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GI > Session 7: Large Intestine & Inflammatory Bowel Disease > Flashcards

Session 7: Large Intestine & Inflammatory Bowel Disease Flashcards

1
Q
A
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2
Q

Where does the large intestine extend from?

A

Caecum to anal canal

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3
Q

Epithelium of the LI

A

Columnar

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4
Q

Functions of the LI

A

Absorption of ions and water to turn chyme into a solid mass. Production of certain vitamins like K and B12 via bacteria. Gut flora, act as a temporary storage unit for faeces. Supplement of short chain fatty acids via bacteria

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5
Q

Why are SCFA important in LI?

A

Because the colonic mucosa doesn’t get its majority of nutrients from blood but from bacteria fermenting dietary fibres.

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6
Q

By-products of the fermentation of dietary fibres by the bacteria.

A

Gases such as CO2, H2 and CH4

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7
Q

In relation to the peritoneum what are the ascending and descending colon?

A

Secondary retroperitoneal

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8
Q

Transverse colon

A

Peritoneal with its own mesentery

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9
Q

Sigmoid colon

A

Peritoneal with its own mesentery

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10
Q

Rectum

A

Upper 1/3 is intra-peritoneal, Middle 1/3 is retroperitoneal and the lower 1/3 has no peritoneum

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11
Q

Arterial supply of the caecum

A

Ileo-colic artery (SMA)

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12
Q

Arterial supply of the ascending colon

A

Right colic artery (SMA)

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13
Q

Arterial supply of the transverse colon

A

Middle colic artery (SMA)

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14
Q

Arterial supply of the descending colon

A

Left colic artery (IMA)

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15
Q

Arterial supply of the sigmoid colon

A

Sigmoid arteries (IMA)

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16
Q

Arterial supply of the upper 1/3 of the rectum

A

Superior rectal artery (IMA)

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17
Q

Venous drainage of midgut

A

SMV

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18
Q

Venous drainage of hindgut

A

IMV

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19
Q

Venous drainage of the upper 1/3 of rectum

A

IMV via superior rectal vein

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20
Q

Venous drainage of middle and lower 1/3

A

Middle and inferior rectal veins draining into systemic venous circulation

21
Q

How does the LI differ from the SI?

A

It is much shorter (6 feet vs 20 feet) The large intestine is also much wider. The large intestine has crypts and not villi. The LI’s longitudinal muscle is incomplete and come in three distinct bands.

22
Q

What are the three distinct bands of the incomplete longitudinal muscle in the LI called?

A

Teniae coli

23
Q

What separate teniae coli?

A

Haustra

24
Q

How are haustra formed?

A

They are sacculations formed by the contraction of teniae coli.

25
Q

Explain the water absorption in the large intestine.

A

By ENaC governed by levels of aldosterone. The movement of sodium and chloride ions leads to water moving with it. There are much tighter tight junctions in the LI as well compared to SI which leads to a bigger gradient forming. There is less back flow of ions and water due to these tight junctions.

26
Q

How much fluid enters the LI daily?

A

Around 1.5 litre

27
Q

How much fluid is excreted via faeces of these 1.5 litre?

A

Around 100 ml. 1.4l is reabsorbed.

28
Q

What are the two main conditions in irritable bowel disease?

A

Crohn’s disease Ulcerative colitis

29
Q

Age of arising symptoms of Crohn’s disease and Ulcerative colitis.

A

Young adults around the age of 20. There is also a spike in older adults around the age of 50-60.

30
Q

Give the general presentation of Crohn’s disease and its features.

A

Any part of the GI tract can be affected. Ileum is however the most commonly involved. It is a transmural disease which means it will effect the entire wall of the intestines. Appearance of skip lesions.

31
Q

Give the general presentation of Ulcerative colitis and its features.

A

Begins in the rectum and can make its way up or remain rectal. Has a continuous pattern compared to the skip lesions in Crohn’s. Also leads to mucosal inflammation.

32
Q

Extra-intestinal problems involving IBD.

A

MSK pain and arthritis. Skin problems such as erythema nodosum, pyoderma gangrenosum and psoriasis. PSC and in some cases (5%) also eye problems.

33
Q

Causes of IBD

A

Genetics, Altered interactions of gut organisms, immune response

34
Q

Common symptoms and signs of Crohn’s

A

Fatigue, weight loss, loose stools without blood, right lower quadrant pain, joint paint, low grade fever, mild anaemia, perianal inflammation/ulceration

35
Q

Gross pathological appearance of Crohn’s disease

A

Skip lesions, hyperaemia, mucosal oedema, discrete superficial ulcers, deeper ulcers, Transmural inflammation, strictures, narrowing of lumen, fistulae, cobblestone appearance

36
Q

Microscopical pathological appearance of Crohn’s disease.

A

Granuloma formation with epithelioid macrophages

37
Q

Investigations of Crohn’s

A

Blood to look for anaemia, CT/MRI scans to look for bowel wall thickening, obstruction and extramural problems. Barium enema to look for strictures and fistulae. Colonoscopy

38
Q

What might you find on a colonoscopy in Crohn’s?

A

Cobblestone appearance, skip lesions, strictures, fistulae

39
Q

Common signs and symptoms of Ulcerative colitis

A

Frequent stools + blood stools. Mucus in stools, weight loss, mild lower abdo pain + cramping. Painful red eye. Normal temp, no perianal inflammation.

40
Q

Microscopical pathological appearance of Ulcerative colitis.

A

Crypt abscesses, chronic inflammation infiltrating lamina propria, crypt distortion with dysplasia and darkened nuclei. Reduced number of goblet cells.

41
Q

Gross pathological appearance of Ulcerative colitis (generally in severe cases)

A

Development of non-neoplastic pseudopolyps. Loss of haustra

42
Q

Investigations of Ulcerative colitis.

A

Bloods to check for anaemia and serum markers. Stool cultures, colonoscopy, X-ray, CT/MRI, Barium enema

43
Q

In the case of difficulty determining whether a patient has UC or Crohn’s what might that suggest? (What category does it fall into?)

A

Indeterminate colitis

44
Q

In barium enema you may see some long strictures.

What is this sign called?

In which condition might this be seen?

A

String sign of kantour.

In Crohn’s disease

45
Q

Radiological features of ulcerative colitis.

A

Double contrast enema

Featureless descending sigmoid and descending colon with lack of haustra. This is called lead pipe colon.

Continuous lesions without skipping.

Whole colon

Mucosal inflammation causing a granular appearance.

46
Q

Medical treatment of IBD.

A

A stepwise approach

1 - Aminosalycates for flares and emission

2 - Corticosteroids for flares

3 - Immunomodulators for fistulas and maintenance of remission

47
Q

Surgical treatment of Crohn’s.

A

Not curative

To remove fistulas and strictures

As little bowel removed as possible.

48
Q

Surgical treatment of UC.

A

Curable via colectomy as it is constrained to the colon.

This is in the case of inflammation not settling.

Precancerous changes

Toxic megacolon

GI (30 decks)

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