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GI > Session 7 Part 2 > Flashcards

Session 7 Part 2 Flashcards

1
Q

What does CCK do

A

Make bile sac move
Released from I cells in duodenum and jejenum
Stimulated by fats in chyme

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2
Q

CKK causes

A

Pancreas to release enzyme rich secretions
GB contraction and sphincter of Oddi relaxation
Production of bile
Inhibits gastric emptying

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3
Q

Features of LI

A

Ascending colon retro peritoneal
Transverse colon has its own mesentary (transverse mesocolon)
Descending colon is retro-peritoneal
Sigmoid colon has its own mesentary

Rectum:
Upper 1/3 intra peritoneal
Middle 1/3 retroperitoneal
Lower 1/3 no peritoneum

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4
Q

Large intestine vs small intestine

A

Large = shorter and wider, has crypts not villi

External longitudinal muscle is incomplete - 3 distinct bands (teniae coli), Haustra are sacculations caused by contraction of teniae coli

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5
Q

How does water absorption happen in colon

A

Facilitated by ENaC
Induced by aldosterone
Approx 1500mls of water enter each day and <100mls excretes in faeces
Most absorption in proximal colon
Much tighter junctions allows bigger gradient and less back diffusion

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6
Q

What is inflammatory bowel disease

A

Group of conditions characterised by idiopathic inflammation of the GI tract
Affect function of the gut

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7
Q

2 common types of inflammatory bowel disease

A

Crohn’s disease
Ulcerative colitis

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8
Q

3 uncommon types of inflammatory bowel disease

A

Diversion colitis
Pouchitis
Microscopic colitis

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9
Q

features of Crohn’s disease

A

Affects anywhere in GI tract
Ileum usually involved
Transmural
Skip lesions

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10
Q

Features of Ulcerative colitis

A

Begins in rectum
Can extend to involve entire colon
Continuous pattern
Mucosal inflammation

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11
Q

Extra-intestinal problems linked with IBD

A

MSK pain (up to 50%)- arthritis
Skin (up to 30%)- erythema nodosum/pyoderma gangrenosum/psoriasis
Liver/biliary tree - Primary sclerosing cholangitis (PSC)
eye problems (5%)

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12
Q

Causes of IBD

A

Genetic, 1st degree relative
Gut organisms altered interaction
Immune response

Trigger? - smoking, diet, infections antibiotics

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13
Q

Smoking and IBD

A

Smoking makes ulcerative colitis better
Makes crohn’s worse or more likely

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14
Q

Gross pathological in Crohns

A

Cobblestone appearance
Fistulae

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15
Q

Extensive list of gross pathological signs in Crohns

A

Skip lesions
Hyperaemia
Mucosal oedema
Discrete superficial ulcers
Deeper ulcers
Transmural inflammation (thickening of bowel wall and narrowing of lumen)

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16
Q

Microscopic pathology of Crohns

A

Granuloma formation (pathognomonic)
Organised collection of epithelioid macrophages

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17
Q

Investigating Crohn’s

A

Bloods- anaemia
CT/MRI scans - bowel wall thickening, obstruction, extramural problems
Barium enema- used less, strictures fistulae
Colonoscopy

18
Q

Findings on crohn’s surgery

A

Gross pathological changes seen in endoscopy
Skip lesions
Cobblestone appearance
Fistulae
Strictures

19
Q

Pathological changes in Ulcerative colitis

A
20
Q

Pathological changes over time in ulcerative colitis

A
21
Q

Investigating UC

A

Bloods- anaemia/serum markers
Stool cultures
Colonoscopy
Plain abdominal radiographs
Barium enema
CT/MRI - less useful in uncomplicated

22
Q

Endoscope risks in UC

A

Perforation

23
Q

Features of difficulty distinguishing IBD

A

10% have disorders that can’t be classified- indeterminate colitis

24
Q

Distinguishing characteristics of Crohn’s and UC

A
25
Q

Distinguishing pathological features of Crohns and UC

A
26
Q

Pathological feature differences Crohns and UC

A
27
Q

Endoscopic changes Crohns vs UC

A
28
Q

What does friable mucosa mean

A

Light touch = bleed

29
Q

What can you sometimes see on barium follow through in Crohns

A

Long strictures- string sign of kantour

30
Q

Radiological features of UC

A

Lost Haustra- featureless descending and sigmoid colon
Lead pipe colon
Continuous lesions without skipping
Whole colon
Mucosal inflammation causes granular appearance

31
Q

Treatment options for IBD medical

A
32
Q

Surgical treatment options for Crohns

A

Not curative
Stricture/fistulas
As little bowel removed as possible

33
Q

Surgical treatment options for UC

A

Curable (colectomy)
Inflammation not settling
Precancerous changes
Toxic megacolon

34
Q

What can too much surgical treatment of Crohns or UC cause

A

Adhesions, hernias, bowel obstruction, pain

35
Q

typical presentation of Crohns

A

Multiple non-bloody loose stools a day
Weight loss
Right lower quadrant pain
15-30 year old

36
Q

Typical presentation of UC

A

Multiple bloody stools a day
Mild abdominal pain
20-30 year old

37
Q

Most diverticula are

A

Pseudo-diverticula where mucosa and submucosa herniate through the external muscle layers of colon

38
Q

Diverticula occur at sites of the

A

Major branches of vasa recta

39
Q

Average size of diverticula

A

3-10mm

40
Q

Difference in supply above and below dentate line

A

Proximal = sympathetic and parasympathetic
Distally = somatic

41
Q

Which type of haemorrhoids are more likely to be damaged by trauma

A

Prolapsed

42
Q

External haemorrhoids are usually

A

Asymptomatic without bleeding

GI (22 decks)

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