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GIHEP > 20. Large Bowel Disease > Flashcards

20. Large Bowel Disease Flashcards

1
Q

Where is the plexus of meissner located?

A

Submucosa

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2
Q

Where is the plexus of auerback located?

A

Muscle

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3
Q

What is Hirschsprung’s disease?

A

Congenital megacolon due to arrested migration of neural crest cells: no meissner or auerbach plexuses so no peristalsis, causing a functional obstruction

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4
Q

What patient group is more likely to have Hirschsprung’s disease?

A

Male

Downes syndrome

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5
Q

What parts of the bowel are susceptible to Hirschsprung’s disease?

A

Rectum and sigmoid

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6
Q

What gene is associated with Hirschsprung’s disease?

A

RET gene

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7
Q

What are the clinical features of Hirschsprung’s disease?

A

Failure to pass meconium

Constipation, vomiting and abdominal distension

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8
Q

What are the complications of Hirschsprung’s disease?

A

Massive dilatation and perforation

Infection

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9
Q

What is the treatment for Hirschsprung’s disease?

A

Resect the part without ganglion cells

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10
Q

What part of the enteric tract is supplied by the superior mesenteric artery?

A

Caecum to splenic flexure

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11
Q

What part of the GIT is supplied by the inferior mesenteric artery?

A

Colon to rectum

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12
Q

What arteries supply the lower rectum?

A

Internal iliac and internal pudendal

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13
Q

What is a transmural infarction caused by?

A

Sudden occlusion of a major vessel causing infarction of all layers

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14
Q

What are the other types of infarction of the bowel?

A

Mural: mucosa and submucosa

Mucosal

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15
Q

What are the clinical features of transmural bowel infarction?

A

Severe abdominal pain
Bloody diarrhoea
Reduced peristaltic sounds
Rigidity

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16
Q

What are the clinical features of mucosal and mural infarcts?

A

Intermittent bloody diarrhoea

Non-specific abdominal complaints

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17
Q

What is angiodysplasia?

A

Dilatation of blood vessels in caecum and right colon

Seen in elderly as a result of wear and tear

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18
Q

What is hereditary haemorrhagic telangiectasia?

A

AD

Thin walled blood vessels in mouth and GIT which can rupture

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19
Q

What are risk factors for haemorrhoids?

A

Constipation
Pregnancy
Portal hypertension

20
Q

What patient group gets necrotising enterocolitis?

A

Premature or low birth weight infants

Any time in first 3 months of life

21
Q

What are the features of necrotising enterocolitis?

A

Ischaemia
Bacterial colonisation
Excess protein in lumen
Functional immaturity

22
Q

What patient groups have higher risks of Crohn’s disease?

A

Females
White, Jewish
Peak in teens and 20s, minor peak in 50-60

23
Q

Where is the most common area affected by Crohn’s disease?

A

Terminal ileum

24
Q

What are the features of Crohn’s disease?

A

Segmental: affected areas are separated by normal

Transmural, affects all layers

25
Q

Give examples of the transmural effects of Crohn’s disease?

A

Creeping fat
Dull serosa
Thickening of wall

26
Q

What causes thickening of the bowel wall in Crohn’s disease?

A

Oedema, inflammation and fibrosis

27
Q

What types of ulcers are seen in Crohn’s disease?

A

Aphthous
Serpentine/linear: ‘cobblestones’
Fissures

28
Q

What are the microscopic features of Crohn’s disease?

A

Crypt architectural distortion
Inflammatory cells in all layers
Cryptitis and crypt abscesses
Non caseating granulomas

29
Q

What is the difference between cryptitis and crypt abscesses?

A

Cryptitis is neutrophils in the wall of the crypt

Crypt abscesses are collections of neutrophils in the lumen

30
Q

What are the clinical features of Crohn’s disease?

A

Relapsing and remitting abdominal pain, fever, bloody diarrhoea
Malabsorption

31
Q

What types of anaemia are associated with Crohn’s disease?

A

Iron deficiency due to ulceration and bleeding

B12 deficiency due to involvement of terminal ileum

32
Q

What are the complications of Crohn’s disease?

A 
Obstruction
Adhesions
Fistula
Malabsorption
Increased risk of carcinoma
33
Q

What structures can be fistulated in Crohn’s disease?

A

Small bowel and colon
Bladder
Vagina
Skin

34
Q

What are the systemic manifestations of Crohn’s disease?

A

Arthritis
Uveitis
Erythema nodosum
Clubbing

35
Q

What is the gross pathology of ulcerative colitis?

A

Begins in the rectum and spreads upwards continuously
Red mucosa
Broad ulcers

36
Q

What are the microscopic features of ulcerative colitis?

A

Cryptitis and crypt abscesses
Architectural distortion of crypts
Epithelial dysplasia
No granulomas

37
Q

What are the clinical features of ulcerative colitis?

A

Relapsing and remitting bloody mucoid diarrhoea, abdominal pain and tenesmus
Fever, weight loss, anaemia

38
Q

What type of anaemia is seen in ulcerative colitis?

A

Only iron deficiency

39
Q

What are the complications of ulcerative colitis?

A

Toxic megacolon caused by damage to the muscularis propia by inflammatory cells, destroying neuromuscular function
Neoplasia

40
Q

What are the systemic manifestations of ulcerative colitis?

A

Arthritis, erythema nodosum, clubbing
Pyoderma gangrenosum
PSC
Uveitis

41
Q

How does a low fibre diet cause diverticular disease?

A

Low fibre > low stool bulk > increased peristalsis > increased pressure

42
Q

What are the clinical features of diverticular disease?

A

Normally asymptomatic

Cramping, lower abdominal pain, tenesmus

43
Q

What complications are associated with diverticular disease?

A 
Diverticulitis
Perforation
Adhesions
Fistula with bladder
Pericolic abscess formation
Haemorrhage
Obstruction
44
Q

What is the cause of intussusception in the elderly?

A

Tumour at the leading edge

45
Q

Which part of the GIT is involved in volvulus in the elderly and young adults?

A

Elderly: sigmoid

Young adults: caecum

GIHEP (30 decks)

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