inflammatory bowel diseas

Question 1

differences between small intestine and large intestine

Answer 1

SI = long + narrow, villi +  microvilli, peyeters patches (lymphoid aggresgates) + circular folds 
LI = shorter and broad, no villi, gobket cells and crypts

Question 2

coeliac disease aetiology

Answer 2

autoimmune = genetic
activated by ingestion of proline (gluten)
triggers SI damage mucose = generalised malabsorption

Question 3

describe coealic disease mciro and macro

Answer 3

normal = surface cilli
coeliac = villous atrophy + surface openings to crypts and ridges

Question 4

diagnosis and treatment of coeliac + complications

Answer 4

gluten challenge, blood test = anti-tissue transglutaminase antibodies
endoscopy
treatment = be gluten free
comps = anaemia, vit deficiencies + malignancy

Question 5

what is IBD and its aetiology

Answer 5

chrons + ulcerative colitis
idiopathic, chronic inflam disease
genetic, env, immunological
= inability to distinguish between self and foreign antigens

Question 6

extraintestinal manifestations + comps of IBD

Answer 6

skin, ocular, arthropathy, arthritis, thromboembolic events, osteoporosis

Question 7

aetiology of chrons

Answer 7

more femals, TNF-alphe major factor, common insmokers

Question 8

where can chrons affects and what are its symptoms

Answer 8

any part GIT 
intermittent attacks: fever, diarrhoea, cramping, loss apetite 
malabsorption
weight loss 
perianal fissures 
extra-intestinal manifestations

Question 9

describe the macroscopy of Chron’s

Answer 9

skip lesions, mucosal ulcers, cobblestoning mucosa, transmural inflam (granulomatous, crypt abscesses, narrowed lumen
thickenes bowel and oedematous
mesenteric lymph nodes = enlarged + firm + matted
creeping fat
fibrosis

Question 10

describe chrons microscopically

Answer 10

patchy tranmural inflam
acute inflam = ulceration, fissuring, neuts isolate crypts -> abscesses
intestinal lumen narrowed bu oedema + fibrosis
chronic mucosal damage = non-necrotising granulomas

Question 11

intestinal complications of chrons

Answer 11

bowel obstruction, ulcers, malabsorption of nutrients, fistulas in other organs, carcinoma of GIT, anaemia

Question 12

UC aetiology

Answer 12

more older men
more common in non-smokers
diagnosis - 15-30 + 50-70

Question 13

what is ulcerative colitis

Answer 13

chronic inflam colon+ rectum + sometimess anus + extends proximally
mucosal involvement
ulcerative proctitis, left-side colitis, sub-total colitis + panocoliits

Question 14

symptoms of UC

Answer 14

Abdominal pain
Blood or pus in stool
Diarrhoea
Proctitis (inflammation of rectum)
Gastrointestinal bleeding

Question 15

describe the 3 stages of UC macroscopically

Answer 15

early = red, oedematous, granular mucosa + yellow exudate + bleeds easy + erosions + ulcers
progressive = atrophy mucosal folds, inflam polyps (tissue destruction + manifestations of tissue repair)
advances = large bowel shortened, mucosal folds indistinct + replaced by cobblestone of smooth mucosal pattetn
psydo-polps = projecting granulation tissue

Question 16

describe the 3 stages of microscopic UC

Answer 16

early = mucosal  congestion, oedema, haem, neuts, damagen and distortion of crypts 
progressive = branching colorectal crypts + mucosa = atrophic 
advances = muscosal metaplasia + inflam infiltrate

Question 17

what are the clinical features of UC

Answer 17

intermittent attacks with partial/complete remission
mild = rectal bleed
moderate = episodes loose, bloody stool, cramp, fever, anaemia
severe = 6-20 bloody bowel mvm/day anaemia, dehydration