Lower GI Tract Flashcards
1
Q
List the 7 main structures within the colon (large intestine)
A
Appendix
Caecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum (—>anus)
2
Q
List the 3 major organs supplied by the celiac artery
A
Stomach
Liver
Spleen
3
Q
List the 3 major organs supplied by the superior mesenteric artery
A
Small intestine
Large intestine
Pancreas
4
Q
Name the organ supplied by the inferior mesenteric artery
A
Colon
5
Q
Name the major vein where the majority of organs in the gastrointestinal tract drains blood into.
A
Portal Vein
6
Q
List the 4 major layers of the GI tract
A
Mucosa
Submucosa
Muscularis
Serosa
7
Q
List the 3 components which make up the mucosa
A
From innermost to outermost:
Epithelium
Lamina propria
Muscularis mucosae
8
Q
List the 2 components which make up the muscularis
A
From innermost to outermost:
Circular muscle
Longitudinal muscle
9
Q
List the 2 components which make up the serosa
A
From innermost to outermost:
Areolar connective tissue
Epithelium
10
Q
State the nerve responsible for parasympathetic innervation of the ascending and transverse colon.
A
Vagus nerve
11
Q
State the nerve responsible for parasympathetic innervation of the distal portions of the colon (e.g descending, sigmoid)
A
Pelvic nerves
12
Q
State vertebral regions of the spinal cord responsible for supplying sympathetic innervation of lower GI tract
A
Lower thoracic
Upper lumbar
13
Q
External anal sphincter is supplied by which nerves and fibres?
A
Somatic motor fibres supplied by pudendal nerves
14
Q
State what afferent sensory nerves of the lower GI tract are responsible for detecting.
A
Detects pressure
15
Q
State the name of the plexus which innervates the submucosa of the GI tract
A
Meissner’s plexus
16
Q
Define Hirchsprung’s Disease and its cause
A
Disorder of the lower GI tract in which there is difficulty in passing stool
Caused by lack of enteric intramural ganglia in most ditsal portions of the colon
17
Q
State the region where myenteric ganglia is located
A
Taenia coli (The longitudinal ribbons of smooth muscle lining the colon)
18
Q
State the 5 main types of lower GI tract disorders
A
Inflammatory
Infective
Structural
Functional
Neoplastic
19
Q
Give 2 examples of inflammatory lower GI tract disorders
A
Inflammatory bowel disease
Microscopic colitis
20
Q
Give 2 examples of infective lower GI tract disorders
A
E coli
C diff (Clostridium difficile)
21
Q
Give 3 examples of structural lower GI tract disorders
A
Fissure
Haemorrhoids
Diverticular disease
22
Q
Give an example of a functional lower GI tract disorders
A
Irritable bowel syndrome (IBS)
23
Q
Give 2 examples of neoplastic lower GI tract disorders
A
Colon cancer
Colonic polyps
24
Q
List 3 other causes for lower GI tract disorders besides those of the main divisions
A
Vascular causes
Metabolic causes
Neurological causes
25
State the incidence of inflammatory bowel disease in america and europe.
1. 5 million americans
2. 2 mil europeans
26
Which demographic of indiviudals are most affected by inflammatory bowel disease?
Young adults
27
List some socioeconomic complications for individuals suffering from IBS
* Burden of therapy for patients
* Hospitalisation
* Surgery
* Health-related quality of life
* Economic productivity
* Social functioning
28
State the 2 main conditions which fall under the umbrella term of inflammatory bowel disease
Crohn's Disease
Ulcerative colitis
29
Define ulcerative colitis
A lower GI tract inflammatory disorder characterised by inflammation of the colonic mucosa
30
Define Crohn's disease
An inflammatory disorder of the GI tract characterised by presentation of chronic transmural granulomatous inflammation
31
State 4 main ways Crohn's disease differs to ulceratve colitis.
1) Can affect any part of the GI tract whereas in UC it is limitted to the colonic mucosa (hence superficial)
2) Crohn's presents with granulomas whereas UC doesnt
3) Crohn's affects more females versus males (5:1). UC affects both equally
4) UC extends in a continuous manner wheres in Crohn's can affect different areas in a non continous way
32
Ulcerative Colitis always involves which part of the lower GI tracts?
Rectum
33
Describe the way inflammation presents itself in Crohn's Disease
Patchy chronic transmural granulomatous inflammation
34
List the 5 main types of ulcerative colitis from least continous to most continuous and state the areas affected
Proctitis (Rectum)
Proctosigmoiditis (Rectum + sigmoid colon)
Distal colitits (rectum--\>descending colon)
Extensive colitis (rectum --\> transverse colon)
Pancolitis (Entirety of the colon)
35
List the 6 main types of Crohn's Disease and state the areas affected.
Gastroduodenal Crohn's Disease (Duoedenum [opening of SI])
Ileocolitis (Ileum [Distal portion of SI] and the LI)
Ileitis (Ileum)
Jejunoileitis (Jejunum [mid portion of SI])
Crohn's colitis (Colon)
Perianal Crohn's (Rectum and anus)
36
What is the most common type of Crohn's Disease?
Ileocolitis
37
Inflammatory bowel disease has a variety of symptoms depending on which areas are affected. List 4 potential symptoms that may arise with individuals with colitis
Bleeding
Diarrhoea
Urgency to empty bowels
Mucus in stool/diarrhea
38
. List 3 potential symptoms that may arise in individuals with perianal inflammation in IBS
Anal pain
Difficulty passing stool
Leakage
39
. List 5 potential symptoms that may arise in individuals with small bowel disease
Abdominal pain
Abdominal mass
Weight loss
Fatigue/Lethargy
Diarrhoea
40
List 4 regions which may display extra-intestinal manifestaions of IBD
Arthritic regions
Skin
Eyes
Liver
41
List 2 types of arthiritis that can be caused by IBD
Ankylosis spondylitis (Arthiritis in the spinal region)
Peripheral arthritis (e.g. joints of arms and legs)
42
List 2 skin manifestations in patients with IBD
Erythema nodosum
Pyoderma gangrenosum
43
Name 2 manifestations of IBD that presents itself within the eyes
Anterior veitis (Inflammation of middle layer of eye suchs as iris and cilliary body)
Iritis/Episcleritis
44
Name 2 manifestations of IBD that presents itself within the liver
Primary sclerosis cholangitis (PSC) [Scarring of the bile ducts]
Autoimmune hepatits
45
Inflammatory disease can occur by a combination of which 3 main factors?
Genetics
Environmental factors such as luminal microbiota
Immune response
46
Name 4 types of gene which can increase the risk of developing IBD
NOD2
HLA
ATP
IL23R
47
Name 2 types of antibodies which can increase the risk of developing IBD
ASCA (Anti-saccaromyces cervisia)
pANCA
48
Give 2 examples of environmental factors which can increase the risk of developing IBD
Luminal microbiota:
Mycobacterium paratuberculosi
MMR (Not definitive proof(
49
Define dysbiosis
Reduced diversity in the microbiota
50
List 3 main pathophysiologies that may arise from dysbiosis
Autoimmunity
Metabolic disorders
Allergy
51
List 11 factors that may increase the risk of dysbiosis
Appendectomy
Stress
Smoking
Sleep hygeine
Hygeine
Diet
UV exposure/Vitamin D
Microbiome
Medications (e.g. ABs)
Physical activity
Genetic susceptibility
52
Presence of which antibody increases risk of developing Crohn's Disease?
Presence of which antibody increases risk of developing Ulcerative Colitis?
ASCA = CD
pANCA = UC
53
State the 3 main management goals for individuals with IBD
Induce clinical remission
Maintain clinical remission
Improve quality of life
54
State 3 other management goals for patients with IBD
Heal mucosa
Reduce hospitilisation/surgery and costs
Minimise IBD and therapy related complications
55
What are the 5 main treatment options for managing IBD?
Steroids
5 ASA (Drugs used to treat IBD)
Immune suppresants
Biologic therapy
Other: Diet, Exercise, ABs, FMT [faecal micribiota transplants], probiotics
56
Name 2 immune suppresants used when treating IBD
Azathioprine
Methotreaxate
57
Explain the pharmacodynamics of steroids
Steroid diffuse and enter nucleus where it binds to GRE (Gluccocorticoid response element).
This results in an increase of anti-inflammatory gene produts and an inhibition of pro-flammatory gene expression
58
State the 3 modes of delivery for steroids
Orally
IV
Rectal enemas (enemas are tools which inject of fluid/gas up the rectum)
59
How should steroids be used when treating patients with IBD?
Should only be used short term and a bridge to other therapies and should be used in the acutely unwell
60
List 3 psychiatric symptoms of steroid usage
Sleep disturbance
Sleepiness
Psychosis
61
List 5 dermatological symptoms of steroid usage
Cushingoid appearance
Hirsutism
Oedema
Acne
Abdominal striae
62
List 2 neurological symptoms of steroid usage
Pseudomotor cerebri
Neuropathy
63
State the main cardiological symptom of steroid usage
Hypertension
64
List 3 musculoskeletal symptoms of steroid usage
Myopathy
Osteoporosis
Aseptic necrosis of bone
65
List 2 endocrine symptoms of steroid usage
Adrenal cortex suppresion
Diabetes mellitus
66
List 2 immunological symptoms of steroid usage
Immunosupresion
Lymphocytopenia
67
List 2 opthalmic symptoms of steroid usage
Acute-angle glaucoma
Cataracts
68
State the main developmental complication of steroid usage
Growth retardation
69
State the 4 main pharmacodynamic actions of 5 ASA
Inhibition of pro-inflammatory cytokines (IL-1 and TNF-a )
Inhibition of the lipo-oxygenase pathway i.e. prostaglandin and leukotrienes
Scavenging of free radicals
Inhibition of NF-kB/ TLR via PPAR-gamma induction (perioxisome proliferator activated
receptor-gamma)
70
What are the 2 main overall effects of 5 ASA?
Some immunosuppresive activity – inhibiting T cell proliferation, activation and differentiation
Impairs neutrophil chemotaxis and activation
71
State the 2 methods of delivery for 5 ASA
Orally
Rectal
72
State 7 side effects of 5 ASA
Intolerance
Headache
Malaise
Pneumonitis (Inflammation of the lungs)
Pancreatitis
Diarrhoea
Renal impairment
73
Explain the pathophysiological actions of Azathioprine
Reduces the production of guanine and adenine ribonucleotides
Results in reduction of T and B lymphocytes, immunoglobulins and interleukins.
Also increases T cell apoptosis
74
Give 7 examples of side effects from azathioprine
Infections
Pancreatitis
Bone marrow suppresion
Malignancy/lymphoma
Allergic reactions (e.g. fever, malaise, rash)
GI disturbance
Hepatotoxicity (nodular regenerative hyperplasia)
75
List 8 things that should be checked before and during administration of azathiroprone to a patient
TPMT (Low levels detected = dont give)
HIV
Hep B/C
Chickenpox (cant give if they never had)
TB
Vaccinations
_During administration:_
Take frequent blood tests intitally
Maintenance blood tests
76
State the 2 ribonucleotides affected by azathioprine
Adenine
Guanine
77
Describe the pharmacodynamics of methotrexate and state its 2 effects
Mechanisms unknown however it affects DNA synthesis and cell replication
Main effects:
Increases adnosine production which is an anti-inflammatory metabolite
Increases apoptosis of peripheral T cells
78
How long does methotrexate take to start having effects?
3 months
79
What 2 types of patients should not be administered methotrexate?
Patients with liver diseases
Patients who are pregnant or planning to become pregnant
80
What should be monitored in patients taking methotrexate?
LFTs (Liver function tests)
FBCs (Detect abnormalities such from complications such as bone marrow suppresion)
81
What should be given to patients alongside methotrexate to reduce the chance of developing side effects?
Folic acid supplemets
82
How often should methotrexate be administered to patients?
Weekly
83
State 8 potential side effects from methotrexate.
Rash
Nausea
Mucositis
Diarrhoea
Bone marrow suppresion
Hypersensitive pneumonitis
Cirrhosis
Liver fibrosis
(N.B. High levels of liver enzymes in circulation indicates liver damage)
84
Why should methotrextae not be given to patients who are pregnant or are planning for pregnancy?
Methotrexate is a abortifacient so can early terminate pregnancies
85
Define abortifacient
A substance that is capable of causing abortion during pregnacy
86
How do methotrexate and azathioprine differ in terms of malignancy risks?
Unlike azathioprine, methotrexate has not been known to cause lymphomas
Also not know to attribute to development of skin cancers
87
Define biologics
A type of drug that reduces inflammatory damage
88
State the 5 effects of TNF-a
Increased inflammation
Increased cell infriltration
Increased CPR in serum (C-reactive protein)
Tissue remodelling
Compromised of barrier functioning
89
Name 2 biologics that have an anti-TNF-a effect
Infliximab
Adalimumab
90
Name a biologic that have an anti-a4ß7 effect
Vedolizumab
91
Name a biologic that have an anti-IL12/IL23 effect
Ustekinumab
92
State how infliximab is admnisitered and how frequent dosgaes should be given
IV administration
Dosages are given in a 0, 2, 6 weeks period
Maintenance dosage 8 weekly
93
How does adalimumab compare in terms of administration and dosage frequency versus infliximab?
Subcutaneously (self-injected)
Can be taken at home versus in hospital and is taken more frequently
94
Give 10 examples of potential side effects of biologics
Opportunistic infection
IV/site infections
Infections
Bone marrow suppresion (neutropenia)
Malignancy (Lymphoma)
Demyelinating diseases
Heart failure (congestive heart failure)
Autoimmunity
Hepatotoxicity
Cutaneous reactions such as psoriasis
95
anti-TNF drugs such as infliximab and adalimumab work best alongside which two types of medication and why?
Azathioprine
6-MP (aka mercaptopurine)
Has a superior effect in maintaining response and remission
Reduces rate of antibody formation
96
Dietary therapy for treating inflammatory bowel disease is most effective in which type of patients?
Young children
97
Dietary therapy in children with IBD can be just as effective as which other alternative treatment method?
Steroids
98
Dietary therapy is most effective for which disease?
Small bowel Crohn's Disease
99
How effective are the use of antibiotics for treating IBD?
No hard evidence suggesting effectiveness however can help in treating sepsis
100
