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BRS Y2 > Lower GI Tract > Flashcards

Lower GI Tract Flashcards

1
Q

What nerve innervates the ascending colon and most of the transverse colon in terms of parasympathetic supply?

A

Vagus nerve

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2
Q

What is distal parasympathetic supply from?

A

Pelvic nerves

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3
Q

What nerves give sympathetic supply to the lower GI tract

A

Lower thoracic and upper lumbar spinal cord

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4
Q

What is the external anal sphincter controlled by?

A

Somatic motor fibres in the pudendal nerves

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5
Q

What disease occurs when theres no enteric nervous system?

A

Hirschsprung’s

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6
Q

Where is the myenteric plexus ganglia concentrated?

A

Below the tenia coli

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7
Q

What are the 4 layers of the colon

A

Mucosa
Submucosa
Muscularis (made of 2 layers circular and longitudinal layers)
Serosa

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8
Q

Where does nerve supply to the lower GI tract come from?

A

Centrally AND from the submucosal and myenteric plexus (they are like localised pacemakers)

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9
Q

What does the mucosa layer contain? Why is this useful?

A

Lots of mucin producing glands to allow easy passage of stool and lubrications

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10
Q

What are the inflammatory lower GI tract disorders?

A

IBD and microscopic colitis

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11
Q

What are the infective lower GI tract disorders?

A

C diff

E coli

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12
Q

What are the structural lower GI tract disorders?

A

Diverticular disease
Haemorrhoids
Fissures

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13
Q

What are the functional lower GI tract disorders?

A

Irritable bowel syndrome

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14
Q

What are the neoplastic lower GI tract disorders?

A

Colonic polyps

Colon cancer

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15
Q

Who does IBD often affect?

A

Young people

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16
Q

What type of condition is IBD?

A

Lifelong, chronic and autoimmune

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17
Q

What is ulcerative colitis?

A

Inflammatory disorder limited to the colonic mucosa

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18
Q

What is the pattern of inflammation in UC?

A

Continuous

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19
Q

What anatomical area is always involved in UC?

A

Rectum

20
Q

Does UC affect males or females more?

A

Effects both equally

21
Q

What is NOT present in UC?

A

Granulomas

22
Q

What anatomical area does Crohn’s effect?

A

Any part of the GI tract

23
Q

What is the pattern of inflammation in Crohn’s?

A

Patchy chronic transmural granulomatous inflammation

24
Q

What structures may be formed in Crohn’s and why?

A

Tendency to form fistula (penetration between 2 walls) or strictures (narrowing of the lumen, there is non expansive fibrous tissue). They form because deeper layers are affected in Crohn’s compared to UC

25
Q

Out of UC and Crohn’s which are painful and why?

A

Crohn’s is more
Generally UC is not
This is because deeper areas are affected in Crohn’s

26
Q

What do IBD symptoms depend on?

A

Site of bleeding

27
Q

What symptoms will colitis present with?

A

Bleeding
Mucus
Urgency
Diarrhoea

28
Q

What symptoms will perianal areas being affected present with?

A

Anal pain
Leakage
Difficulty passing stool

29
Q

What symptoms will small bowel disease present with?

A 
Abdominal pain
Weight loss (due to less absorption)
Tiredness/lethargy (less absorption causes anaemia) 
Diarrhoea
Abdominal mass
30
Q

What are some extra intestinal manifestations of IBD?

A 
Arthritis (axial – Ankylosing spondylitis)
Peripheral
Skin (Erythema nodosum
Pyoderma gangrenosum
Eyes (Anterior uveitis
Episcleritis/Iritis)
Liver (Primary Sclerosing Cholangitis (PSC)
Autoimmune hepatitis)
31
Q

What are the 3 biggest influencers in the development of IBD?

A

Environmental factors like luminal microbes
Genetic susceptibility
Immune response

32
Q

What does immune response in Crohn’s involve?

A

Anti-saccaromyces cervisiae (ASCA)

33
Q

What does immune response in UC involve?

A

pANCA

34
Q

In terms of urination/bowel movements what does urgency mean?

A

You have control but you have to go

35
Q

In terms of urination/bowel movements what does incontinence mean?

A

You don’t have control over what you pass and when

36
Q

What IBD is perianal disease associated with?

A

Crohn’s only

37
Q

Why do strictures and fistulations form in Crohn’s?

A

Due to deeper areas being affected whereas UC is superficial

38
Q

Define dysbiosis

A

Microbial imbalance or impaired microbiota

39
Q

What does poor bacterial community in the microbiota cause?

A

Inflammation

40
Q

What are the 3 main goals when treating IBD?

A

Induce clinical remission
Maintain clinical remission
Improve patient quality of life

41
Q

What is the main action of steroids for IBD?

A

Diffuses and bind in nucleus to Glucocorticoid Responsive Elements (GRE) which increases anti-inflammatory gene products blocks pro-inflammatory genes

42
Q

How are steroids for IBD administered?

A

IV, oral or rectal enema

43
Q

How long can steroids be used? Why?

A

Only short term for acutely unwell patients as they cause lots of side effects and become less effective long term

44
Q

What is the main action of 5 ASA for IBD?

A

Reduces inflammation via methods such as
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

45
Q

What is the main action of azathioprine for IBD?

A

Results in reduced number of B and T lymphocytes, immunoglobulins and interleukins with the overall aim of reducing inflammation

46
Q

What things do we need to monitor/check when giving immunosupressants?

A 
Thiopurine
TPMT
Hep B/C
HIV
Chickenpox
If they gave had all their vaccinations
TB
Frequently check bloods when starting and also regularly afterwards
47
Q

What are some side effects of biologic therapies?

A 
Opportunistic infections
Infusion or site reactions
Neutropenia
Demyelinating disease
Heart failure (HF)
Cutaneous reactions, including psoriasis
Malignancy
Induction of autoimmunity

BRS Y2 (85 decks)

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