L1: Inflammation of the bowel Flashcards by Ellen Moore

small intestine is between

gastric pylorus to ileocecal valve

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2 functions of the small intestine

absorption of nutrients

- enzymatic digestion

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what is absorbed in the duodenum

iron

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what is absorbed in the jejunum (3)

sugars
amino acids
fatty acids

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what is absorbed in the ileum (2)

B12

bile salts

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absorptive cells called

enterocytes

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type of epithelium in small intestine

columnar epithelium

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2 types of cells in the columnar epithelium

enterocytes

goblet cells

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where are endocrine cells found in the small intestine

amongst columnar cells and in crypts

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what cells are at the base of crypts

paneth cells

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what do paneth cells contain

eosinophilic lysozyme-rich granules

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paneth cells possible role

regulating cell proliferation and differentiation

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how many intraepithelial lymphocytes

less than 20/100 enterocytes

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what do brunner’s glands do

produce alkaline mucous secretions and epidermal growth factor

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role of brunner’s glands

encouraging regeneration and repair after injury

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lymphoid tissue in mucous membranes is called

MALT: mucosa associated lymphoid tissue

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MALT contains predominately –>

T suppressor cells (maintaining tolerance to food antigens)

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functions of large intestine

storage and elimination of food
maintaining fluid/ electrolyte balance
bacterial degradation

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4 cells of the large intestine

goblet cells
absorptive coloncytes
endrocrine cells
paneth cells

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mucosa surface of large intestine has

a smooth surface with regular crypts

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3 predisposing factors for coeliac disease

genetic
sensitivity to gliadin
viral infection

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gliadin=

toxic component increasing intraepithelial T-cell lymphocytes

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classic presentation of coeliac disease (in children) -3

weight loss
diarrhoea
failure to thrive

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

IBS- type symptoms
abdominal pain
altered bowel habits
anaemia

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first line test for Coeliac disease

tissue transglutaminase antibody (tTG)

where is biopsy taken to assess severity of coeliac disease

duodenum

histology of coeliac disease (4)

- blunting and atrophy of mucosa - crypt hyperplasia - increased intraepithelial lymphocytes - increase chronic inflammatory cells

main complication of coeliac disease

malabsorption

why is there malabsorption in coeliac disease (3)

- mucosal damage resulting in reduction of surface area - immature enterocytes incapable of absorption - disaccharide deficiency

associated risk of coeliac disease

- enteropathy-associated T-cell lymphoma (EATL) | - non-Hodgkin lymphoma

What effect do NSAIDs have on gut

reduce blood flow in mucosa

what can chronic NSAID users develop

-ulcers/ erosions | in distal ileum and duodenum

where does chronic NSAID enteropathy usually effect

ileum

what can cause pseudomembranous colitis

C.Difficile

what is C.diff

spore forming Gram+ anaerobe

what is the histological appearance of Pseudomembranous colitis

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

what is appendicitis

inflammation of the appendix

what can cause appendicitis (7)

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

5 complications of appendicitis

- abscess formation - extensive necrosis - perforation - spread of suppurative inflammation - septicaemia

what is diverticular disease

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

where do herniations of the muscular wall happen

at entry or exit points of blood vessels

where is the commonest site for diverticular disease

sigmoid colon

3 symptoms of diverticular disease

abdo pain altered bowel habits bleeding

4 complications of diverticular disease

diverticulitis pericolic abscess perforation fistula

what is diverticulitis

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

where in the GI tract can Crohn's affect

anywhere from mouth to anus

3 risk factors for Crohn's disease

cigarette smoking microvascular infarction infective agents (mycobacteria/ viruses)

what does the presentation of Crohn's disease depend on

location

presentation of colon crohn's disease

bloody diarrhoea

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

severe abdo pain vomiting weight loss

presentation of perianal crohn's disease

ulcers fissures perinanal abscess fistula

5 microscopic appearances of crohn's

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

what is crohns affect on the bowel wall layers

transmural (effects all layers)

pyloric metaplasia=

response to chronic inflammation/ injury

indications for surgery with crohn's

fistula, strictures intra-abdominal abscess perforation

complications of surgery for Crohn's (6)

- malabsorption - fistula formation - anal lesions - perforation, - haemorrhage - increase risk of small intestine malignancy

what 2 things may be protective of UC

appendicectomy | smoking

where does UC pathology always begin

rectum

what is rectum UC called

ulcerative proctitis

how does UC spread

in a continous manner

what is it called when UC involves the whole larger intestine

pancolitis

what layer does UC primarily involve

mucosa layer

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

fulminant colitis (toxic megacolon)

what can you get on the mucosa in UC

pseudopolyps (islands of oedematous mucosa)

3 indications for surgery in UC

resistance to therapy severe disease complications (dysplasia/ carcinoma)

dysplasia=

unregulated cell proliferation due to chronic inflammatory stimulus

invasive adenocarcinoma has reached______

beyond the basement membrane

5 extraintestinal manifestations of IBD

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

which IBD has fistulas

Crohn's

which IBD has small intestine obstruction

Crohn's

which IDB has more colonic obstruction

Crohn's

which IBD doesn't respond to antibiotics

which IBD has skip lesions

Crohn's

affected segment of UC=

mucosal ulceration | dilated lumen

affected segment Crohn's=

thickened wall | narrowed lumen

ulcer type in UC =

undermining (horizontal)

ulcer type in Crohn's

fissuring (vertical)

which IBD forms polyps or pseudopolyps

which IBD is more likely to have a granuloma

Crohns

what is connective tissue change in Crohn's

smooth muscle hypertrophy | neural hyperplasia