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HHD 2 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

The mouth is part of the _________ tract

A

aerodigestive

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2
Q

What is the peritoneal space?

A

potential space surrounding abdominal organs, contained by the peritoneal sac

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3
Q

What is the blood supply for the foregut ?

A

Coeliac axis

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4
Q

What is the blood supply for the midgut?

A

superior mesenteric artery

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5
Q

What is the blood supply for the hindgut?

A

inferior mesenteric artery

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6
Q

What are the sections of the stomach?

A

cardia
fundus
Body
pylorus

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7
Q

What are the layers of the stomach?

A

mucosa
submucosa
muscularis externa (3 layers of smooth mucsle)
serosa

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8
Q

What is the blood supply of the stomach?

A

Coeliac axis

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9
Q

What is the vein that drains the stomach?

A

venous drainage into the portal vein

Portal vein receives blood from the GI tract; carries it into the liver

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10
Q

What are the cell types found in the stomach?

A

Mucous cells
G cells
Parietal cells
Chief cells
Enteroendocrine cells

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11
Q

What is the function of the mucous cells of the stomach?

A

secretes gel lining of the stomach

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12
Q

What is the function of G cells of the stomach?

A

secretion of gastrin (gastrin hormone then causes HCl secretion)

gastrin hormone then stimulates parietal cells for the release of gastric acid (HCl)

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13
Q

What is the function of parietal cells of the stomach ?

A

secretion of gastric acid (HCl) and intrinsic factor (IF used for B12 absorption)

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14
Q

What is the function of chief cells?

A

secretion of pepsinogen

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15
Q

Pepsinogen is converted into the enzyme pepsin by __________.

A

gastric acid
HCl
Change in pH ?

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16
Q

The enteroendocrine cells of the stomach are involved in endocrine secretion. Give examples of hormones released by these cells.

A

CCK- cholecytokinin
Secretin

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17
Q

What section of the stomach is referred to as the pre-exit area?

A

the pylorus

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18
Q

What are the functions of the stomach?

A

Neuroendocrine
Sterilisation
Storage
Absorption
Mechanical breakdown (pH)
Digestion (pepsinogen)

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19
Q

What are the sections of the small intestine?

A

duodenum
jejunum
ileum

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20
Q

What are the histological parts of the small intestine?

A

Mucosa (epithelium, lamina propria, muscularis mucosa)
Submucosa
Muscularis externa
Serosa

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21
Q

Where does the small intestine receive blood from?

A

coeliac axis
Superior mesenteric artery (SMA)

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22
Q

Venous drainage of the small intestine is to the ____________.

A

hepatic portal vein
takes blood to the liver

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23
Q

Name an important characteristic of the mucosa of the small intestine. Why is it important?

A

Mucosa is highly folded into villi and microvilli
This increase the surface area for absorption to take place

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24
Q

What are the functions of the small intestine?

A
  • Motility - moves things along via peristalsis
  • Chemical digestion of proteins lipids and carbohydrates
  • Mixing- pancreatic juice (exocrine) and bile (gallbladder/liver) are mixed in the small intestine
  • Immunological- peyers patches (MALT)
  • Absorption- iron, vitamin B12, fatty acids, amino acids, fructose, glucose, bile salts
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25
Q

Where are iron and folate absorbed?

A

the jejunum

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26
Q

Where is B12 absorbed?

A

terminal ileum

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27
Q

How long is the duodenum?

A

25cm

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28
Q

How long is the jejunum?

A

200cm

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29
Q

How long is the ileum?

A

300cm

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30
Q

What are the sections of the large intestine?

A

Caecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Anus

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31
Q

The appendix is attached to what part of the large intestine?

A

the caecum

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32
Q

What are the structures of the large intestine?

A

taeniae coli
haustra
colonic crypts

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33
Q

What is the blood supply for the large intestine?

A

superior mesenteric arteries
Inferior mesenteric arteries

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34
Q

Venous drainage from the large intestine is carried by …

A

portal vein
internal iliacs

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35
Q

What is a veriform appendix?

A

muscular structure attached to the caecum of the large intestine

dorsomedially attached to the caecum

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36
Q

What are the functions of the large intestine?

A
  • Motility- faecal movement
  • Microbiome- >700 types of bacteria
  • Absorption- water and remaining nutrients; performs the final touches of absorption an makes sure you do not lose too much water
  • storage
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37
Q

What is a barium enema ?

A

a radiological examination of the journey of barium in the gut

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38
Q

Give examples of imaging we are able to carry out to view the gut

A

Abdominal radiograph
Barium enema
Ultrasound
Barium meal
CT
Endoscopy

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39
Q

According to Eatwell guidance, what does a balanced diet look like?

A

5 portions of fruit and veg a day

carbohydrate should make up 1/3 of food (choose high fibre and wholegrain)

dairy should make up 1/6

proteins should make up 1/6- aim for 2 portions of oily fish per week

small amounts of unsaturated fats

small and infrequent amounts of high sugar, salt and high fat foods

6-8 cups of water a day

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40
Q

What is the recommended number of calories to be consumed by women?

A

2000 kcal
including all foods and all drinks

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41
Q

What is the recommended number of calories to be consumed by men?

A

2500 kcal
including all food and drinks

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42
Q

What is inflammatory bowel disease?

A

these are a group of autoimmune diseases which cause inflammation of the GI tract

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43
Q

What are the two main types of IBD?

A

Crohns disease
Ulcerative colitis

44
Q

What is intermediate IBD?

A

this is colitis without specific features to allow for classification

45
Q

What is the characteristic of crohns disease?

A

can affect any part of the GI tract
can also affect the mouth

Crohns disease classically appears as “skip lesions”; there is no continuity for lesions; they are not continuous and do not affect just one area of the GI tract

46
Q

What is the characteristic of ulcerative colitis ?

A

only the colon and rectum are inflammed
begins at the anus and continues a variable distance up the colon

There is continuity, no break in the affected area of the colon

does not affect the small bowel

47
Q

What is the aetiology of crohns disease?

A

Aetiology is unknown but there is a likely interaction between the following factors:
genetic susceptibility
intestinal microbiota
environmental factors

These all have an effect on the host immune system which then begins to attack the GI tract

48
Q

What gene mutation potentially has an impact on risk of crohns disease

A

NOD2 gene mutations on chromosome 16
there is a greatly increased risk if homozygous (two identical alleles)

49
Q

____% of crohns disease cases do not have the NOD2 mutation

A

75

50
Q

What other genetic links have been for crohns disease?

A

> susceptibility loci (locations on genes?) that could possibly influence how the immune system interacts with the gut flora

51
Q

What environmental factors can have an impact on the development of crohns disease?

A

Smoking- worsens crohns

oral contraceptive pill

Measles

Mycobacterium avium paratuberculosis

Acute gastroenteritis (infection which can lead to chronic disease)

52
Q

What part of the world is IBD most common in?

A

developed part of the world

53
Q

What type of IBD is more common?

A

ulcerative colitis more common than crohns

54
Q

What is the typical age of onset for IBD?

A

20-40 years

55
Q

More men are likely to suffer from IBD compared to women. True or false

A

True

56
Q

What is an ulcer?

A

an ulcer is characterised by segmental or more extensive loss of the epidermis (top layer) including the basement membrane

(does not involve the dermis)

57
Q

What is erosion?

A

there is partial loss of the epithelium, basement membrane remains intact

58
Q

What is a fistula?

A

an abnormal connection/passage-way that connects two organs or vessels that do no usually connect

abnormal connection between 2 epithelialised surfaces

59
Q

What part of the GI tract (histolgically) does ulcerative colitis affect?

A

Mucosa
does not affect deeper than the submucosa

60
Q

What are the histological characteristics of ulcerative colitis?

A

distortion of crypt architecture

ulceration confined to submucosa

crypt abscesses

pseudopolyps

inflammatory cells in lamina propria (mucosa)

61
Q

What are the histological characteristics of crohns disease

A

fistulation

stricturing

ulceration (full thickness- epithelium, mucosa, muscularis)- beyond submucosa unlike UC

granulomata

Skip lesions

cobblestone

62
Q

Briefly describe the distribution of ulcerative colitis

A

limited to the colon
with or without backwash ileitis (inflammation of the ileum)

ileitis is however classically caused by crohns disease and is the inflammation of the ileum of the small intestine

63
Q

Briefly describe the distribution of crohns disease

A

anywhere from the mouth to the anus
can have patches in between known as skip lesions

64
Q

What are the most common sites of crohns disease ?

A

distal ileum
colon
perineum

65
Q

What is the clinical presentation of IBD ?

A

abdominal pain
prolonged diarrhoea
bloody stools
fatigue
weight loss
extra GI manifestations

66
Q

What are crohns specific clinical presentations?

A

perianal lesions
obstructions
fever
fistulations

67
Q

What are ulcerative colitis specific presentations?

A

mucous in stools
toxic megacolon

68
Q

What is the presentation of crohns perianal disease?

A

characterised by inflammation near the anus
presentation includes:
-skin tags
-discolouration
-fissuring ulcers
-fistulae

69
Q

Fistulae forms in crohns disease and not in ulcerative colitis becasuse…

A

microscopically, inflammation occurs in all layers whereas in UC ulceration is confined to submucosa

70
Q

What are the categories of crohns fistulaes?

A

Internal
External

71
Q

Give an example of an external intestinal fistulae

A

entero-cutaneous - this is a fistulae which connects the intestine to the skin

72
Q

Give examples of internal fistulae

A

entero-vaginal?

colo-vesical- connection between colon and bladder; allows faecal matter to enter the bladder

73
Q

Give examples of extra GI manifesations of IBD on the skin

A

Erythema nodosum- inflammation of fat tissue in subepithelial tissues

Pyoderma gangrenosum- pyoderma dermatitis, can be seen in the mouth

74
Q

Give examples of extra GI manifestations of IBD in the eyes

A

Iritis- localised inflammation around the iris of the eye

Anterior uveitis- full anterior chamber inflammation

Episcleritis- partial inflammation of the sclera

75
Q

Give examples of extra GI manifestations of IBD in joints

A

seronegative arthritis (small joint polyarthropathy or large joint arthopathy); seronegative for being negative for rheumatoid arthritis

Sacroilitis- pain around sacroiliac joint

Ankylosing spondilitis- inflammation nearly causing fusion of the spinal column; the ligaments that connect each vetebrae start to fibrose

76
Q

Give examples of extra GI manifestations of IBD in the biliary system

A

gall stones- leads to disruption in normal bile salt absorption

Primary sclerosing cholangitis

77
Q

What is cholangitis?

A

this is inflammation of the bile duct system
there is chronic/progressive fibrosis and structuring of the biliary tree

Biliary tree includes - cystic duct, common hepatic duct, common bile duct

78
Q

__% of patients with ileitis or ileal resection develop gallstones

A

30

crohns disease commonly affect ileum
UC can also be associated with ileitis?

79
Q

3-7% of patients with ulcerative colitis develop primary sclerosing cholangitis. True or false

A

True

80
Q

What are the consequences of primary sclerosing cholangitis?

A

jaundiced
cannot absorb fatty food

81
Q

What are the extra GI manifestation of IBD in the mouth ?

A

oral ulcers- histologically similar to those found in the rest of the GI tract

Orofacial granulomatosis- persistent swelling of the lips, face and other areas of the mouth

82
Q

What are the characteristics of orofacial granulomatosis?

A

persistent or recurrent enlargement of lips
full width gingivitis and gingival enlargment
swelling of peri-oral and peri-orbital soft tissues
fissuring of tongue
cobblestones in mouth possible (similar to cobblestone present in GI tract in crohns)

83
Q

Orofacial granulomatosis is associated with _________ or can exist __________.

A

crohns
can exist alone

84
Q

Crohns disease can lead to different types of anaemia. Why is this ?

A

This is because crohns disease can affect different parts of the GI tract

Crohns affecting jejunum affects folate and iron absorption

Crohns affecting ileum affects B12 absorption

85
Q

What initial investigations are carried out for diagnosis of IBD?

A

FBC
CRP
Iron studies (B12 and folate)
stool sample for MC&S (microscopy, culture and sensitivity) and c difficile toxins
Abdominal xray

86
Q

What imaging can be carried out for diagnosis of IBD?

A

contrast studies
CT with IV and PO contrast (MR where contrast contraindicated)
Technitium-99 WBC labelling and PER scans are non invasive options

87
Q

Faecal calprotein and lactoferrin have a __________ diagnostic role for IBD

A

limited

88
Q

What definitive diagnostic test can be used for IBD?

A

Endoscopy as biopsies can be taken

89
Q

There is a risk of developing adenocarcinomas with what type of IBD?

A

ulcerative colitis

90
Q

What are the complications of IBD

A

Stenosis and obstruction- narrowing from active inflammation, chronic fibrotic scarring

Nutritional inadequacy- poor intake, high output, poor absorption, iron and B12 deficiency/anaemia

Short bowel syndrome- this usually occurs after multiple resections, requires parenteral nutrition

Osteoporosis- especially treatment with steroids (steroids encourage bone resorption)

Colorectal cancer- primarily applies to UC

Fistulation

91
Q

What are the management options of IBD?

A

Medical
Surgical -resections
Nutritional
Psychological
Smoking cessation- makes crohns worse; risk of development

92
Q

Treatment choices of IBDa are influenced by:

A

age
site and activity of disease
behaviour of disease
previous drug tolerance and response to treatment
previous relapses on treatment
presence of extra intestinal manifestations

93
Q

When is surgical treatment appropriate for IBD?

A

neoplastic or pre-neoplastic lesions
obstructive stenoses
suppurative complications
fistulating disease
medically intractable disease- cannot be controlled by medicine

94
Q

Medical management of IBD is usually done with steroids to control inflammation. Give example of drugs that can be used

A

5-ASA (salicylates e.g. mesalasine)

immunosuppresants

Antibodies:
Anti-TNFa- e.g infliximab (antibody)
Anti-integrin

95
Q

What is the surgical management of crohns disease?

A

resection of affected GI tract
mostly ileocaecal rection
scar tissue is left behind

96
Q

What is the surgical management of UC?

A

colectomy

97
Q

When should you consider early/emergent colectomy for UC?

A

in fulminant colitis which has been non responsive to steroids

98
Q

When is nutritional support required for IBD?

A

if food intake is poor
if absorption is poor

99
Q

What kinds of nutritional support should be aimed for for those with anatomically intact and functioning GI tract?

A

enteral feeding
feeding through GI tract

100
Q

What kind of diet should be implemented for those place on nutritional support ? Why?

A

elemental diet
reduce remission

101
Q

When should parenteral nutrition (feeding intravenously) be implemented?

A

those with fistulating disease (not anatomically intact)
those with short bowel syndrome (again not anatomically intact)

102
Q

What is high output stoma?

A

this is when output is enough to cause dehydration (loss of water and sodium)

103
Q

IBD can be profoundly disabling. Highlight some ways IBD can be disabling

A

limitations to lifestyle and ability to work
body issues with stomas, fistulation

104
Q

What support is available for people suffering with IBD?

A

GI psychologist
IBD specialist nurse support

105
Q

Crohns disease is a chronic relapsing condition that affects the whole GIT. True or false

A

True

106
Q

Ulcerative colitis is a recurring condition that is confined to the large bowel. True or false

A

true

107
Q

What is coeliac disease?

A

autoimmune disorder that affects the proximal jejunum. Patients may present with anaemia (iron and folate) malabsorption

HHD 2 (37 decks)

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