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Y2 - GI > Large Intestine/inflammatory Bowel Disease > Flashcards

Large Intestine/inflammatory Bowel Disease Flashcards

1
Q

What part of the colon is retroperitoneal?

A

Ascending and descending colon

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2
Q

What part of the rectum is Intra peritoneal, Retroperitoneal and no peritoneum?

A

Upper 1/3 = Intra-peritoneal
Middle 1/3 = Retroperitoneal
Lower 1/3 = no peritoneum

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3
Q

What is the arterial supply to the midgut? (look at foregut DR slide)

A

Branch from SMA
Ileo-colic arerty = caecum
Right colic = ascending colon
Middle colic = transverse colon (2/3s)

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4
Q

What is the arterial supply to the hindgut? Look at foregut DR slide

A

Inferior mesenteric artery:

Left colic = descending colon
Sigmoid = descending colon
Superior rectal artery = upper 1/3 rectum

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5
Q

How does the longitudinal muscle surround the large intestine?

A

Incomplete longitudinal muscle layer leads to 3 distinct bands called teniae coli forming

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6
Q

What is the function of the teniae coli?

A

Maintaining the folds called Haustra in the large intestine

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7
Q

What ion channel facilitates water absorption in the colon?

A

ENaC

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8
Q

What hormone induces upregulatioon of ENaC?

A

Aldosterone

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9
Q

What is Inflammatory Bowel Disease?

A

Group of conditions characterised by idiopathic inflammation of the GI tract

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10
Q

What are the 2 most common types of Inflammatory bowel Disease?

A

Chrons disease
Ulcerative colitis

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11
Q

What ages are Chrons disease and ulcerative colitis most common in?

A

Young adults 20s

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12
Q

What is the key difference in location where Chron’s disease an Ulcerative colitis develop?

A

Chrons = anywhere in the GI tract but rarely ever the rectum

Ulcerative colitis = ALWAYS starts in RECTUM and stays contained in large intestine/colon

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13
Q

What is the most common spot of inflammation in Chrons disease?

A

Terminal ileum

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14
Q

What substances are mainly absorbed in they terminal ileum and therefore can be affected by Chron’s disease?

A

B12 absorption
Bile salts reabsorption

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15
Q

How does the pattern of inflammation differ in Chrons disease and ulcerative colitis?

A

Chrons = skip lesions (area of inflammation then normal, then inflammation)

Ulcerative colitis = continous pattern of inflammation

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16
Q

What part of inflammed area of gut is affected in Chron’s and ulcerative colitis?

A

Chron’s = transmural/full wall thickness

Ulcerative colitis = superficial/only the mucosal layer is inflammed

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17
Q

Despite Ulcerative colitis only being able to affect the colon/large intestine, what complication can occur affecting the terminal ileum with UC?

A

Backwash ileitis

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18
Q

What is backwash ileitis?

A

When patients with ulcerative colitis develop inflammation of terminal ileum due to the backwash of contents of the caecum into the terminal ileum

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19
Q

What are some extra intestinal problems that can occur with inflammatory bowel diseases?

A

MSK pain
Arthritis

Erythema nodosum (red nodules on kness)
Pyoderma gangrenosum (slide 12)

Cirrhosis of liver
Primary Sclerosing cholangitis

Uveitis (inflammation of middle eye)

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20
Q

What can trigger inflammatory bowel disease?

A

Genetics

Antibiotics
Infections
Smoking
Diet

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21
Q

What can trigger inflammatory bowel disease?

A

Antibiotics
Infections
Smoking
Diet

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22
Q

Which IBD does smoking increase the risk of?

Which IBD does smoking help dampen the symptoms of?

A

Smoking = inc risk of Chron’s

Smoking = reduced symptoms of ulcerative colitis

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23
Q

Why can Chron’s disease present with weight loss?

Why is the weight loss seen with Chron’s disease different to the weight loss seen with ulcerative colitis?

A

Nutrients are absorbed in the small intestine

Weight loss in Chrons s due to malabsorption of nutrients

Weight loss seen in Ulcerative colitis due to water loss

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24
Q

Why do patients with Chrons disease often have Right Lower Quadrant pain whereas ulcerative colitis is more broad?

A

In Chron’s, the terminal ileum is often the most commonly affected inflamed spot which is in the RLQ

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25
Q

What is a key symptom of Chrons that doesn’t normally occur in ulcerative colitis?

A

Perianal lesions in Chrons:
Skin tags
Fistulae
Abscesses
Scarring or sinuses

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26
Q

What is a fistula?

A

Abnormal connection between epithelial lined surfaces or organs

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27
Q

What is the term normally given to the abnormal connection between a structure and the skin?

A

Sinus

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28
Q

What is a skin tag?

A

Remnants of having a prolapsed haemorrhoid

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29
Q

What is a key difference in the stool contents of a patient with Chrons disease and ulcerative colitis?

A

Chrons = loose stool NO BLOOD

Ulcerative colitis = bloody stools (contain mucus)

30
Q

What is a seton knot?

A

A knot that’s tied at a fistula which helps the fistula heal and drain any infection

31
Q

What is the gross pathological appearance of Chron’s (what can be seen with an endoscope)?

A

Skip lesions
Hyperaemia (Red appearance)
Mucosal oedema
Superficial ulcers + deep ulcers
Transmural inflammation (full wall thickness) can narrow lumen

Cobblestone appearance
Fistulae

32
Q

Describe the Cobblestone appearance seen in Chrons disease:

A

Cobbles = inflamed/oedmatous mucous

Grout/in between cobbles = ulcerations/bleeding

33
Q

What is a key histological indications that an inflammtory bowel disease is Chrons disease and NOT UCLERATIVE COLITIS?

A

Epitheliod Granulomas

34
Q

What is a granuloma?

A

Collection of epithelioid macrophages surrounded by lymphocytes

35
Q

Look on slide 16 to see granuloma

A
36
Q

How do you investigate Chrons disease?

A

Bloods to check for anemia to see for blood loss

CT/MRI (bowel wall thickening, obstruction and extramural problems)

Do barium enemas and follow through as contrast

37
Q

Why can fistula, strictures an adhesions form in Chrons but not ulcerative colitis?

A

Chrons is transmural affecting the full thickness of the gut so needs to undergo repair which can go wrong

Whereas ulcerative colitis is superficial so doesn’t undergo repair

38
Q

Go to the last slide, look at the CT on the left, what is the sign seen?

What is it indicative of?

Describe what causes this sign

A

Target sign

Chrons disease

Thickening and oedema of bowel wall due to chrons being transmural

39
Q

The patient in the MRI on the right has chrons, what complication have they developed?

Where has it developed?

A

Stricture at hepatic flexure in transverse colon

40
Q

What pathological changes can be seen in endoscopy of a patient with chrons?

A

Skip lesions
Cobblestone appearance
Fistulae
Strictures

41
Q

What disease is indicated on the endoscope on the last slide?
Why?

A

Chrons disease

Cobblestone appearance

42
Q

Are there Perianal diseases with Ulcerative colitis?

A

No

43
Q

Why is blood loss per rectum very noticeable in Ulcerative colitis?

A

Since its always starts in the rectum

44
Q

What are some different types of ulcerative colitis?

A

Proctitis
Proctosigmoiditis
Distal colitis
Extensive colitis
Pancolitis

45
Q

What is proctiis?

A

Ulcerative colitis affecting just the rectum

46
Q

What is pancolitis?

A

Ulcerative colitis affecting whole large intestine e

47
Q

Why does ulcerative colitis present with mildly tender abdomen whereas Chrons is localised to the RLQ?

A

No focus point in UC

48
Q

What pathological changes can be seen on a histology slide indicating ulcerative colitis?

A

Crypt abscesses
Crypt distortion
Reduced number of goblet cells
Chronic inflammatory infiltration of lamina propria

49
Q

Go to the last slide:

What disease is the histology slide indicating?

Why?

A

Ulcerative colitis

Infilatrion of Lamina propria

50
Q

Why is a reduction n goblet cells bad in UC?

A

Mucus acts as a protective barrier from microbes

51
Q

What structure is absent in the large bowel but present in small intestine?

A

No villi

52
Q

What are the folds called in the stomach?

A

Rugae

53
Q

What are the permanent folds called in the small intestine called?

A

Plica circularis

54
Q

What are the folds called in the large bowel?

A

Haustra

55
Q

What changes can be seen in endoscopy with Ulcerative colitis?

A

Pseudopolyps

Loss of Haustra

56
Q

What causes pseudopolyps in UC?

A

Inflammation then healing

57
Q

What maintains Haustra in the large intestine?

A

The contraction of the 3 bands of muscle called the tiniae coli

58
Q

Why are the haustra lost in Ulcerative colitis?

A

Inflammation leads to damage of the tiniae coli causing them to relax leading to loss of the haustra

59
Q

How are the haustra distributed from the rectum through the large intestine?

A

Rectum smooth
As your progress through gets more and more haustra/folded

60
Q

What are some investigations done for UC?

A

Bloods (anaemia)
Stool samples
Colonoscopy

61
Q

If lesions are spotted on the mouth is it more likely Chrons or UC?

A

Chrons

62
Q

Which IBD is fibrosis very common in?

A

Chrons

63
Q

Which IBD are crypt abcesses common in?

A

Ulcerative colitis

64
Q

Why can the bowel become obstructed in Chrons?

A

Deep inflammation leads to fibrosis which can produce strictures

65
Q

Look at slide 35 to see skip lesions

A
66
Q

Look at the last slide, CT labelled 2

What is this sign?
What is it indicative of?

A

Lead pipe colon
Descending and sigmoid colon featureless due to the haustra being absent since tiniae coli damaged by inflammation so are relaxed

67
Q

What are the general medications given to treat IBD?

A

Aminosalicylates
Corticosteroids
Immunomodulators

68
Q

When are steroids prescribed for IBDs?

A

With flare ups

69
Q

How is Chrons cured?

A

Not curable

Structures and fistulas develop

If surgery remove as little bowel as possible

70
Q

How is Ulcerative colitis cured?

A

Colectomy

But only done if inflammation doesn’t settle, getting pre cancerous changes or a toxic mega colon

71
Q

What is a toxic mega colon?

A

Consequence of UC

Inflammation of colon so aggressive the colon distends
Due to loss of its tone it could burst

Y2 - GI (35 decks)

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