Inflammation of the bowel

Question 1

What is absorbed in the duodenum?

Answer 1

Iron

Question 2

What is absorbed in the jejunum?

Answer 2

Folate

Question 3

What is absorbed in the ileum?

Answer 3

B12

Bile salts

Question 4

Histology of the GI tract:

Answer 4

Simple columnar

Question 5

Histology of oesophagus:

Answer 5

Stratified squamous non-keratinised

Question 6

Absorbative cells of GI tract =

Answer 6

Enterocytes

Question 7

Brunner’s gland are found in

Answer 7

Duodenum

Question 8

What does Brunner’s gland do?

Answer 8

Secrete alkaline fluid for anti-acid effect

Question 9

Layers of the GI tract from lumen

Answer 9

1. Lumen
2. epithelium
3. Lamina propria
4. Muscularis mucosa
5. Submucosa
6. Muscularis externa
7. Serosa

Question 10

What layers make up the mucosa?

Answer 10

2. epithelium
3. Lamina propria
4. Muscularis mucosa

Question 11

Plexus in the submucosa

Answer 11

Submucosal/Meissner’s

Question 12

Function of submucosal plexus =

Answer 12

Secretions, vessel dilation

Question 13

Plexus in muscle layer

Answer 13

Myenteric/Auerbachs

Question 14

Function of Auerbach’s plexus

Answer 14

Movement

Question 15

Main causes of diarrhoea in developed countries:

Answer 15

IBS
IBD
Malabsorption dyndromes
Chronic infections

Question 16

Main causes of diarrhoea in developing countries:

Answer 16

Mycobacteria

Parasitic infection

Question 17

Diarrhoea can be due to:

Answer 17

1. Osmotic
2. Increased secretion
3. Permeability defect
4. Defect absorption
5. Motility disturbance

Question 18

Ex of what can cause osmotic diarrhoea

Answer 18

Lactose intolerance

Question 19

Ex of what can cause secretory diarrhoea

Answer 19

Cholera

Question 20

Signs of B12 decificency =

Answer 20

Anemia (macrocytic)

Glossitis

Question 21

Bleeding can be a sign of what deficiency?

Answer 21

Vitamin K

Question 22

Features of general ill health found in inflammatory conditions:

Answer 22

Anorexia
Weight loss
Lethargy
Oedema
Dehydration
Amenorrhoea, infertility, impotence

Question 23

Anorexia =

Answer 23

Suppression of appetite

Question 24

Coeliac disease normally presents in

Answer 24

Childhood

Question 25

F:M ratio coeliac

Answer 25

2:1

Question 26

Trigger of coeliac disease:

Answer 26

Gliaden in gluten

Question 27

Pathophysiology of coeliac disease:

Answer 27

Consume gluten - degrade in duodenum - sIgA binds to gliaden - binds to transferrin receptor to lamina propria - tissue transglutaminase deaminates - macrophage uptakes - INF-y and TNF released - damage and destruction of billi

Question 28

Coeliac disease has a strong associated with what gene?

Answer 28

HLA-DQ2/8

Question 29

What cancer risk is increased in coeliac?

Answer 29

T-cell lymphoma

Question 30

Presentation of coeliac in children:

Answer 30

Abdo distension Diarrhoae/steatorrhea Failure to thrive

Question 31

Dermatitis herpetiformis is found it what disease?

Answer 31

Coeliac disease

Question 32

Non-classical presentations of coeliac:

Answer 32

``` Asymptomatic Abdominal pain Altered bowel habit Anaemia Bone problems Depression Infertility ```

Question 33

First line test for coeliac:

Answer 33

Anti-tTG

Question 34

Other tests for coeliac that aren't first line:

Answer 34

EMA (endomysial antibody) | DGP (deaminated gliadin peptide antibody)

Question 35

What should be biopsied to test for coeliac?

Answer 35

Duodenum

Question 36

Histology of coeliac:

Answer 36

Blunting and atrophy of mucosa Crypt hyperplasia Increased intraepithelial lymphocytes Increased lamina propria inflammatory cells

Question 37

What's more common, UC and Crohn's disease?

Answer 37

Ulcerative colitis

Question 38

Gene associated with Crohn's?

Answer 38

NOD2

Question 39

NOD2 is a

Answer 39

Pattern recognition receptor

Question 40

When NOD2 is upregulated

Answer 40

IL-28 --> Th17 --> IL-17 (extracellular, chronic inflammation)

Question 41

Infections associated with Crohn's?

Answer 41

Mycobacterium paratuberculosis | Microbiome

Question 42

Smoking is

Answer 42

Causative of Crohns | Protective for UC

Question 43

Pain in UC is in the

Answer 43

Left lower region

Question 44

Pathological features of UC:

Answer 44

- Colon - Rectum always affected - Normal thickness - Ulcerations in superficial layers - Adhesions and fistulae rare

Question 45

Histology of UC:

Answer 45

- Crypt abcesses | - Lymphocytic infiltration and graunulomas rare

Question 46

Pathological features of Crohn's:

Answer 46

- Segmental, proximal - 50% rectum - Transmural - Cobblestone appearance - Fitsula and adhesions common

Question 47

Histology of Crohn's:

Answer 47

Granulomas | Lymphocytic infiltration

Question 48

Presentation age of Crohn's:

Answer 48

15-35

Question 49

Presentation of UC:

Answer 49

Throughout lifespan

Question 50

Erythemia nodosum is a systemic complication of:

Answer 50

Crohns

Question 51

Cancer risk with IBD:

Answer 51

Increased colorectal