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GI System > Inflammatory Bowel Disease And Diarrhoea/Constipation > Flashcards

Inflammatory Bowel Disease And Diarrhoea/Constipation Flashcards

1
Q

Which parts of the large intestine are retroperitoneal?

Which have their own mesenteries?

A

Ascending and descending.

Transverse and sigmoid.

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2
Q

What is the relation of the rectum to peritoneum?

A

Upper 1/3 intraperitoneal, middle 1/3 retroperitoneal, lower 1/3 no peritoneum.

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3
Q

Which veins drain the rectum?

What is the clinical relevance of this?

A

Upper 1/3 superior rectal vein,
Lower 2/3 systemic venous system.
Portosystemic anastomoses.
Common site of Varices due to portal hypertension.

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4
Q

What is the name for the three distinct bands of longitudinal muscle surrounding the large intestine?

A

Teniae coli

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5
Q

What are Haustra?

A

Sacculations created by contraction of teniae coli.

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6
Q

How is water absorbed in the proximal colon?

A

Facilitated by ENaC, induced by aldosterone

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7
Q

What differentiates crohn’s from ulerative colitis?

A

Crohn’s is transmural, has skip lesions and affects anywhere in the GI tract.
UC begins in rectum and continuously spreads through colon. Inflammation of mucosa only.

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8
Q

What extra intestinal problems are common in IBD?

A

MSK pain (arthritis),
Erythema nodisum, pyoderma gangrenosum, psoriasis, Primary sclerosing cholangitis,
Uveitis.

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9
Q

What complications of crohn’s are caused by its transmural nature?

A

Fistulation (bladder, bowel, vagina) and stricture

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10
Q

What microscopic feature is pathopneumonic for crohn’s?

A

Granuloma formation

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11
Q

What investigations are used for IBD?

A

Blood tests - CRP, anaemia
CT, MRI bowel (crohn’s)
Barium enema (UC, less often used now)
Stool cultures (UC)

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12
Q

What sign is often seen in Crohn’s disease during colonoscopy?
What about UC?

A

Cobblestone appearance and skip lesions.

Pseudopolyps and loss of haustra in UC

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13
Q

Which type of IBD more presents with crypt abscesses on histology?

A

Ulcerative Colitis

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14
Q

What are Aphthous ulcers?

A

Ulcers found in the mouth, often in Crohn’s disease.

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15
Q

What sign is seen on barium follow through that indicates Crohn’s disease?

A

String sign of kantour - stricturing of bowel

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16
Q

What radiological features are seen in UC?

A

Lead pipe colon due to loss of haustra

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17
Q

How can Ulcerative colitis be surgically managed? Why is this poor management for Crohn’s disease?

A

Colectomy (removal of colon), curative in UC. As Crohn’s disease affects the whole GI tract, inflammation may arise elsewhere.

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18
Q

How is diarrhoea defined?

A

Loose or watery stools more than three times a day

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19
Q

What is osmotic diarrhoea?

A

Build up of osmotic material in the gut draws water into the lumen and causes watery stools. This goes away when fasting

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20
Q

What is secretory diarrhoea?

A

Great secretion of ions into the gut lumen, leading to movement of water in by solvent drag. (Chloride ions transported in by action of CFTR trans membrane protein due to an increase in cAMP)

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21
Q

How is constipation defined?

A

Hard stools or difficulty or inability passing stools.

22
Q

What risk factors are there for constipation?

A 
Female gender,
Medications (opioids), 
Low physical activity,
Bed bound,
Increasing age.
23
Q

what causes slow colonic transport?

A 
Large colon (megacolon),
Fewer intestinal pacemaker cells (interstitial cells of cajal),
Fewer peristaltic movements,
Hypothyroidism,
Diabetes.
24
Q

What are shuttle contractions?

A

Material moves backwards and forwards in transit towards the anus. Occurs during fasting.

25
Q

What generates the urge to defecate?

A

Stretching of the rectum

26
Q

How is constipation managed?

A

Increase fluid intake,
Increase activity levels,
Laxatives.

27
Q

How do different types of laxative work?

A

Osmotic laxatives eg magnesium sulphate - increase osmolarity of lumen.
Stimulators - activate chloride ion channels.
Stool softeners - make stool easier to pass.

28
Q

Which artery supplies blood to the appendix?

A

Ileocolic branch of the superior mesenteric artery. Comes through the mesoappendix.

29
Q

Which locations may the appendix be found in?

A

Retro-caecal,
Pelvic,
Sub-caecal,
Para-ileal (pre or post).

30
Q

When does appendicitis present classically?

A

When making contact with the parietal peritoneum in the right iliac fossa - causes RLQ pain.

31
Q

What is the classic cause of appendicitis?

A

Blockage of appendiceal lumen creating higher pressure in the appendix, leading to a rise in venous pressure and oedema that compresses arterial blood supply to the appendix. Ischaemia in walls of appendix as a result, followed by bacterial infection

32
Q

what are classic symptoms of appendicitis?

A

Poorly localised umbilical pain that becomes more intense in the right iliac fossa after 12-24 hours,
Nausea and vomiting,
Loss of appetite,
Low grade fever.

33
Q

What classic sign is there on palpating for appendicitis?

A

Localised right quadrant tenderness and rebound tenderness (pain felt on removal of pressure when palpating area)

34
Q

What is McBurney’s point?

A

2/3 away from the umbilicus towards the ASIS. Site of appendectomy and tenderness

35
Q

What tests should be done for appendicitis?

A

Pregnancy test - rule out pregnancy. Usually history is enough. CT in non classical presentation

36
Q

What are treatment options for appendicitis?

A

Open appendectomy and laparoscopic appendectomy with antibiotics

37
Q

What is diverticulosis?

A

Asymptomatic. Outpouchings of mucosa (diverticula) in the colon due to raised intra-luminal pressure.

38
Q

What is diverticular disease?

A

Pain associated with diverticulosis but no inflammation or infection.

39
Q

What is Acute diverticulitis?

A

Inflammation of the diverticula leading to possible perforation, bleeding and abscess formation.

40
Q

What is the difference between uncomplicated and complicated diverticulitis?

A

Uncomplicated - inflammation and small abscesses confined to colonic wall.
Complicated - larger abscesses, possible fistula and perforation.

41
Q

What are common symptoms of diverticulitis?

A 
Abdominal pain at the site of inflammation,
Fever,
Bloating,
Constipation,
Haematochezia.
42
Q

What tests can be done to diagnose diverticulitis?

A

Ultrasound abdomen,
CT scan,
Colonoscopy If haematochezia.

43
Q

How is acute diverticulitis managed?

A

Antibiotics, fluid resuscitation and analgesia. Surgery if complicated.

44
Q

What are anal cushions?

A

Primarily venous blood vessels that fill and increase sphincter mechanism of the anus

45
Q

What does the dentate (white) line separate?

A

Hindgut and proctoderm. Visceral pain receptors and Columnar epithelium above and somatic receptors and stratified squamous epithelium below

46
Q

What are haemorrhoids?

A

Anal Cushions that swell and bleed.

47
Q

How are internal haemorrhoids defined?

How are they treated?

A

Above the dentate line, often painless. Managed by avoiding straining and hydration, with rubber band ligation and surgery if necessary.

48
Q

What are external haemorrhoids and how are they treated?

A

Below dentate line, very painful, surgical management with good outcomes

49
Q

What is an anal fissure?

A

Linear tear in anoderm due to passing of hard stool. Causes haematochezia and pain on defecation.

50
Q

How are anal fissures managed?

A

Hydration, dietary fibre, analgesia. Medication trying to relax the internal anal sphincter.

51
Q

What causes haematochezia?

What causes malaena?

A

Lower GI bleeds,

Upper GI bleeds due to haemaglobin being altered by digestive enzymes.

GI System (11 decks)

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