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Week 11 Victoria > Learning Objectives > Flashcards

Learning Objectives Flashcards

1
Q

Give an overview of the differences in symptoms of UC and Crohn’s

A
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2
Q

What are some common Clinical features of IBD?

A
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3
Q

What are the main extra-intestinal features of IBD?

A
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4
Q

What are the main histological features of Ulcerative Colitis?

A

Ulcerative Colitis

LIMITED TO MUCOSA

ALWAYS starts at rectum, and moves up the colon CONTINUOUSLY (No skip lesions)

  • Limited to Colon
  • Mucosa appears Granular
  • Friable Muscosa (the ease with which the mucosa is damaged by contact with the endoscope or biopsy instrument)
  • Crypt Abscesses
  • Reduced Goblet Cells
  • Inflammatory Pseudopolyps and Ulcers (may be bleeding)
  • Lack of haustra
  • Crypt Abcesses
  • Crypt distortion:
  1. Crypt atrophy – Atrophy is a loss of tissue compared to normal - crypts that are seen are smaller than normal, healthy crypts.

2. Crypt loss – There is a complete loss of crypts in some areas of the colon.

3. Crypt branching – Instead of being long and straight, these crypts split to form multiple branches.

  • Basal plasmacytosis - defined as the presence of plasma cells between the base of the crypts and the muscularis mucosae
  • Hyperplasia of the lamina propria
  • Mucin cell depletion
  • Paneth cell metaplasia
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5
Q

What are the main histological features of Crohn’s?

A

TRANSMURAL

Can appear anywhere mouth to anus - especially prevalent in terminal Ilium (rarely involves rectum)

Patchy - Presence of skip lesions

  • Granulomas (an aggregation of macrophages that forms in response to chronic inflammation.)
  • Submucosal Oedema (swelling of muscularis propriae)
  • Fibrosis
  • Normal Goblet cell numbers
  • Cobblestone appearance of the lumen
  • “Creeping mesenteric fat”
  • Fistulas/Strictures/Fissures
  • Apthous Ulcerations
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6
Q

What are the percentages of locality of UC and Crohn’s?

A
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7
Q

What are the main causes of steatorrhea?

A
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8
Q

Discuss the four main types of Diahorrea, and give some examples of causes/conditions

A
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9
Q

What the amounts/frequency required for diagnosis of Acute or Chronic diahorrea?

A
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10
Q

In what parts of the Small Intestine are different nutrients absorbed?

A

Majority of nutrient absorption takes place in the jejunum:

EXCEPTIONS

Iron: Duodenum

Vitamin B12: Ileum (terminal)

Bile Salts: Ileum (terminal)

Water and Lipids: Throughout (Passive Diffusion)

Sodium Bicarb: Throughout (Active Transport + Glucose/A.A. Co-transport)

Fructose: Throughout (Facilitated Diffusion)

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11
Q

Give a brief outline of how absorption of Fat, Carbs and Protein works in healthy GI

A
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12
Q

Which vitamins are fat soluble, and therefore rely on fat absorption to enter circulation?

A

A, D, E & K

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13
Q

Which vitamins are water soluble?

A

B and C

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14
Q

What is the difference between Global and Isolated Malabsorption? And what are the three most common symptoms?

A
  • Chronic Diarrhoea
  • Weight Loss
  • Anaemia
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15
Q

What are Howell-Jolly Bodies? And in which Anemias are they typically present?

A

Caused by nuclear remnants in erythrocytes

Typical in:

Folate, B12 Deficiency

Sickle Cell

Thalassemia

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16
Q

What is the mnemonic for remembering which deficiencies - and the area of the intestine in which malabsorption will occur - will lead to which anemias?

A

Dude I’m

Just Feeling

Ill Bro

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17
Q

What are 5 main functions of the PNS?

A
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18
Q

What is the the chain of neurotransmitter and receptors for the PNS

A

Long pre-ganglionic axon - Ach/NIC - Short post-ganglionic axon - Ach/Mus

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19
Q

Which four cranial nerves play major roles in the PNS? And which areas do they affect?

Which other area of the central nervous system is utilised?

A

III: Occulomotor - Eyes

VII: Facial - Lacrimal, Submandibular, and Sublingual glands.

IX: Glossopharygeal: Parotid Glands, and Pharynx

X: Vagus - Airways, Heart, Stomach, Pancreas, Liver

Sacral Nerves (S2-S4):

Bladder, Genitals and Large Intestine

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20
Q

Outline the PNS effect on the heart.

Include

  • Nerve
  • Neurotransmitter/Receptor
  • Primary effect
  • Physiological consequence
  • Notes
A
  1. Vagus Nerve
  2. Ach/M2
  3. Decrease in HR, and in rate of transmission between SA and AV node (to keep them in time with each other)
  4. Decreases HR, so decreases CO (CO = HR x SV)
  5. See Image
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21
Q

How do M2 receptors work?

Which G-coupled proteins are they associated with?

What effect will agonists and antagonists have?

What cautions/contraindications are there?

A
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22
Q

Outline the PNS effect on the eyes.

Include:

  • Nerve
  • Neurotransmitter/Receptor
  • Primary effect
  • Physiological consequence
  • Notes
A
  1. Oculomotor (III)
  2. Ach/M3
  3. Contraction of circular smooth muscles (constrictor pupillae) of the iris
  4. Pupillary constriction (miosis), Opening of canal of Schlemm (which allows drainage of aqueous humour), and accommodation (focussing).
  5. See Image
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23
Q

Outline the PNS effect on the Bladder.

Include:

  • Nerve
  • Neurotransmitter/Receptor
  • Primary effect
  • Physiological consequence
  • Notes
A
  1. Sacral Nerves S2-S4, activated by Micturion Brainstem centre
  2. Ach/M3
  3. Smooth muscle contraction of bladder (accompanied by switching off of motor neurone activated contraction of external sphincter)
  4. Voids bladder, is activated by afferent sensory neurones that sense fullness of bladder and switch off SNS and activate PNS
  5. See image
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24
Q

Outline the MUSCULAR PNS effects on the Gut.

Include:

  • Nerve
  • Neurotransmitter/Receptor
  • Primary effect
  • Physiological consequence
  • Notes
A
  1. Vagus Nerve + Enteric Nervous System
  2. Ach/M3
  3. Contraction of circular and longitudinal smooth muscle
  4. Assists in peristalsis, in conjunction with the ENS (see image) and afferent fibres in Vagus nerve that allow for peristaltic reflex control.
  5. See image
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25
Q

Outline the SECRETORY PNS effects on the Gut.

Include:

  • Nerve
  • Neurotransmitter/Receptor
  • Primary effect
  • Physiological consequence
  • Notes
A
  1. Vagus (Pancreas and Stomach), Facial (VII) + Glossopharyngeal (IX) (Salivary Glands)
  2. UNKNOWN
  3. Stimulates
  • Acinar and Islet cells - Pancreas
  • Parietal cells - Stomach
  • Acinar cells - Salivary Glands
  1. Increase in secretions (Insulin - Pancreas, Gastric Acid - Stomach, Amylase & Mucins - Salivary Glands)
  2. See Image
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26
Q

Outline the PNS effect on the Lungs.

Include:

  • Nerve
  • Neurotransmitter/Receptor
  • Primary effect
  • Physiological consequence
  • Notes
A
  • Vagus
  • Ach/M3
  • Smooth muscle contraction of airways
  • Bronchoconstriction
  • See Image
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27
Q

Give an overview of the functioning of M3 receptors

A
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28
Q

Outline the PNS effect on Male Genitalia.

Include:

  • Nerve
  • Neurotransmitter/Receptor
  • Primary effect
  • Physiological consequence
  • Notes
A
  1. Sacral Nerves S2-S4
  2. Nitrous Oxide
  3. Stimulation of specialised vasodilator sacral nerves to release NO - a lipophilic membrane-permeable gas
  4. NO causes dilation of the vascular smooth muscle cells that make up the corpus cavernosum - allowing it to dilate and fill with blood, maintainin erections
  5. See Image
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29
Q

What are the four types of diahorrea, and what are some differentials for their causes?

A
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30
Q

What is a definition of diarrhoea is terms of stool amount?

A

>300g in 24hrs

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31
Q

What are the three phases of malabsorption, and what are some differentials for each phase?

A
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32
Q

What information would we look for when taking a history of a patient with Diarrhoea?

A
33
Q

What investigations can one order with regard to diarrhoea?

A

Chronic and Acute:

M,C and S (Microscopy, Culture and Sensitivity)

FBC

U’s and E’s

Chronic only:

Fecal Calprotectin

Coeliac Serology

LFTs

TFTs

34
Q

IBS is defined as a “Functional” GI disorder, i.e. a disorder of gut–brain interaction, and is also regarded as a diagnosis of exclusion.

It can be defined as a combination of any of which five factors?

A
  • motility disturbance
  • visceral hypersensitivity
  • altered mucosal and immune function
  • altered gut microbiota
  • altered central nervous system processing.

Common symptoms include

Diarrhoea • Constipation • Abdominal pain • Abdominal bloating • Nausea

35
Q

Outline the ROME IV criteria for IBS

A

Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:

  • Related to defecation
  • Associated with a change in frequency of stool
  • Associated with a change in form (appearance) of stool.

NB: Symptoms must have started 6 months before diagnosis

36
Q

Outline the management options for IBS

A
37
Q

Outline the common presentation of Coeliac disease in adults and children

A
38
Q

What are the four main serological tests for Coeliac disease, and what are their approximate sensitivity and specificities? What other tests can we do?

A

Additional Tests: FBC , iron studies, vit B12, folate, ESR/CRP, TFTs, DEXA scan

Genetic testings for HLA-DQ2/HLA-DQ8 can diagnose coeliac in children

39
Q

Give an outline of the pathophysiology of Coeliac disease

A
40
Q

What are the histological/physiological changes caused by the pathophys of coeliac?

A
41
Q

What are the main risk factors for Coeliac Disease?

A
42
Q

Is there a biopsy option for testing for Coeliac?

A

Duodenal Biopsy = in adults NOT children 4 x distal duodenum + 2 x bulb whilst on gluten diet Repeat after 6m on gluten-free diet to show improvements.

43
Q

Where can IgA and IgG be found in the body?

A
44
Q

What are the main investigations used for diagnosing IBD (either Crohn’s or UC)?

A
45
Q

What are the micro and macro scopic features of coeliac disease in the GI Tract?

A
46
Q

What are the main complications associated with Coeliac disease?

A

Children:

Faltered growth / Delayed Puberty

Bone dematerialisation fractures

Dental Issues

Adults:

Deficiency Anaemias (Iron, B12, Folate)

Low birth weight baby • Small bowel carcinoma • T cell lymphoma

(All less common)

47
Q

What are some of the main macroscopic differences visible on colonoscopies between crohn’s and UC?

A
48
Q

Why is a Faecal Calprotectin test used?

A

There are several gastrointestinal symptoms that may indicate either irritable bowel syndrome (IBS) or IBD.

Nearly 99% of patients who have active IBD have elevated fecal calprotectin levels.

This thereby helps suggest a diagnosis of IBD, not IBS

NB: At the same time, 15% to 20% of patients with IBS have mildly elevated calprotectin levels.

49
Q

What are the main complications of IBD (either UC or Crohn’s)?

A
50
Q

What is the treatment for IBD?

A

Almost all of these drugs inhibit the process of inflammation

Note of the function of Aminosalycates:

“The mechanism of action of this class of drugs remains uncertain, although it seems likely that they are important free radical scavengers, can reduce leukotriene production and can inhibit the cellular release of interleukin-1, all of which are likely to be important in reducing the acute inflammatory response in inflammatory bowel disease.”

51
Q

Outline the most important symptomatic treatment of diarrhoea

A
52
Q

Outline the distribution of iron, from absorption to utilization and loss, on a daily basis.

A
53
Q

Give an outline of Iron deficiency anaemia - what sort of test results would we expect to see?

A

Notes:

  1. Reticulocytes may be in range, but actually they are low considering the state of anaemia - the body should be producing loads to make up for shortage - suggests failure of production
  2. If you look at blood film, cells appear hypochromic, with a wide variety in size and colour (large RDW, not isochromic)
  3. You would expect TIBC to be high, as more transferring is produced as the body tries to offset low iron levels
54
Q

How is Iron stored in the body?

A
55
Q

What are the two types of Iron that are present in food, in what foods are they present, and what receptors in what part of the intestine are used to absorb it?

A
56
Q

Outline the role of transferrin

A

A transport protein:

57
Q

What are the three main Iron studies? And what would we expect to see in a case of iron deficiency anaemia?

A
58
Q

What does TIBC stand for, what does it test, and give two examples in which it would be high or low.

A
59
Q

Give 7 possible aetiologies for Iron Deficiency Anaemia

3 x Poor Intake

4 x Losing too much

A
60
Q

Give the two main features of Folate and B12 deficiencies as seen on a blood film. What type of anaemia are they?

A

Megaloblastic Macrocytic Anaemias

Characterised on the peripheral smear by macroovalocytes and hypersegmented neutrophils

61
Q

Draw a table of the main causes of Folate Deficiency

A
62
Q

Explain why Folate, B12 and Iron are important for erythropoiesis:

A

Erythroblasts require folate and vitamin B12 for proliferation during their differentiation. Deficiency of folate or vitamin B12 inhibits purine and thymidylate syntheses, impairs DNA synthesis, and causes erythroblast apoptosis, resulting in anemia from ineffective erythropoiesis.

Erythroblasts require large amounts of iron for hemoglobin synthesis. Large amounts of iron are recycled daily with hemoglobin breakdown from destroyed old erythrocytes.

63
Q

What is Pernicious Anemia?

A

Notes:

Vitamin B12 is combined with a protein called intrinsic factor in your stomach. This mix of vitamin B12 and intrinsic factor is then absorbed into the body in part of the gut called the distal ileum.

Pernicious anaemia causes your immune system to attack the cells in your stomach that produce the intrinsic factor, which means your body is unable to absorb vitamin B12.

64
Q

Give the names of varying degrees of the spread of colitis in the large intestine

A
65
Q

What are pseudopolyps?

A

Pseudopolyps are projecting masses of scar tissue that develop from granulation tissue during the healing phase in repeated cycle of ulceration (especially in inflammatory bowel disease). Inflammatory tissue without malignant potential,[1] pseudopolyps may represent either regenerating mucosal islands between areas of ulceration, edematous polypoid tags or granulation tissue covered by epithelium

66
Q

What are the main macroscopic differences between Crohn’s and UC?

A
67
Q

What are the main microscopic differences between Crohn’s and UC?

A
68
Q

What are the main clinical feature differences between Crohn’s and UC?

A
69
Q

For full lists of differences visit the link and see the image below

A

https://sgul.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=20a1e0fe-8b37-43a8-a5b2-ade500fe00b1&query=abed

70
Q

Draw a pictographic illustration of the differences between UC and Crohn’s, include detailed explanations of ulcer formation and inflammation

A
71
Q

What investigations can be ordered to detect IBD?

A
72
Q

What are M cells?

A

M cells are highly specialised cells present within the epithelium overlying organised lymphoid follicles of the small and large intestine. They play a central role in the initiation of mucosal immune responses by transporting antigens and microorganisms to the underlying lymphoid tissue.

73
Q

Give an overview of the pathophysiology of IBD

A
74
Q

What is toxic megacolon?

A
  • Toxic megacolon (megacolon toxicum) is an acute form of colonic distension - characterized by a very dilated colon - accompanied by abdominal distension, and often fever, abdominal pain and shock
75
Q

How should ASAs be administered depending on the severity/spread of colitis?

A
  • Proctitis: 5-ASA suppository
  • Distal colitis: 5-ASA foam enema
  • L sided colitis: 5-ASA liquid enema
  • Extensive/pancolitis: topical Rx PLUS oral Rx
76
Q

Give an outline of the Truelove and Watts classification of Acute colitis.

A
77
Q

Going from slight to extensive, what features will see on an endoscopy (real pictures)

A
78
Q

Give an overview of sympathetic vs parasympathetic

A

Week 11 Victoria (2 decks)

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