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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
what is diarrhoea and how is it caused
loose watery stools due to failure to absorb water and electrolytes. caused by infection, chronic disease and drug side-effects
26
describe diverticulum
outpouching of the gut wall
27
where does diverticulum usually occur
sigmoid colon at the sites of arteries
28
describe diverticulitis
inflammed irritated diverticulum causing symptoms (diverticulous)
29
what are the symptoms of diverticulitis
altered bowel habit left sided abdo pain relieved by defaecation nausea and flatulence
30
what is the treatment for simple and complicated diverticulitis
simple - IV fluids and antibiotics at home | complicated relates to fistula, abscess etc requiring surgery
31
inflammatory bowel disease covers which disease
ulcerative colitis | Crohns disease
32
which areas of GI tract and layers of GI tract does UC affect
rectum and colon only | mucosal and submucosal layers
33
which areas of the GI tract and layers of the GI tract doe Crohns affect
``` from mouth to anus in skip lesions (gaps) transmural inflammation (all layers affected) ```
34
UC has granulomas formed true/false
false - granulomas in Crohns
35
which type of T cell mediation is UC and Crohns
Crohns - TH1 mediated | UC - TH1+TH2 mediated
36
which inflammatory bowel disease is aggravated by smoking
Crohns disease
37
which inflammatory bowel disease has an increased risk of developing colorectal carcinoma
UC
38
what 3 factors are thought to make up the aetiology of IBD
``` genetic predisposition (NOD2 gene) environmental factors (smoking) mucosal immunity ```
39
what investigations are required for IBD and what would they show
raised CRP low Hb and albumin possible malabsorption deficiencies endoscopy/colonoscopy inflammed
40
what does the mucosa look like at endoscopy in IBD
cobblestoning
41
name the 4 types of drugs that are used for treatment of IBD and an example of each
5ASA - mesalazine steroids - prednisolone/budesonide immunosuppressants - azathioprine/methotrexate anti-TNF - infliximab
42
what are some routes of administration and side effects of mesalazine
oral or topical enema/suppository | side effects - diarrhoea and renal problems
43
what are some side effects of steroids
weight gain, neuropsychiatric problems, osteoporosis
44
when in IBD are steroids used for and for how long
used to induce remission | only used for 6-8 weeks and dose slowly reduces
45
what are the side effects of azathioprine
pancreatitis, hepatitis and increased risk of developing skin cancer
46
how is infliximab administered and what is it mainly used for
IV administration | mainly used as long term therapy
47
what is one precaution doctors must take before beginning anti-TNF treatment
can reactivate latent TB
48
surgery is curative of IBD true/false
only in UC, as inflammation can be anywhere in GI tract areas cannot be resected
49
where does Crohns disease typically present in GI tract
terminal ileum and colon
50
what are some of the symptoms of Crohns disease
``` diarrhoea abdominal pain nausea apthous ulcers anywhere joint pain anal fissures erythema nodosum uveitis ```
51
what are some complications of Crohns disease
stricture, fistula, short bowel syndrome from resections, malabsorption, anaemia
52
short bowel syndrome is a bowel length less than __
200 cm
53
what are some common surgeries for Crohn's disease
fistula, stricture repair | resection of bowel
54
what are some of the symptoms of UC
``` bloody diarrhoea increased frequency and urgency LIF pain night rising tenesmus erythema nodosum arthritis ```
55
what criteria measures the severity of UC symptoms
Truelove and Witt criteria
56
for a severe episode of UC what symptom criteria must be met
``` >6 bloody stools per day + one of tachycardia anaemia raised CRP fever ```
57
what are some of the complications of UC
toxic megacolon colorectal cancer primary sclerosing cholangitis
58
what is toxic megacolon
condition causing dilatation of the bowel and muscle atrophy due to persistent inflammation
59
name some common surgeries for UC
right hemicolectomy proctocolectomy removal of part of bowel with ileostomy or colonostomy
60
what type of gut disorder is IBS
functional gut disorder - no underlying cause
61
who typically presents with IBS
young women family history of IBS mental health problems or stressful lifestyle caffeine, menstruation can also trigger
62
what are the symptoms of IBS
``` abdominal pain, bloating or distension change in bowel habit either way change in stool appearance tenesmus NO ALARM SYMPTOMS PRESENT ```
63
what investigations are carried out for IBS
CRP, anti-TTG for coeliac, FIT all to rule out differentials
64
what is the treatment for IBS
``` antispasmodics for pain but can cause diarrhoea anti-motility/anti-diarrhoeals fybogel peppermint oil capsules FODMAP diet ```

Gastrointestinal (7 decks)

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