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GIHEP > L20: Inflammatory Diseases of the Bowel > Flashcards

L20: Inflammatory Diseases of the Bowel Flashcards

1
Q

What parts of the large intestine does the superior mesenteric artery supply?

A

caecum to the splenic flexure

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2
Q

What part of the large intestine does the inferior mesenteric artery supply?

A

splenic flexure to rectum

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3
Q

What is the main function of the large intestine?

A
  • absorb water + salts

- remove waste products

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4
Q

The large intestine does not have any villi. True or False?

A

True

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5
Q

Where is Meissner’s plexus located in the large intestine?

A

in the submucosa

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6
Q

Where is the Auerbach/Myenteric plexus located in the large intestine?

A

muscularis propria

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7
Q

Which parts of the large intestine does Hirschsprung’s Disease normally affect?

A

sigmoid colon + rectum

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8
Q

What is Hirschsprung’s Disease?

A
  • congenital megacolon
  • aperistaltic, narrow segment present causing a functional obstruction and dilation of proximal colon
  • a/w RET gene mutation
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9
Q

Why does Hirschsprung’s Disease occur? (pathogenesis)

A
  • arrested migration of parasympathetic neural crest cells into bowel wall
  • absence of ganglion cells in Auerbach and Meissner’s plexus
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10
Q

Which mutation is associated with Hirschsprung’s Disease?

A

RET gene mutation

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11
Q

What is the clinical presentation of Hirschsprung’s Disease?

A

failure to pass meconium, constipation, abdominal distension, vomiting

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12
Q

What is the treatment of Hirschsprung’s Disease?

A

resection of the involved bowel

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13
Q

What are the 4 types of ischaemic bowel disease that affect the large intestine?

A
  1. Transmural Infarction
  2. Mural Infarction
  3. Mucosal Infarction
  4. Chronic Ischaemic Colitis
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14
Q

What is mural infarction of the large intestine?

A

necrosis of the mucosa and submucosa

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15
Q

What is mucosal infarction of the large intestine?

A

necrosis of the mucosa only

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16
Q

Mural and/or mucosal infarction of the large intestine is mainly caused by what?

A

hypoperfusion - especially in watershed areas

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17
Q

What are the clinical features/symptoms of a transmural infarction?

A
  • severe abdominal pain
  • bloody diarrhea
  • decreased persistaltic sounds
  • rigidity
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18
Q

What is angiodysplasia of the large intestine? Where does it normally occur?

A
  • breakdown/dilatation of blood vessels
  • usually in caecum and right colon
  • usually in elderly
19
Q

What is hereditary haemorrhagic telangiectasia?

A
  • autosomal dominant disorder
  • thin walled blood vessels in the mouth and GIT
  • may rupture and bleed
20
Q

What are haemorrhoids? How do they present?

A
  • variceal dilatation of submucosal venous plexi around anus and lower rectum
  • can be inside anus or on skin around anus
  • presents w/ bright red stool and painful swelling around anus
21
Q

What is necrotising enterocolitis? Which population does it occur in?

A
  • occurs in neonates (occurs usually between day 2-4; up to 3 months)
  • – premature + low birth weight infants
  • acute necrotising inflammation of small and large bowel
22
Q

Which population is necrotising enterocolitis most likely to occur in?

A

premature infants or low birth weight infants

23
Q

Why does necrotising enterocolitis occur? [4]

A

combination of:

  • ischaemia
  • colonization of pathogenic organisms
  • excess protein in lumen
  • functional immaturity of gut
24
Q

What is another name for pseudomembranous colitis?

A

antibiotic-associated colitis

25
Q

What is antibiotic-associated colitis? (aka pseudomembrane colitis)

A
  • characterized by pseudomembrane (adherent inflammatory exudate)
  • occurs following a course of broad spectrum antibiotics
26
Q

What is the treatment of antibiotic-associated colitis? (aka pseudomembrane colitis)

A

metronidazole, vancomycin
OR
faecal microbiota transplant (FMT)

27
Q

List some of the characteristics of Crohn’s Disease

A
  • affects any portion of the GIT
  • segmental lesions/skip lesions
  • transmural involvement
  • aphthous ulcers that coalesce into serpentine ulcers
  • a/w fistulas
28
Q

What is cryptitis? What is crypt abscess? What are they associated with?

A

Cryptitis: neutrophils in the wall of the crypt

Crypt Abscess: collection of neutrophils within lumen of the crypt

a/w Crohn’s disease

29
Q

What type of anaemia is associated with Crohn’s disease?

A

Iron Deficiency Anaemia*

Megaloblastic Anaemia - due to malabsorption of B12

30
Q

List the systemic manifestations of Crohn’s disease

A
  • arthritis
  • uveitis
  • erythema nodosum
  • clubbing of fingers
31
Q

List some of the characteristics of ulcerative colitis

A
  • limited to mucosa + submucosa
  • usually begins in rectum and extends proximally
  • continuous
  • relapsing and remitting
32
Q

What is a complication of Ulcerative Colitis? (not systemic)

A

toxic megacolon

33
Q

List the systemic manifestations of Ulcerative Colitis

A

Joint:

  • migratory polyarthritis
  • sacroiliitis
  • ankylosing spondylitis

Skin:

  • erythema nodosum
  • necrotising skin lesion (pyoderma gangrenosum)
  • clubbing

Liver:
- primary sclerosing cholangitis

Uveitis

34
Q

What is diverticular disease and why does it occur?

A
  • outpouching of the intestines
  • almost always in sigmoid colon
  • occurs due to increased pressure in intestines
35
Q

List some of the complications of diverticulosis

A
  • diverticulitis
  • perforation
  • adhesions
  • fistula formation
  • pericolic abscess formation
  • inflammatory mass formation
  • haemorrhage
  • obstruction
36
Q

Is intestinal obstruction more common in the large or small intestine?

A

small intestine as it has a smaller lumen

37
Q

What is a hernia?

A

weakness in the wall of the peritoneal cavity - organs may get trapped
– incarceration then strangulation

38
Q

What are adhesions of the GIT?

A

fibrous bands develop b/w loops of bowel or b/w organs and abdominal wall
– due to previous surgery, peritonitis, endometriosis..

39
Q

What is intussusception?

A

telescoping of the proximal segment of the bowel into the distal segment

40
Q

What is the most common cause of intussusception in the elderly?

A

almost always a tumour

41
Q

What is the most common cause of intussusception in children?

A

most common cause = lymhoid hyperplasia

42
Q

What is a volvulus?

A

twisting of a loop of bowel along its mesentery - cuts of blood supply and results in acute ischaemia

    • elderly = sigmoid colon
    • young adults = caecum
43
Q

Where is a volvulus most likely in the elderly?

A

sigmoid colon

44
Q

Where is a volvulus most likely in young adults?

A

caecum

GIHEP (24 decks)

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