Small Intestine, Large Intestine and Rectum

Question 1

Steatorrhoea

Answer 1

Passing of stool that is pale, oily and floats on water. Caused by malabsorption of fat.

Question 2

Gliadin

Answer 2

Fraction of gluten coeliacs are sensitive too

Question 3

Tropical Sprue

Answer 3

Causes folate deficiency, responds to antibiotics

Question 4

Giardia Lamblia

Answer 4

Water borne unicellular parasite, causes hypogammaglobulinaemia. Treated with metronidazole

Question 5

Whipples disease

Answer 5

Caused by Tropheryma whippelii and presents with weight loss, abdominal pain and malabsorption. Very rare and effects skin, brain, joints and cardiac.

Question 6

Myenteric Plexus

Answer 6

Made up of Meissener’s plexus (base of submucosa) and Auerbach’s plexus (between 2 layers of muscularis propria)

Question 7

Inflammatory Bowel Disease

Answer 7

Chronic inflammatory condition resulting from inappropriate and persistent activation of the mucosal immune system driven by the presence of normal intra-luminal flora.

Question 8

Skip lesions

Answer 8

Distribution of Crohn’s disease, in which random patches of disease are distributed throughout GI tract

Question 9

Ischaemic Enteritis

Answer 9

Ischaemic lesions effecting any section of the small or large bowel due to occlusion of blood vessel.

Question 10

Infarcted bowel

Answer 10

Occlusion of coeliac, superior mesenteric or inferior mesenteric leading to large transmural injury in bowel.

Question 11

Radiation Colitis

Answer 11

Inflammatory reaction to abnormal irradiation. Impairs proliferation activity of cells in bowel. Mimics IBD in presentation.

Question 12

Appendicitis

Answer 12

Acute inflammation of the appendix.

Question 13

Adenoma of large bowel

Answer 13

Development of polyps in large bowel. Can be tubular, villous or tubulovillous.

Question 14

Colorectal adenocarcinoma

Answer 14

Glandular tumour in large bowel, presentation varies depending on left or right sided.

Question 15

Dukes’ Staging

Answer 15

Staging algorithm for colorectal cancer (A-D)

Question 16

Ulcerative Colitis

Answer 16

IBD that features continuous inflammation of the rectum and potentially colon.

Question 17

Crohn’s Disease

Answer 17

IBD that features skip lesions of inflammations anywhere in the GI tract.

Question 18

Anal Crohn’s

Answer 18

Formation of fistula due to Crohn’s disease that protrudes out of anus

Question 19

Calprotectin

Answer 19

White cell protein in leukocytes of bowel, can be detected in stool test as marker of inflammation

Question 20

Sclerosing cholangitis

Answer 20

Disease of the bile ducts that causes strictures and can lead to liver cirrhosis. Associated with ulcerative colitis.

Question 21

Aminosalicylates (5ASA)

Answer 21

Drugs used to induce and maintain remission of IBD

Question 22

Thiopurines

Answer 22

Immunosuppressive agents used in induction and maintenance of remission in IBD. Used as steroid sparing agents but have significant side effects too.

Question 23

Ciclosporin

Answer 23

IV rescue therapy for IBD

Question 24

Biologics

Answer 24

Monoclonal antibodies used the treatment of IBD

Question 25

Infliximab

Answer 25

Biologic drug. Anti TNFalpha antibodies used to treat IBD.

Question 26

Pouch procedure

Answer 26

Small bowel is mobilised and lengthened to create a false rectum.

Question 27

proctocolectomy

Answer 27

Surgical removal of the rectum and most/all of large colon, patient is left with stoma

Question 28

ileostomy

Answer 28

Opening made in abdomen during surgery, end is brought through opening to form stoma.

Question 29

Micro-satellite instability

Answer 29

Defective DNA repair pathway genes

Question 30

Adjuvant chemotherapy

Answer 30

Chemotherapy given post surgery

Question 31

Neoadjuvant chemotherapy

Answer 31

Chemotherapy given pre surgery

Question 32

Faecal occult blood test

Answer 32

Screening test for colorectal cancer, detects blood in stool

Question 33

Scottish Bowel Screening Programme

Answer 33

Patients aged 50-74 invited to do at home FOBT every 2 years. Positive tests invited for colonoscopy.

Question 34

Familial adenomatous polyposis

Answer 34

Autosomal dominant condition that causes development of multiple adenomas throughout colon. Patients usually undergo prophylactic proctocolectomy before they are 24. Screened annually.

Question 35

HNPCC

Answer 35

Autosomal dominant condition featuring mutation in DNA mismatch repair genes, causing patients to develop early onset colorectal cancer. Screened every 2 years.

Question 36

Pancolitis

Answer 36

Inflammation from rectum to caecum, bowel is ulcerated with thick wall

Question 37

Toxic mega-colon

Answer 37

Advancement of ulcerative colitis, very thin colon wall that is ischemic

Question 38

Diverticular disease

Answer 38

Formation of tiny pockets in the lining of the bowel

Question 39

Right hemicolectomy

Answer 39

Removal of right sided of colon. Indicated for adenoma, cancer and Crohn's disease.

Question 40

Sigmoid colectomy

Answer 40

Removal of left side of colon.

Question 41

Low anterior resection

Answer 41

Removal of rectum, colon joined directly to anal canal.

Question 42

Appendectomy

Answer 42

Removal of appendix, requires division of appendiceal artery (branch of ileocolic)

Question 43

Base of appendix

Answer 43

Site where the 3 teniae coli running along the large bowel merge.

Question 44

Hirschprung's myenteric plexus deficiency

Answer 44

Congenital condition in which internal anal sphincter is unable to relax and defecation is impossible.

Question 45

Haemorrhoids

Answer 45

Disrupted and dilated anal cushions causing painless bleeding.

Question 46

Anal cushions

Answer 46

Spongy vascular tissue that lines the anus

Question 47

Prolapsing haemorrhoids

Answer 47

Haemorrhoids that are outside the annus

Question 48

Dentate line

Answer 48

Point at which anus receives sensory supply (pain line)

Question 49

Anal Fissure

Answer 49

Tear in the sensitive skin-lined lower anal canal distal to dentate line

Question 50

Fistula-in-ano

Answer 50

Abnormal communication between 2 epithelial surfaces, track communicates between skin and anal canal/rectum

Question 51

Goodsall's rule

Answer 51

States that if anal fistula is anterior then interior opening is in a straight line from external opening but if it is posterior then internal opening is at 6 o'clock position, taking a torturous course.

Question 52

Seton suture

Answer 52

Used for anal fistulas, canal filled with collagen.