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GI tract > Inflammatory bowel disease > Flashcards

Inflammatory bowel disease Flashcards

1
Q

What is the primary function of the large intestine?

A
  • Removes water from all indigestible gut contents
  • Turns chyme into a semi-solid
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2
Q

What are the other functions of the large intestine?

A
  • Production of certain vitamins
  • Microbiome contains lots of commensal bacteria
  • Acts as temporary storage until defecation
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3
Q

Where does the colonic mucosa get the majority of its nutrients from?

A
  • Not from blood
  • Short chain fatty acids derived from fermentation of dietary fibre
  • The by-products of this fermentation include CO2, methane and hydrogen gas
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4
Q

Outline the relationship of the large intestine with the peritoneum

A
  • Ascending and descending colon are retro-peritoneal
  • Transverse colon and sigmoid colon have their own mesenteries
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5
Q

Outline the relationship of the rectum with the peritoneum

A
  • Upper 1/3 is intra-peritoneal
  • Middle 1/3 is retroperitoneal
  • Lower 1/3 has no peritoneum
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6
Q

Outline the arterial supply of the mid-gut

A
  • Supplied by branches of superior mesenteric artery
  • Ileo-colic branch supplies caecum (small intestine)
  • Right colic branch supplies ascending colon
  • Middle colic branch supplies transverse colon
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7
Q

Outline the arterial supply of the hindgut

A
  • Supplied by branches of inferior mesenteric artery
  • Left colic branch supplies descending colon
  • Sigmoid branch supplies descending colon and sigmoid colon
  • Superior rectal artery supplies upper 1/3 of rectum
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8
Q

Outline the venous drainage of the midgut

A
  • Drains into superior mesenteric vein
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9
Q

Outline the venous drainage of the hindgut

A
  • Drains into inferior mesenteric vein
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10
Q

Outline the venous drainage of the rectum

A
  • Upper 1/3 drains into superior rectal vein (IMV)
  • Middle and lower 1/3s drain into systemic venous system
  • This is a site of portosystemic anastomosis (i.e. varices can occur here)
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11
Q

Compare the structure of the large intestine with the structure of the small intestine

A
  • Large intestine is much shorter
  • Large intestine is much wider
  • Has crypts, not villi
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12
Q

Describe the muscular walls of the large intestine

A
  • External longitudinal muscle is incomplete
  • Instead it is divided into 3 distinct bands called taeniae coli
  • Haustra are sacculations caused by contraction of taeniae coli
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13
Q

Give an overview of water absorption in the large intestine

A
  • Facilitated by ENac channels (like in DCT)
  • Induced by aldosterone
  • <100mls water excreted in faeces each day bu 1500mls enter colon each day
  • Most absorption in proximal colon
  • Much tighter tight junctions allows a bigger gradient to form and means there’s less back diffusion of ions
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14
Q

What is the broad definition for inflammatory bowel disease?

A
  • Group of conditions characterised by idiopathic inflammation of the GI tract
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15
Q

What are the 2 common types of IBD?

A
  • Crohn’s disease
  • Ulcerative colitis
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16
Q

Give an overview of Crohn’s disease

A
  • Affects anywhere in GI tract from mouth to anus
  • Ileum involved in most cases
  • Transmural
  • Skip lesions (areas in between affected areas of bowel)
17
Q

Give an overview of Ulcerative colitis

A
  • Begins in rectum
  • Can extend to involve entire colon
  • Continuous pattern
  • Mucosal inflammation (superficial)
18
Q

What other issues are associated with IBD?

A
  • MSK pain e.g. arthritis
  • Skin e.g. erythema nodosum, pyoderma gangrenosum, psoriasis
  • Liver/biliary tree e.g. primary sclerosing cholangitis
  • Eye problems
19
Q

What are the causes of IBD?

A
  • Genetic
  • Gut organisms (altered interaction)
  • Immune response
  • Antibiotics
  • Infections
  • Smoking (though this slightly suppresses UC)
  • Diet
20
Q

What might you see in a classic presentation of Crohn’s disease?

A
  • Multiple loose stools per day
  • Not bloody
  • Weight loss
  • Right lower quadrant pain
  • Maybe joint pains
  • Tender mass due to scarring
  • Mild perianal inflammation/ulceration
  • Low grade fever
  • Mild anaemia
21
Q

What pathology does Crohn’s disease cause?

A
  • Skip lesions
  • Hyperaemia
  • Mucosal oedema
  • Discrete superficial ulcers
  • Deeper ulcers
  • Transmural inflammation
  • Thickening of bowel wall
  • Narrowing of lumen
  • Cobblestone appearance
  • Fistulae
22
Q

What causes the cobblestone appearance seen in Crohn’s disease?

A
  • Inflamed oedematous tissue in between linear ulcers
23
Q

What are fistulae?

A
  • Abnormal connections between 2 epithelium lined surfaces
  • In Crohn’s can be bowel-bowel/bladder/vagina/skin
24
Q

What microscopic details would you see in Crohn’s disease?

A
  • Granuloma formation
  • Organised collection of epithelioid macrophages
25
Q

How would we investigate Crohn’s disease?

A
  • Bloods - check for anaemia
  • CT/MRI scans - check for bowel wall thickening, obstruction, extramural problems
  • Barium enema/follow through - identify strictures
26
Q

What would be seen on a colonoscopy in someone with Crohn’s?

A
  • Gross pathological changes
  • Skip lesions
  • Cobblestone appearance
  • Fistulae
  • Strictures
  • Less blood than in ulcerative colitis
27
Q

What might you see in a typical presentation of ulcerative colitis?

A
  • Multiple bloody stools per day
  • Mucus in stools
  • Weight loss
  • Mild lower abdominal pain/cramping
  • Mildly tender abdomen
  • No perianal diseases
  • Normal temperature
28
Q

What microscopic changes can be seen in histology of ulcerative colitis?

A
  • Chronic inflammatory infiltrate of lamina propria
  • Crypt abscesses (neutrophilic exudate in crypts)
  • Crypt distortion
  • Irregular shaped glands with dysplasia
  • Dark crowded nuclei
  • Reduced numbers of goblet cells
29
Q

What pathological changes occur in ulcerative colitis?

A
  • Pseudopolyps can develop after repeated episodes of inflammation then healing
  • Non-neoplastic
  • Loss of haustra due to inflammation
30
Q

How do we investigate ulcerative colitis?

A
  • Bloods - anaemia, serum markers
  • Stool cultures
  • Colonoscopy
  • Plain abdominal radiographs
  • Barium enema (mild cases only)
  • CT/MRI (less useful in diagnosing uncomplicated UC)
31
Q

What is indeterminate colitis?

A
  • Even after diagnostic evaluation, there are disorders that cannot be classified
  • Occurs in 10% of cases
32
Q

Outline the distinguishing characteristics of Crohn’s vs UC

A
  • Crohn’s disease occurs anywhere in GI tract, UC only in rectum/colon
  • Only UC involves rectum
  • 25% patients have gross bleeding in Crohn’s, 75% in UC
  • 75% patients have perianal disease in Crohn’s, this is rare in UC
  • Fistula formation in Crohn’s only
  • Potential for malnutrition in Crohn’s only
33
Q

Outline the pathological features of Crohn’s vs UC

A
  • Transmural inflammation occurs in Crohn’s but is rare in UC
  • Granulomas seen in 75% of Crohn’s cases but not in UC
  • Fibrosis common in Crohn’s only
  • Crypt abscesses common in UC but rare in Crohn’s
34
Q

Outline the endoscopic changes in Crohn’s vs UC

A
  • Skip lesions in Crohn’s but continuous mucosal involvement in UC
  • Aphthous ulcers common in Crohn’s but rare in UC
  • Linear ulcers common in Crohn’s but rare in UC
  • Friable mucosa common in UC but rare in Crohn’s
  • Cobblestone appearance seen in severe cases of Crohn’s but not at all in UC
  • Fistula common in Crohn’s but not seen in UC
  • Narrowing common in Crohn’s but rare in UC
35
Q

What can be seen in radiology of Crohn’s disease?

A
  • On barium follow through can sometimes see long strictures
  • String sign of kantour
36
Q

What are the radiological features of UC?

A
  • Double contrast enema
  • Featureless descending and sigmoid colon
  • Lacking haustral markings
  • Lead pipe colon
  • Continuous lesions without skipping
  • Whole colon
  • Mucosal inflammation
  • Causes granular appearance
37
Q

What are the treatment options for IBD?

A
  • Aminosalicylates (sulfasalazine) - for flares and remission
  • Corticosteroids (prednisolone) - fore flares only
  • Immunomodulators (azathioprine) for fistulas/maintenance of remission
  • Faecal transplants help with UC
38
Q

What are the surgical treatments for Crohn’s disease?

A
  • Not curative
  • Strictures/fistulas
  • As little bowel removed as possible
  • Small intestine can’t be too short otherwise pt ends up with permanent diarrhoea
  • Every time you do surgery, you risk causing adhesions
39
Q

What are the surgical treatments for ulcerative colitis?

A
  • Curable (colectomy) - entire colon removed and ileum connected directly to rectum
  • Carried out if inflammation is not settling/there are precancerous changes/toxic megacolon

GI tract (23 decks)

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