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Flashcards in GI Tract 2 (Lower) Deck (75)
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1

What is a 'true' diverticulum?

Congenital

2

What is a 'false' or 'pseudo' diverticulum?

Acquired

3

Is sigmoid diverticulosis congenital or acquired?

Acquired

4

Is diverticulosis of the right colon acquired or congenital?

Can be either?

5

What is diverticulosis of the colon?

Protrusions of mucosa and submucosa through the bowel wall

6

Where does diverticulosis of the colon most commonly occur?

Sigmoid colon.

7

Where in the bowel wall are diverticula located?

Located between mesenteric and anti-mesenteric taenia coli ( also between anti-mesenteric t.coli in 50 % cases )

8

What percentage of diverticula are found in the caecum?

15%

9

What is the epidemiology of diverticulosis?

- Common in developed ( western ) world
- Rare in Africa , Asia , S. America
- Common in urban cf. rural areas
- Changing prevalence in migrant populations
- Relationship with fibre content of diet
- Increases with age
- Male = female
- Less common in vegetarians

10

What is the pathology of diverticulosis?

- Increased intra-luminal pressure
- Irregular, uncoordinated peristalsis
- Thickening of muscularis propria ( earliest change – “prediverticular disease” )
- Elastosis of taeniae coli ( leading to shortening of colon )
- Redundant mucosal folds and ridges
- Sacculation and diverticula

11

What are the clinical features of diverticular disease?

- Asymptomatic ( 90 – 99 % )
- Cramping abdominal pain
- Alternating constipation and diarrhoea
- Acute and chronic complications ( 10 – 30 %)

12

What are the acute complications of diverticulosis?

- Diverticulitis / peridiverticular abscess ( 20 – 25 % )
- Perforation
- Haemorrhage ( 5 % )

13

What are the chronic complications of diverticulosis?

- Intestinal obstruction ( strictures : 5 – 10 % )
- Fistula ( urinary bladder, vagina )
- Diverticular colitis ( segmental and granulomatous )
- Polypoid prolapsing mucosal folds

14

How is colitis classified into acute and chronic?

Acute - days to few weeks
Chronic - months to years

15

What disease is associated with transmural colitis?

Crohn's disease

16

What disease is predominantly associated with submucosal/muscular colitis?

Eosinophilic colitis

17

Which types of colitis are acute?

- Acute infective colitis eg. campylobacter, salmonella, CMV
- Antibiotic associated colitis (including PMC)
- Drug induced colitis
- Acute ischaemic colitis ( transient or gangrenous )
- Acute radiation colitis
- Neutropenic colitis
- Phlegmonous colitis

18

Which types of colitis are chronic?

- Chronic idiopathic inflammatory bowel disease
- Microscopic colitis ( collagenous & lymphocytic )
- Ischaemic colitis
- Diverticular colitis
- Chronic infective colitis eg. amoebic colitis & TB
- Diversion colitis
- Eosinophilic colitis
- Chronic radiation colitis

19

Which three diseases fall under the 'idiopathic inflammatory bowel disease' umbrella?

Ulcerative colitis
Crohn's disease
Indeterminate colitis (10-15%)

20

What is the epidemiology of IBD?

- UC 5 – 15 cases per 100,000 p.a.
- CD 5 – 10 cases per 100,000 p.a.

- Incidence highest in Scandinavia, UK, Northern Europe, USA
- Lower in Japan, Southern Europe, Africa

- Peak age incidence 20 – 40 years of age

- CD more common in females 1.3 : 1

- UC equally common in males and females

- Incidence of UC is increased in urban areas

21

For which IBD condition is smoking a risk factor and for which does it have a protective effect?

UC - protective
CD - risk factor

22

Give some other risk factors for IBD.

Oral Contraceptive
MMR
Childhood infections
Domestic hygeine
Appendicectomy

23

What is the risk of UC in the 1st degree relative of someone with UC?

x8

24

What is the risk of CD in the 1st degree relative of someone with UC?

x1.7

25

What is the risk of UC in the first degree relative of someone with CD?

x3.8

26

What is the risk of CD in the first degree relative of someone with CD?

x8

27

What is the clinical presentation of UC?

- Diarrhoea ( > 66 % ) with urgency/tenesmus
- Constipation ( 2 % )
- Rectal bleeding ( > 90 % )
- Abdominal pain ( 30 – 60 % )
- Anorexia
- Weight loss ( 15 – 40 % )
- Anaemia

28

What are the possible complications of UC?

- Toxic megacolon
- Haemmorhage
- Stricture (rare)
- Adenocarcinoma

29

What are the clinical features of CD?

- Chronic relapsing disease
- Affects all levels of GIT from mouth to anus
- Diarrhoea ( may be bloody )
- Colicky abdominal pain
- Palpable abdominal mass
- Weight loss / failure to thrive
- Anorexia
- Fever
- Oral ulcers
- Peri – anal disease
- Anaemia

30

What is the distribution of CD across the GI tract epidemiologically speaking?

Ileocolic 30 – 55 %
Small bowel 25 – 35 %
Colonic 15 – 25 %
Peri-anal / ano-rectal 2 – 3 %
Gastro – duodenal 1 – 2 %

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