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Gastrointestinal > Large Intestine > Flashcards

Large Intestine Flashcards

1
Q

what 3 areas is the large intestine divided into

A

appendix
caecum
colon

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2
Q

what are the areas of the colon

A

ascending
transverse
descending
sigmoid

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3
Q

what are the three strands of longitudinal smooth muscle called in large intestine

A

taeniae coli

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4
Q

what is the gastroileal reflex

A

ileocaecal valve opens in response to CCK and gastrin allowing the entry of fluid from the terminal ileum

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5
Q

what are the 3 main functions of the large intestine

A

absorption of water and electrolytes
secretions of K+ and HCO3 for mucus protection and neutralisation
storage and elimination of faeces

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6
Q

the large intestine contains villi true/false

A

false but does contain microvilli, crypts and colonic folds

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7
Q

what are glycoaminoglycans secreted from and what is their function

A

secreted from goblet cells as part of mucus to provide protection between faeces and gut wall

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8
Q

what is haustration

A

non-propulsive segmentation allowing time for fluid and electrolyte absorption

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9
Q

what are mass movements

A

contraction of circular muscle driving faeces into distal regions of the large intestine - occurs 1-3 times a day

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10
Q

describe the defaecation reflex

A

mass movement of faeces into the rectum, activates rectal stretch receptors and parasympathetic efferents

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11
Q

what happens to internal anal sphincter when faeces moves into the rectum

A

it relaxes - made of smooth muscle

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12
Q

what nerve supplies the rectum

A

pudendal nerve via S2, 3, 4

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13
Q

what is the purpose of colonic flora

A

increase intestinal immunity and outcompete pathogens for nutrients

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14
Q

where does colonic gas arise from

A

swallowed air passed in the colon

reactions with bacteria which attack carbohydrates humans cant digest

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15
Q

what is constipation

A

presence of hard faeces in the colon which make passing stools difficult and painful due to enhanced absorption of H2O

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16
Q

what are the main causes of constipation

A

ignoring the urgency to defaecate
decreased colonic motility due to diet and drugs
obstruction of faecal movement
loss of defaecation reflex

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17
Q

water absorption in the GI tract requires energy true/false

A

false - passive process

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18
Q

what drives the absorption of H2O

A

absorption on Na+ occurs through 4 different transport mechanisms

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19
Q

what are the 4 ways sodium is absorbed in the GI tract

A

Na/glucose co-transport
Na/amino acid co-transport
Na/H+ exchange
Na/H and Cl/HCO3 in parallel

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20
Q

which mechanisms are the main post-prandial absorption of Na+

A

Na/glucose and Na/amino acid co-transport

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21
Q

how is Cl- absorbed in the large intestine

A

occurs passively either transcellularly or paracellularly

provides the driving force for Na+ absorption via ENaC

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22
Q

Cl- absorption is greater than Cl- secretion true/false

A

true otherwise diarrhoea would occur

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23
Q

Cl- is secreted via which channel

A

CFTR - usually remains closed

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24
Q

give examples how the CFTR transporter can be activated causing diarrhoea

A

bacterial enterotoxins
hormones and neurotransmitters eg ACh
immune cells producing histamine and prostaglandin

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25
Q

what is diarrhoea and how is it caused

A

loose watery stools due to failure to absorb water and electrolytes.
caused by infection, chronic disease and drug side-effects

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26
Q

describe diverticulum

A

outpouching of the gut wall

27
Q

where does diverticulum usually occur

A

sigmoid colon at the sites of arteries

28
Q

describe diverticulitis

A

inflammed irritated diverticulum causing symptoms (diverticulous)

29
Q

what are the symptoms of diverticulitis

A

altered bowel habit
left sided abdo pain relieved by defaecation
nausea and flatulence

30
Q

what is the treatment for simple and complicated diverticulitis

A

simple - IV fluids and antibiotics at home

complicated relates to fistula, abscess etc requiring surgery

31
Q

inflammatory bowel disease covers which disease

A

ulcerative colitis

Crohns disease

32
Q

which areas of GI tract and layers of GI tract does UC affect

A

rectum and colon only

mucosal and submucosal layers

33
Q

which areas of the GI tract and layers of the GI tract doe Crohns affect

A 
from mouth to anus in skip lesions (gaps)
transmural inflammation (all layers affected)
34
Q

UC has granulomas formed true/false

A

false - granulomas in Crohns

35
Q

which type of T cell mediation is UC and Crohns

A

Crohns - TH1 mediated

UC - TH1+TH2 mediated

36
Q

which inflammatory bowel disease is aggravated by smoking

A

Crohns disease

37
Q

which inflammatory bowel disease has an increased risk of developing colorectal carcinoma

A

UC

38
Q

what 3 factors are thought to make up the aetiology of IBD

A 
genetic predisposition (NOD2 gene)
environmental factors (smoking)
mucosal immunity
39
Q

what investigations are required for IBD and what would they show

A

raised CRP
low Hb and albumin
possible malabsorption deficiencies
endoscopy/colonoscopy inflammed

40
Q

what does the mucosa look like at endoscopy in IBD

A

cobblestoning

41
Q

name the 4 types of drugs that are used for treatment of IBD and an example of each

A

5ASA - mesalazine
steroids - prednisolone/budesonide
immunosuppressants - azathioprine/methotrexate
anti-TNF - infliximab

42
Q

what are some routes of administration and side effects of mesalazine

A

oral or topical enema/suppository

side effects - diarrhoea and renal problems

43
Q

what are some side effects of steroids

A

weight gain, neuropsychiatric problems, osteoporosis

44
Q

when in IBD are steroids used for and for how long

A

used to induce remission

only used for 6-8 weeks and dose slowly reduces

45
Q

what are the side effects of azathioprine

A

pancreatitis, hepatitis and increased risk of developing skin cancer

46
Q

how is infliximab administered and what is it mainly used for

A

IV administration

mainly used as long term therapy

47
Q

what is one precaution doctors must take before beginning anti-TNF treatment

A

can reactivate latent TB

48
Q

surgery is curative of IBD true/false

A

only in UC, as inflammation can be anywhere in GI tract areas cannot be resected

49
Q

where does Crohns disease typically present in GI tract

A

terminal ileum and colon

50
Q

what are some of the symptoms of Crohns disease

A 
diarrhoea
abdominal pain
nausea
apthous ulcers anywhere
joint pain 
anal fissures 
erythema nodosum 
uveitis
51
Q

what are some complications of Crohns disease

A

stricture, fistula, short bowel syndrome from resections, malabsorption, anaemia

52
Q

short bowel syndrome is a bowel length less than __

A

200 cm

53
Q

what are some common surgeries for Crohn’s disease

A

fistula, stricture repair

resection of bowel

54
Q

what are some of the symptoms of UC

A 
bloody diarrhoea 
increased frequency and urgency 
LIF pain 
night rising
tenesmus 
erythema nodosum 
arthritis
55
Q

what criteria measures the severity of UC symptoms

A

Truelove and Witt criteria

56
Q

for a severe episode of UC what symptom criteria must be met

A 
>6 bloody stools per day + one of 
tachycardia 
anaemia 
raised CRP
fever
57
Q

what are some of the complications of UC

A

toxic megacolon
colorectal cancer
primary sclerosing cholangitis

58
Q

what is toxic megacolon

A

condition causing dilatation of the bowel and muscle atrophy due to persistent inflammation

59
Q

name some common surgeries for UC

A

right hemicolectomy
proctocolectomy
removal of part of bowel with ileostomy or colonostomy

60
Q

what type of gut disorder is IBS

A

functional gut disorder - no underlying cause

61
Q

who typically presents with IBS

A

young women
family history of IBS
mental health problems or stressful lifestyle
caffeine, menstruation can also trigger

62
Q

what are the symptoms of IBS

A 
abdominal pain, bloating or distension 
change in bowel habit either way 
change in stool appearance 
tenesmus 
NO ALARM SYMPTOMS PRESENT
63
Q

what investigations are carried out for IBS

A

CRP, anti-TTG for coeliac, FIT all to rule out differentials

64
Q

what is the treatment for IBS

A 
antispasmodics for pain but can cause diarrhoea 
anti-motility/anti-diarrhoeals 
fybogel 
peppermint oil capsules 
FODMAP diet

Gastrointestinal (7 decks)

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