Large intestine

Question 1

Comparing anatomy of large intestine to small intestine

Question 2

Physiology of the large intestine

Answer 2

• one of the main portion of absorption of fluid, Na
• secretion: HCO3, K (second place after kidney to regulate K levels)
  Storage of waste products (peristaltic, reverse (unique)
• main store place of microbiome: short chain fatty acid production
• conversion of primary bile acids to secondary bile acids (Clostridium hiranonis)
• mucous production

Question 3

Short chain fatty acid. Role

Answer 3

• influence water absorption
• energy
• ## beneficial fr peristalsis

Question 4

Primary vs secondary bile acids

Question 5

Large intestine disorders. History

Answer 5

• large bowel diarrhea: small amount, many times, pudding-like, mucous-containing, if blood - not digested
• tenesmus: straining to defecate
• dyschezia: difficult, painful defecation
• fresh blood: hematochezia
• general state is ok
• rectal digital palpation should be performed !!

Question 6

What is the goal of rectal digital palpation

Question 7

Large bowel disorder. Diagnosis

Answer 7

• history, rectal digital palpation
• basic lab
• feces
• exfoliating cytology, “rectal smear”
• USG could be informative, layers of colon should be examined (thickened?)
• colonoscopy and biopsy key diagnostic step

Question 8

Feces examination in large intestines disorder suspicion

Question 9

List of large intestine disorders

Question 10

Acute colitis

Answer 10

• LBD = large bowel diarrhea
• cause: diet, infective
• usually self-limiting
• rarely cause is identified
• treatment: DIET + fibre supplementation

Question 11

Why fibre supplementation is beneficial in acute colitis?

Answer 11

• normalizing motility
  …
  …

Question 12

Acute colitis. List of possible infectious causes

Answer 12

PARASITES
- Trichuris vulpine
- Trichomonas blagburni

BACTERIAL
- Clostridium

FUNGAL

Question 13

Acute colitis. Trichuris vulpis.

Answer 13

• intermittent exacuation - 1 negative result will not exclude (giardia, salmonella, isospora) -> 3 days collected feces

Question 14

Acute colitis. Trichomonas

Answer 14

• looks like giardia, so if misdiagnosed, treatment won’t help
• PCR is key diagnostic step
• cow pat-like feces
• ronidazol as treatment, could be neurotoxic

Question 15

Acute colitis. Bacterial infection (list of agents)

Answer 15

-

Question 16

Acute colitis. Clostridium perfrigens

Answer 16

• anaerob, spore formation, toxin producing strain
• part of normal micro flora
• PCR for bacteria, ELISA for toxins
• ## severity doesnt correlate with spore number or toxin number

Question 17

Chronic colitis. List of types of

Question 18

Chronic colitis

Answer 18

= colon infiltration by inflammatory cells
- idiopathic => diagnosis by exclusion
- clin signs:
- **diagnosis by

Question 19

Pathophysiology of chronic colitis

Answer 19

• dysbiosis can be both cause and consequence

Question 20

IBD

Answer 20

LYMPHOCYTIC-PLASMACYTIC COLITIS
- most common

EOSINOPHILIC COLITIS
- more severe

Question 21

Granulomatous colitis

Answer 21

• formerly Histiocytic Ulcerative colitis
• boxers are predisposed
• ≠ IBD
• severe
• ## suspected cause: AIEC (adherent-invasive E.coli) + aberrant immune system, mutant TLR

Question 22

Granulomatous colitis. Diagnosis, treatment

Question 23

General treatment of colitis

Question 24

Antibiotic usage in colitis

Question 25

Irritable bowel syndrome (IBS)

Answer 25

• non-inflammatory bowel disease
• often stress-induced

Question 26

IBD vs IBS

Question 27

Constipation

Answer 27

• can be predisposed by diet, inactivity, obesity, endocrine diseases, drugs with antiperistaltic effect
• can be caused by colonic obstruction

Question 28

Colonic neoplasia

Question 29

Disease of anorectum