L24 Lower GI pathology

Question 1

Coeliac disease: characteristics

Answer 1

autoimmune

damages mucosa of small intestine which leads to generalized malabsorption because folds are flattened

Question 2

Coeliac disease: pathogenesis

Answer 2

uptake and processing of gluten peptides
T cell activation
tissue damage

Question 3

Coeliac disease: what are gluten peptides made up of

Answer 3

proline rich and glutamine rich proteins

Question 4

Coeliac disease: symptoms

Answer 4

diarrheoa, pain, deficiencies, fatigue, bloating

extra-intestinal: altered LOC, anaemia, malignancies

Question 5

Coeliac disease: diagnosis

Answer 5

gluten challenge diet, blood tests, endoscopy + biopsy (essential to confirm)

Question 6

Coeliac disease: treatment

Answer 6

GF diet

Question 7

Coeliac disease: complications

Answer 7

other autoimmune, chronic inflammation in other organs, deficiencies, malignancies

Question 8

Pathogenesis of IBD

Answer 8

defective host interactions with intestinal microflora, epithelial dysfunction, mucosal inflammatory response

Question 9

IBD complications

Answer 9

osteoporosis, skin problems, arthritis

Question 10

Crohn’s: characterisitcs

Answer 10

familial, more females than males, TNF-alpha major is a factor, more common in smokers

Question 11

Crohn’s: symptoms

Answer 11

intermittent attacks, malabsorption, weight loss, extra-intestinal manifestations

Question 12

Crohn’s: macroscopic

Answer 12

skip lesions (cobblestone appearance), transmural inflammation (abcesses), strictures, thickened mesentery, creeping fat

Question 13

Crohn’s: microscopic

Answer 13

transmural inflammation, acute inflammation, crypt abscesses, oedema, chronic mucosal damage (granulomas without caseous necrosis)

Question 14

Crohn’s: complications

Answer 14

bowel obstruction, ulcers, malabsorption, fistulas to other organs, carcinoma, anaemia

Question 15

Crohn’s: treatment

Answer 15

no cure, corticosteroids, biologics, surgical resection

Question 16

Ulcerative colitis: characteristics

Answer 16

bimodal distribution of onset (middle age and older)
more common in non-smokers
only affects colon
predominantly only mucosa
can be divided by location

Question 17

Ulcerative colitis: symptoms

Answer 17

pain, blood in stool, diarrhoea

Question 18

Ulcerative colitis: stages and macroscopic appearance

Answer 18

1. early: mucosal surface is red, oedema, granular, covered with yellow exudates and bleeds, superficial ulcers
2. progressive: mucosal folds atrophy, inflammatory polps (all normal layers of mucosa), pseudopolyps (granulation tissue)
3. advanced: shortening of LI, mucosal folds are indistinct (cobblestoneing or smooth)

Question 19

Ulcerative colitis: clinical features

Answer 19

mild - rectal bleeding
moderate - loose, bloody stools and pain and anaemia
severe - lots of bad bowel movements, anaemia, dehydration

Question 20

Ulcerative colitis: treatment

Answer 20

mild - 5-aminosalicylate-based compounds
moderate - corticosteroids, immunosuppressive + regulatory agents
severe - surgery