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Gastoenterology > Large Intestine > Flashcards

Large Intestine Flashcards

1
Q

What are the sacs in the colon called?

A

Haustra

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2
Q

What re the 3 strips of longitudinal muscle in the large colon called?

A

Teneai coli

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3
Q

What are the 2 bends in the large colon called and which is higher?

A

Hepatic flexure and splenic flexure

Splenic flexure is higher

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4
Q

What are the parts of the colon from proximal to distal?

A 
Caecum,
Ascending,
Transverse,
Descending,
Sigmoid
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5
Q

Where is McBurnies point and what is it?

A

1/3rd of the way in from superior anterior ileac spine to umbilicus
Point of maximal tenderness in appendicitis

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6
Q

What does the mesentery on the sigmoid colon put it at risk of?

A

Twisting around itself and cutting off its blood supply (sigmoid volvulus)

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7
Q

What branches off the aorta from L1-4?1

A

L1: superior mesenteric artery
L2: renal arteries
L3: inferior mesenteric artery
L4: bifurcation into common ileacs

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8
Q

Which artery supplies the transverse colon and what does it come from?

A

Middle colic

Superior mesenteric artery

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9
Q

Which artery supplies the ascending colon and which artery does it originate from?

A

Right colic

Superior mesenteric artery

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10
Q

Which artery supplies the descending colon and which artery does it originate from?

A

Left colic

Inferior mesenteric artery

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11
Q

What is the only blood supply to the appendix?

A

Appendicular artery from the superior mesenteric artery

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12
Q

What is the name of the arch of arteries that supplies the ascending, transverse and descending colon?

A

Marginal artery of Drummond

Anastomoses of right colic, middle colic and left colic

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13
Q

What supplies the sigmoid colon and where does it originate from?

A

Sigmoid arteries

Inferior mesenteric artery

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14
Q

Does the inferior mesenteric artery supply any of the rectum and anus?

A

The proximal part of the anal canal (superior rectal artery)

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15
Q

Is there any connection between the hindgut and distal rectal blood supply?

A

Anastomoses between the superior, middle and inferior rectal arteries (supplied by the IMA and branches of the internal ileac)

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16
Q

What are the 3 anastomoses in the portal venous system?

A

Skin around umbilicus
distal end of oesophagus
Rectum/anal canal

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17
Q

What causes varicose veins?

A

Back pressure through the anastomoses between the portal and canal venous systems

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18
Q

What is the gross sign of varicose veins on the abdomen?

A

Caput medusa

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19
Q

Are polyps benign or malignant and what can they be called?

A

Can be either
Benign = adenoma
Malignant = adenocarcinoma

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20
Q

What is the progression from normal mucosa to malignancy in the colon?

A 
Normal mucosa 
-->
Adenoma (benign)
-->
Adenocarcinoma (malignant)
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21
Q

How should adenomas in the colon be dealt with?

A

Removed as are pre-malignant

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22
Q

What are dukes A, B and C

A

Staging for colorectal cancer
Dukes A = no metastasis - good prognosis
Dukes B = limited metastasis - poor prognosis
Dukes C = metastases to lymph nodes - very poor prognosis

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23
Q

What is lynch syndrome?

A

Inherited syndrome that predisposes to lots of polyps which can develop to become malignant - presents in 50s

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24
Q

What is the differences between the internal and external anal sphincter?

A

At the same place; internal is smooth muscle and external is skeletal muscle

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25
Q

What is the purpose of the appendix?

A

No purpose in humans

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26
Q

What controls contraction and relaxation of the ileocaecal valve?

A

Distension of the caecum causes contraction to prevent backflow
Distension of the duodenum causes relaxation to allow passage of food

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27
Q

How is water absorbed from the large intestine?

A

Absorption of Na and Cl back into the blood which causes water to follow it by osmosis

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28
Q

What is secreted in the large intestine?

A

Mucous (to form slippery surface gel)

Proteins for host defence

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29
Q

What mixes the contents of the large intestine?

A

Hautration - very slow process

30
Q

What is mass movement and how often does it occur?

A

Contraction of large segments of the large intestine to drive faeces distally - often triggered by a meal
Occurs roughly 3 times per day

31
Q

What causes the need to defecate?

A

Faeces in the rectum cause it to stretch, when stretched enough causes relaxation of the internal anal sphincter, the external anal sphincter voluntarily controls until is convenient to defecate

32
Q

What reduces the resistance to stool achieved by squatting?

A

Straightening out of the anal-rectal angle

33
Q

How does intraabdominal pressure affect defecation?

A

Contraction of abdominal muscles and suspension of breathing increase intraabdominal pressure which assists defecation

34
Q

Where are the most commensal bacteria in the human body present?

A

Colon

35
Q

Where does intestinal gas occur from?

A

Swallowing of air (mostly burped up)

Fermentation of certain foods

36
Q

What is constipation?

A

Presence of hard dry faeces in the colon that are hard to defecate

37
Q

What causes constipation?

A

Delay in defecation causing increased water to be absorbed

38
Q

What is the difference between a laxative and purgative?

A

Laxative: assists emptying of the colon
Purgative: clears the whole small and large intestine - used prior to surgery

39
Q

How does a laxative work?

A

Softens or lubricates the stool to make it easier to pass

40
Q

What is a diverticulum?

A

Outpouching of a mucosal tissue through the muscle wall

41
Q

What is a false diverticulum?

A

A diverticulum that does not breach through the muscle coat, these are acquired

42
Q

How is diverticulosis (the presence of diverticulums) diagnosed?

A

Colonoscopy

Barium enema

43
Q

What is diverticulitis?

A

Inflammation of diverticula

44
Q

What are the clinical features of diverticulitis?

A

Left inferior quadrant pain
Sepsis
Altered bowel habit

45
Q

What is a fistula?

A

An abnormal connection between 2 epithelial surfaces

46
Q

What is the treatment for diverticulitis?

A

Oral antibiotics, can be managed in the community

47
Q

What are the two types of inflammatory bowel disease and what characterises them?

A

Crohns disease
Ulcerative colitis
Presence of ulcers in the colon

48
Q

What are the 4 types of colitis?

A

Infective colitis,
Ischaemic colti,
Ulcerative coltis,
Crohns colitis

49
Q

What are the symptoms of colitis?

A

Diarrhoea (can contain blood)
Abdominal cramps
Dehydration
Sepsis

50
Q

How is colitis diagnosed?

A

Sigmoidoscopy (colonoscopy) + biopsy
Stool cultures
Barium enema

51
Q

How is ulcerative colitis or crohns colitis treated?

A

IV fluids,
IV steroids,
GI rest
If not better within 3/4 days, surgery

52
Q

What causes large bowel obstruction?

A

Tumour,
Stricture,
Volvulus

53
Q

What are the clinical signs of colonic obstruction?

A

Vomiting
Absolute constipation
Distended abdomen
Pain

54
Q

What causes watery diarrhoea?

A

Collagenous colitis,

Lymphocytic colitis

55
Q

What are the 4 types of laxatives and how do they work?

A

Bulk laxatives: increase vol in the GI tract
Osmotic laxatives: increase H2O in the GI tract
Faecal softeners: lubricate stool
Stimulate laxatives: stimulate ENs to increase peristalsis

56
Q

What are the two types of route that water can be reabsorbed by?

A

Transcellular or paracellular

57
Q

Which method of water reabsorption is favoured in the fed state?

A

Inward movement of Na (and thus water) coupled to glucose or amino acids

58
Q

What is the use of bicarbonate in water reabsorption?

A

Mops up excess protons from Na/H exchanger

59
Q

Movement of what ion is more important in water reabsorption in the fasting state?

A

Chlorine

60
Q

Which ion channel is used for secretion of Cl across the apical membrane of enterocytes in the large intestine?

A

CFTR - means CF also affects water reabsorption

61
Q

What is the first priority in treatment of diarrhoea?

A

Maintenance of fluid and electrolyte balance

62
Q

What is used for treatment of diarrhoea?

A

Rehydration therapy - specific concentrations of fluid and electrolyte are given to optimise reabsorption of water along the colon

63
Q

What types of drug (and which is the most common) are used as anti-motility agents in diarrhoea?

A

Opioids - Loperimide (available over the counter)

64
Q

What is the key symptom of colorectal cancer?

A

Rectal bleeding (if painful is less likely to be cancer)

65
Q

What type of cell change occurs in anal cancers and are they common?

A

Very uncommon

Squamous cell carcinoma

66
Q

What diseases increase the risk of colorectal cancer?

A

IBD (Crohns disease + ulcerative colitis)

67
Q

What are the symptoms of colorectal cancer?

A 
Rectal bleeding, 
Colicky abdominal pain,
Change in bowel habit,
Weight loss,
Iron deficiency anaemia,
Abdominal mass
68
Q

What investigations are done to investigate possible colorectal cancer and what is the gold standard?

A

Barium enema
CT colonography
Colonoscopy/Sigmoidoscopy - gold standard

69
Q

What screening test is done for colorectal cancer?

A

FIT test - stool sample

If positive, offered colonoscopy

70
Q

How is colorectal cancer usually treated and how successful is this?

A

Surgery - colectomy

Very successful

71
Q

What is the follow up for colorectal surgery?

A

CT scans

Gastoenterology (15 decks)

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