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Block 15 Ellen > L1: Inflammation of the bowel > Flashcards

L1: Inflammation of the bowel Flashcards

1
Q

small intestine is between

A

gastric pylorus to ileocecal valve

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2
Q

2 functions of the small intestine

A
  • absorption of nutrients

- enzymatic digestion

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3
Q

what is absorbed in the duodenum

A

iron

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4
Q

what is absorbed in the jejunum (3)

A

sugars
amino acids
fatty acids

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5
Q

what is absorbed in the ileum (2)

A

B12

bile salts

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6
Q

absorptive cells called

A

enterocytes

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7
Q

type of epithelium in small intestine

A

columnar epithelium

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8
Q

2 types of cells in the columnar epithelium

A

enterocytes

goblet cells

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9
Q

where are endocrine cells found in the small intestine

A

amongst columnar cells and in crypts

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10
Q

what cells are at the base of crypts

A

paneth cells

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11
Q

what do paneth cells contain

A

eosinophilic lysozyme-rich granules

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12
Q

paneth cells possible role

A

regulating cell proliferation and differentiation

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13
Q

how many intraepithelial lymphocytes

A

less than 20/100 enterocytes

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14
Q

what do brunner’s glands do

A

produce alkaline mucous secretions and epidermal growth factor

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15
Q

role of brunner’s glands

A

encouraging regeneration and repair after injury

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16
Q

lymphoid tissue in mucous membranes is called

A

MALT: mucosa associated lymphoid tissue

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17
Q

MALT contains predominately –>

A

T suppressor cells (maintaining tolerance to food antigens)

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18
Q

functions of large intestine

A
  • storage and elimination of food
  • maintaining fluid/ electrolyte balance
  • bacterial degradation
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19
Q

4 cells of the large intestine

A

goblet cells
absorptive coloncytes
endrocrine cells
paneth cells

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20
Q

mucosa surface of large intestine has

A

a smooth surface with regular crypts

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21
Q

3 predisposing factors for coeliac disease

A

genetic
sensitivity to gliadin
viral infection

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22
Q

gliadin=

A

toxic component increasing intraepithelial T-cell lymphocytes

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23
Q

classic presentation of coeliac disease (in children) -3

A

weight loss
diarrhoea
failure to thrive

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24
Q

non-classical (adult 4-5th decades) presentation of coeliac disease

A

IBS- type symptoms
abdominal pain
altered bowel habits
anaemia

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25
Q

first line test for Coeliac disease

A

tissue transglutaminase antibody (tTG)

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26
Q

where is biopsy taken to assess severity of coeliac disease

A

duodenum

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27
Q

histology of coeliac disease (4)

A
  • blunting and atrophy of mucosa
  • crypt hyperplasia
  • increased intraepithelial lymphocytes
  • increase chronic inflammatory cells
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28
Q

main complication of coeliac disease

A

malabsorption

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29
Q

why is there malabsorption in coeliac disease (3)

A
  • mucosal damage resulting in reduction of surface area
  • immature enterocytes incapable of absorption
  • disaccharide deficiency
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30
Q

associated risk of coeliac disease

A
  • enteropathy-associated T-cell lymphoma (EATL)

- non-Hodgkin lymphoma

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31
Q

What effect do NSAIDs have on gut

A

reduce blood flow in mucosa

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32
Q

what can chronic NSAID users develop

A

-ulcers/ erosions

in distal ileum and duodenum

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33
Q

where does chronic NSAID enteropathy usually effect

A

ileum

34
Q

what can cause pseudomembranous colitis

A

C.Difficile

35
Q

what is C.diff

A

spore forming Gram+ anaerobe

36
Q

what is the histological appearance of Pseudomembranous colitis

A

volcano like eruptions of mucus, epithelial cells, neutrophils and fibrin on surface

37
Q

what is appendicitis

A

inflammation of the appendix

38
Q

what can cause appendicitis (7)

A

-obstruction by faecoliths and food residues
-lymphoid hyperplasia (children viral infection)
-diverticulosis
-neoplasia
-IBD
specific infections

39
Q

5 complications of appendicitis

A
  • abscess formation
  • extensive necrosis
  • perforation
  • spread of suppurative inflammation
  • septicaemia
40
Q

what is diverticular disease

A

increase intraluminal pressure causing herniation of mucosa into/ through muscle wall

41
Q

where do herniations of the muscular wall happen

A

at entry or exit points of blood vessels

42
Q

where is the commonest site for diverticular disease

A

sigmoid colon

43
Q

3 symptoms of diverticular disease

A

abdo pain
altered bowel habits
bleeding

44
Q

4 complications of diverticular disease

A

diverticulitis
pericolic abscess
perforation
fistula

45
Q

what is diverticulitis

A

mucosal inflammation of the segment affected by diverticulosis
(can mimic IBD)

46
Q

where in the GI tract can Crohn’s affect

A

anywhere from mouth to anus

47
Q

3 risk factors for Crohn’s disease

A

cigarette smoking
microvascular infarction
infective agents (mycobacteria/ viruses)

48
Q

what does the presentation of Crohn’s disease depend on

A

location

49
Q

presentation of colon crohn’s disease

A

bloody diarrhoea

50
Q

presentation of upper GI/ small intestine of Crohn’s disease (3)

A

severe abdo pain
vomiting
weight loss

51
Q

presentation of perianal crohn’s disease

A

ulcers
fissures
perinanal abscess
fistula

52
Q

5 microscopic appearances of crohn’s

A
  • flat surface
  • crypt architecture often preserved
  • ulcer, patchy activity
  • plasma cell-rich infiltrate
  • granuloma
53
Q

what is crohns affect on the bowel wall layers

A

transmural (effects all layers)

54
Q

pyloric metaplasia=

A

response to chronic inflammation/ injury

55
Q

indications for surgery with crohn’s

A

fistula,
strictures
intra-abdominal abscess
perforation

56
Q

complications of surgery for Crohn’s (6)

A
  • malabsorption
  • fistula formation
  • anal lesions
  • perforation,
  • haemorrhage
  • increase risk of small intestine malignancy
57
Q

what 2 things may be protective of UC

A

appendicectomy

smoking

58
Q

where does UC pathology always begin

A

rectum

59
Q

what is rectum UC called

A

ulcerative proctitis

60
Q

how does UC spread

A

in a continous manner

61
Q

what is it called when UC involves the whole larger intestine

A

pancolitis

62
Q

what layer does UC primarily involve

A

mucosa layer

63
Q

what is it called when UC rarely involves deeper layers of intestine

A

fulminant colitis (toxic megacolon)

64
Q

what can you get on the mucosa in UC

A

pseudopolyps (islands of oedematous mucosa)

65
Q

3 indications for surgery in UC

A

resistance to therapy
severe disease
complications (dysplasia/ carcinoma)

66
Q

dysplasia=

A

unregulated cell proliferation due to chronic inflammatory stimulus

67
Q

invasive adenocarcinoma has reached______

A

beyond the basement membrane

68
Q

5 extraintestinal manifestations of IBD

A 
liver pathology 
primary scleorsing cholangitis 
skin (erthyma nodosum, pyoderma gangrenosum) 
-eyes (iritis, uveitis) 
-Joints (ankylosing spondylitis)
69
Q

which IBD has fistulas

A

Crohn’s

70
Q

which IBD has small intestine obstruction

A

Crohn’s

71
Q

which IDB has more colonic obstruction

A

Crohn’s

72
Q

which IBD doesn’t respond to antibiotics

A

UC

73
Q

which IBD has skip lesions

A

Crohn’s

74
Q

affected segment of UC=

A

mucosal ulceration

dilated lumen

75
Q

affected segment Crohn’s=

A

thickened wall

narrowed lumen

76
Q

ulcer type in UC =

A

undermining (horizontal)

77
Q

ulcer type in Crohn’s

A

fissuring (vertical)

78
Q

which IBD forms polyps or pseudopolyps

A

UC

79
Q

which IBD is more likely to have a granuloma

A

Crohns

80
Q

what is connective tissue change in Crohn’s

A

smooth muscle hypertrophy

neural hyperplasia

Block 15 Ellen (11 decks)

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