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GI > Large intestine and IBD > Flashcards

Large intestine and IBD Flashcards

1
Q

What structures encompass the large intestine?

A

Caecum to anal canal

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2
Q

What epithelia lines the large intestine?

A

columnar epithelium

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3
Q

What is the function of the LI?

A
  • removes water from indigestible gut contents turning the chyme into a semi sold (occurs in proximal part)
  • produces vitamines
  • microbiome
  • distal part of LI acts as a temporary storage until defaecation
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4
Q

Where does colonic mucosa get the majority of its nutrients from?

A

not the blood

  • SCAA derived from the fermentation of dietary fibre
  • the by product includes CO2, methane and H2(g) which the mucosa uses
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5
Q

What is the LI relationship with the peritoneum?

A

Ascending and descending colon - retro-peritoneum
Sigmoid and transverse colon - has its own mesentery
rectum
-upper 1/3 is intra-peritoneal
-middle is retro-peritoneum
-lower 1/3 is not peritoneum

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6
Q

How can you get sigmoid volvulus?

A
  • it is twisting of the gut

- the sigmoid colon has its own mesentery and can turn on itelf

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7
Q

Where does the SMA come off the AA?

What does the SMA supply?

A

L1 - just under the coeliac artery branch

-supplies the midgut component of the large bowel

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8
Q

What are the branches of the SMA and what do they supply?

A

ileo-colic - caecum
middle colic - transverse colon
right colic - ascending colon

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9
Q

What is the marginal artery?

A

summation of all the terminal branches anastomosing with each other

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10
Q

What supplies the foregut structures?

A

coeliac artery branch of the AA

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11
Q

Where does the IMA come off and what does it supply?

A
  • L3

- hindgut

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12
Q

What are the branches of the IMA and what structures do they supply?

A
  • left colic - descending colon
  • sigmoid arterires - descending colon
  • superior rectal arter - upper 1/3 of rectum
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13
Q

What is significant about the superior rectal artery?

A

-the IMA becomes this as it enters the pelvis (past the pelvic brim

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14
Q

Foregut venous draining?

A

blood drains into splenic vein and portal hepatic vein

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15
Q

Mid gut venous drainage?

A
  • SMV

- meets splenic vein splenic vein and both become portal vein (occurs behind the neck of the pancreas

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16
Q

Hind gut venous drainage?

A

IMV

-meets splenic vein and goes into portal vein

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17
Q

rectum venous drainage?

A
  • upper 1/3 drains into superior rectal vein (IMV)

- middle and lower 1/3 drain into systemic venous drainage (bypass liver)

18
Q

What are portosystemic anastomosis?

A

resistance in the portal system (cirrhosis) - increased pressure on veins draining gut through liver
-portosystemic anastomosis - allow the rest of the gut to drain without going through the liver if there is portal hypertension

19
Q

What can be caused if the portosystemic anastomosis become dilated?

A
  • varices - due to increase pressure

- can cause oesophageal varices

20
Q

Differences between LI and SI?

A
  • LI shorter
  • LI wider
  • LI has crypts not villi
  • incomplete external longitudinal muscle - teniae coli
  • haustra - sacculations caused by contraction of the teniae coli
  • tighter tight junctions allowing bigger gradient to form and less back flow of ions
21
Q

What is the role of the colon and what is it facilitated by?

A

Water absorption

-faciliatated by ENAC induced by aldosterone

22
Q

What is IBD?

A

-group of conditions by idiopathic inflammation of the GI tract than affect function of the gut

23
Q

What are the 2 common type of IBD?

A

Chrohn’s disease

UC

24
Q

What is chrohn’s disease?

A
  • affects anywhere in the GI tract
  • mostly involves the ileum
  • transmural
  • skip lesions
25
Q

What does transmural mean?

A

affects all the layers of the bowel (right through the tissue)

26
Q

What does skip lesions mean?

A

you can have bits of normal tissue, then affected tissue, then normal tissue again

27
Q

What is UC?

A
  • begins distally in the rectum and can extend the entire colon (doesn’t affect SI)
  • continuous pattern
  • mucosal inflammation
28
Q

What are the other complications of these diseases?

A
  • Arthritis
  • MSK pain
  • Erythema nodosum (knee red lumps)
  • liver and biliary tree
  • eye problems
29
Q

What are the causes of IBD?

A
  • genetic
  • gut organisms disrupted
  • immune response
  • trigger by diet, smoking, infections, antibiotics
30
Q

How does crohn’s present?

A
  • 22 yr old
  • RLQ pain
  • non bloody diarrhoea
  • low grade fever
  • mildly anaemia
  • fistulas and ulceration in perianal disease (not common in UC)
31
Q

What is the gross pathology of crohn’s?

A
  • skip lesions
  • cobblestone appearance
  • mucosal oedema
  • discrete superficial ulcers and deeper ulcers
  • transmural
  • thickening of the bowel wall narrowing the lumen
32
Q

What else is microscopic pathological of crohns?

A
  • granuloma formation (organised collection of epithelioid macrophages)
  • tries to destroy
33
Q

How would you investigate crohn’s?

A
  • bloods (anaemia)
  • colonoscopy
  • CT/MRI (bowel thickening, obstruction)
  • Barium enema (used less if risk of fistulae as barium could go everywhere)
34
Q

What are the cross pathological changes that can be seen during endoscopy for Crohn’s?

A
  • skip lesions
  • cobblestone appearance
  • fistulae
  • strictures
35
Q

How would a patient present with UC?

A
  • females
  • younger
  • more common to have bloody stools with mucus (as losing mucosal lining)
  • weight loss
  • mild lower abdominal pain/cramping - not specific to RLQ
  • painful red pain
  • no perianal disease
  • no fever
36
Q

What are the pathological changes seen with UC?

A
  • chronic inflammatory infiltrate of the lamina propria
  • crypt abscesses (neutrophilic exudate)
  • crypt distortion
  • redcued number of goblet cells
  • repeated episodes - pseudo polyps (inflammation then healing)
  • loss of haustra (inflammation reduces the appearance of haustra on imagin
37
Q

How would you investigate UC?

A
  • bloods (anaemia and serum markers)
  • STOOL CULTURES (BLOOD)
  • colonoscopy
  • plain abdominal radiographs
  • barium enema (mild only)
  • CT/MRI (less common as only affects mucosa
38
Q

What are the radiological features of UC?

A

Do a double contrast enema (barium and air to help the barium stick to things more)

  • lead pipe colon (lacking haustral markings
  • continuous lesions
  • whole colon
  • mucosal inflammations
39
Q

What are the radiological features fo Crohn’s?

A

-sting sign on Kantour - long strictures

40
Q

What are the surgical treatment options for Crohn’s and UC?

A

Crohn’s

  • not curative
  • strictures/fistulas
  • as little bowel removed as possible

UC

  • curable if remove whole colon
  • only is UC ruining life
  • precancerous changes

GI (10 decks)

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