. Inflammation through all bowel layers 2. Increase in chronic inflammatory cells 3. Lymphoid hyperplasia 4. Granulomas
72
What are the investigations for Crohn's disease? (5 things)
1. Colonoscopy 2. Upper GI Endoscopy 3. Small Bowel Imaging 4. Perineal MRI / Endoanal US 5. Capsule endoscopy
73
When should colonoscopy be done for Crohn's disease?
If colonic involvement suspected
74
When is Upper GI Endoscopy required for Crohn's disease patients?
To exclude Oesophageal + Gastroduodenal diseases in patients with relevant symptoms
75
When is Small Bowel Imaging requried?
Mandatory if suspected Crohn's
76
What are the different types of Small Bowel Imaging?
1. Barium 2. CT scan with oral contrast 3. US 4. MRI
77
What are the findings Small Bowel Imaging for Crohn's disease? (3 things)
1. Asymmetrical alteration in mucosal pattern 2. Deep ulceration 3. Areas of narrowing
78
Why is Perineal MRI / Endoanal US used for Crohn's?
To evaluate perianal disease
79
When is Capsulse endoscopy needed for Crohn's patients?
For Crohn's disease patients with NORMAL radiological exam
80
What are the investigations for Ulcerative Colitis? (2 things)
1. Colonoscopy (gold standard for UC) * Assesses disease activity + extent 2. X-Ray → to exclude colonic dilation
81
What are the treatments for Crohn's disease for: 1. Induction of Remission (3 things) 2. Maintenance of Remission (2 things) 3. Perianal disease (2 things) (Remission = diminution in severity)
API Azathioprine (immunosuppresant) Prednisolone (oral) / Hydrocortisone (IV) (corticosteroids) Infliximab (monoclonal antibody) 1. Induction of Remission * Oral / IV Glucocorticoids * Enteral Nutrition (artificial) * Anti-TNF antibodies 2. Maintenance of Remission * Methotrexate * Anti-TNF antibodies 3. Perianal disease * Azathioprine * Anti-TNF antibodies
82
What are the treatments for Ulcerative Colitis for: 1. Distal disease (1 thing) 2. Extensive disease (2 things)
1. Mesalamine (5-ASA) 2. Azathioprine (immunosuppresant) 3. Prednisolone (oral) / hydrocortisone (iv) (corticosteriods) 4. Infliximab (monoclonal antibody) MAPI
83
What should be done for **Ulcerative Colitis** and **Crohn's** if there are complications and the treatments are working?
Colectomy

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