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Y2 - GI > Large Intestine/inflammatory Bowel Disease > Flashcards

Large Intestine/inflammatory Bowel Disease Flashcards

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1
Q

What part of the colon is retroperitoneal?

A

Ascending and descending colon

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2
Q

What part of the rectum is Intra peritoneal, Retroperitoneal and no peritoneum?

A

Upper 1/3 = Intra-peritoneal
Middle 1/3 = Retroperitoneal
Lower 1/3 = no peritoneum

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3
Q

What is the arterial supply to the midgut? (look at foregut DR slide)

A

Branch from SMA
Ileo-colic arerty = caecum
Right colic = ascending colon
Middle colic = transverse colon (2/3s)

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4
Q

What is the arterial supply to the hindgut? Look at foregut DR slide

A

Inferior mesenteric artery:

Left colic = descending colon
Sigmoid = descending colon
Superior rectal artery = upper 1/3 rectum

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5
Q

How does the longitudinal muscle surround the large intestine?

A

Incomplete longitudinal muscle layer leads to 3 distinct bands called teniae coli forming

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6
Q

What is the function of the teniae coli?

A

Maintaining the folds called Haustra in the large intestine

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7
Q

What ion channel facilitates water absorption in the colon?

A

ENaC

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8
Q

What hormone induces upregulatioon of ENaC?

A

Aldosterone

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9
Q

What is Inflammatory Bowel Disease?

A

Group of conditions characterised by idiopathic inflammation of the GI tract

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10
Q

What are the 2 most common types of Inflammatory bowel Disease?

A

Chrons disease
Ulcerative colitis

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11
Q

What ages are Chrons disease and ulcerative colitis most common in?

A

Young adults 20s

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12
Q

What is the key difference in location where Chron’s disease an Ulcerative colitis develop?

A

Chrons = anywhere in the GI tract but rarely ever the rectum

Ulcerative colitis = ALWAYS starts in RECTUM and stays contained in large intestine/colon

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13
Q

What is the most common spot of inflammation in Chrons disease?

A

Terminal ileum

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14
Q

What substances are mainly absorbed in they terminal ileum and therefore can be affected by Chron’s disease?

A

B12 absorption
Bile salts reabsorption

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15
Q

How does the pattern of inflammation differ in Chrons disease and ulcerative colitis?

A

Chrons = skip lesions (area of inflammation then normal, then inflammation)

Ulcerative colitis = continous pattern of inflammation

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16
Q

What part of inflammed area of gut is affected in Chron’s and ulcerative colitis?

A

Chron’s = transmural/full wall thickness

Ulcerative colitis = superficial/only the mucosal layer is inflammed

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17
Q

Despite Ulcerative colitis only being able to affect the colon/large intestine, what complication can occur affecting the terminal ileum with UC?

A

Backwash ileitis

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18
Q

What is backwash ileitis?

A

When patients with ulcerative colitis develop inflammation of terminal ileum due to the backwash of contents of the caecum into the terminal ileum

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19
Q

What are some extra intestinal problems that can occur with inflammatory bowel diseases?

A

MSK pain
Arthritis

Erythema nodosum (red nodules on kness)
Pyoderma gangrenosum (slide 12)

Cirrhosis of liver
Primary Sclerosing cholangitis

Uveitis (inflammation of middle eye)

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20
Q

What can trigger inflammatory bowel disease?

A

Genetics

Antibiotics
Infections
Smoking
Diet

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21
Q

What can trigger inflammatory bowel disease?

A

Antibiotics
Infections
Smoking
Diet

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22
Q

Which IBD does smoking increase the risk of?

Which IBD does smoking help dampen the symptoms of?

A

Smoking = inc risk of Chron’s

Smoking = reduced symptoms of ulcerative colitis

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23
Q

Why can Chron’s disease present with weight loss?

Why is the weight loss seen with Chron’s disease different to the weight loss seen with ulcerative colitis?

A

Nutrients are absorbed in the small intestine

Weight loss in Chrons s due to malabsorption of nutrients

Weight loss seen in Ulcerative colitis due to water loss

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24
Q

Why do patients with Chrons disease often have Right Lower Quadrant pain whereas ulcerative colitis is more broad?

A

In Chron’s, the terminal ileum is often the most commonly affected inflamed spot which is in the RLQ

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25
What is a key symptom of Chrons that doesn’t normally occur in ulcerative colitis?
Perianal lesions in Chrons: Skin tags Fistulae Abscesses Scarring or sinuses
26
What is a fistula?
Abnormal connection between epithelial lined surfaces or organs
27
What is the term normally given to the abnormal connection between a structure and the skin?
Sinus
28
What is a skin tag?
Remnants of having a prolapsed haemorrhoid
29
What is a key difference in the stool contents of a patient with Chrons disease and ulcerative colitis?
Chrons = loose stool NO BLOOD Ulcerative colitis = bloody stools (contain mucus)
30
What is a seton knot?
A knot that’s tied at a fistula which helps the fistula heal and drain any infection
31
What is the gross pathological appearance of Chron’s (what can be seen with an endoscope)?
Skip lesions Hyperaemia (Red appearance) Mucosal oedema Superficial ulcers + deep ulcers Transmural inflammation (full wall thickness) can narrow lumen Cobblestone appearance Fistulae
32
Describe the Cobblestone appearance seen in Chrons disease:
Cobbles = inflamed/oedmatous mucous Grout/in between cobbles = ulcerations/bleeding
33
What is a key histological indications that an inflammtory bowel disease is Chrons disease and NOT UCLERATIVE COLITIS?
Epitheliod Granulomas
34
What is a granuloma?
Collection of epithelioid macrophages surrounded by lymphocytes
35
Look on slide 16 to see granuloma
36
How do you investigate Chrons disease?
Bloods to check for anemia to see for blood loss CT/MRI (bowel wall thickening, obstruction and extramural problems) Do barium enemas and follow through as contrast
37
Why can fistula, strictures an adhesions form in Chrons but not ulcerative colitis?
Chrons is transmural affecting the full thickness of the gut so needs to undergo repair which can go wrong Whereas ulcerative colitis is superficial so doesn’t undergo repair
38
Go to the last slide, look at the CT on the left, what is the sign seen? What is it indicative of? Describe what causes this sign
Target sign Chrons disease Thickening and oedema of bowel wall due to chrons being transmural
39
The patient in the MRI on the right has chrons, what complication have they developed? Where has it developed?
Stricture at hepatic flexure in transverse colon
40
What pathological changes can be seen in endoscopy of a patient with chrons?
Skip lesions Cobblestone appearance Fistulae Strictures
41
What disease is indicated on the endoscope on the last slide? Why?
Chrons disease Cobblestone appearance
42
Are there Perianal diseases with Ulcerative colitis?
No
43
Why is blood loss per rectum very noticeable in Ulcerative colitis?
Since its always starts in the rectum
44
What are some different types of ulcerative colitis?
Proctitis Proctosigmoiditis Distal colitis Extensive colitis Pancolitis
45
What is proctiis?
Ulcerative colitis affecting just the rectum
46
What is pancolitis?
Ulcerative colitis affecting whole large intestine e
47
Why does ulcerative colitis present with mildly tender abdomen whereas Chrons is localised to the RLQ?
No focus point in UC
48
What pathological changes can be seen on a histology slide indicating ulcerative colitis?
Crypt abscesses Crypt distortion Reduced number of goblet cells Chronic inflammatory infiltration of lamina propria
49
Go to the last slide: What disease is the histology slide indicating? Why?
Ulcerative colitis Infilatrion of Lamina propria
50
Why is a reduction n goblet cells bad in UC?
Mucus acts as a protective barrier from microbes
51
What structure is absent in the large bowel but present in small intestine?
No villi
52
What are the folds called in the stomach?
Rugae
53
What are the permanent folds called in the small intestine called?
Plica circularis
54
What are the folds called in the large bowel?
Haustra
55
What changes can be seen in endoscopy with Ulcerative colitis?
Pseudopolyps Loss of Haustra
56
What causes pseudopolyps in UC?
Inflammation then healing
57
What maintains Haustra in the large intestine?
The contraction of the 3 bands of muscle called the tiniae coli
58
Why are the haustra lost in Ulcerative colitis?
Inflammation leads to damage of the tiniae coli causing them to relax leading to loss of the haustra
59
How are the haustra distributed from the rectum through the large intestine?
Rectum smooth As your progress through gets more and more haustra/folded
60
What are some investigations done for UC?
Bloods (anaemia) Stool samples Colonoscopy
61
If lesions are spotted on the mouth is it more likely Chrons or UC?
Chrons
62
Which IBD is fibrosis very common in?
Chrons
63
Which IBD are crypt abcesses common in?
Ulcerative colitis
64
Why can the bowel become obstructed in Chrons?
Deep inflammation leads to fibrosis which can produce strictures
65
Look at slide 35 to see skip lesions
66
Look at the last slide, CT labelled 2 What is this sign? What is it indicative of?
Lead pipe colon Descending and sigmoid colon featureless due to the haustra being absent since tiniae coli damaged by inflammation so are relaxed
67
What are the general medications given to treat IBD?
Aminosalicylates Corticosteroids Immunomodulators
68
When are steroids prescribed for IBDs?
With flare ups
69
How is Chrons cured?
Not curable Structures and fistulas develop If surgery remove as little bowel as possible
70
How is Ulcerative colitis cured?
Colectomy But only done if inflammation doesn’t settle, getting pre cancerous changes or a toxic mega colon
71
What is a toxic mega colon?
Consequence of UC Inflammation of colon so aggressive the colon distends Due to loss of its tone it could burst

Y2 - GI (35 decks)

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