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SA gastro-intestine > S8) Colon and Inflammatory Bowel Disease > Flashcards

S8) Colon and Inflammatory Bowel Disease Flashcards

1
Q

Compare and contrast UC and CD in terms of:

  • Location
  • Pathology
  • Rectum involvement
  • Mucosal inflammation
  • Fistula formation
A
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2
Q

What sort of epithelium is found in the large intestine?

A

Columnar epithelium

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3
Q

State three functions of the large intestine

A
  • Removes water from all the indigestible gut contents
  • Vitamin production
  • Temporary storage until defaecation
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4
Q

Distinguish between the small intestine and the large intestine in terms of structure

A
  • Colon is much shorter (6 feet)
  • Colon is much wider (average 6cm)
  • Colon has crypts not villi
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5
Q

Describe the structure of the wall of the colon

A

External longitudinal muscle is incomplete:

  • Three distinct bands (teniae coli)
  • Haustra are sacculations caused by contraction of teniae coli
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6
Q

Describe mechanism of water absorption in the colon

A
  • H2O absorption is facilitated by ENaC
  • Induced by aldosterone
  • most absorption is in proximal colon
  • tighter tight junctions for a bigger gradient to form and less back diffusion of ions
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7
Q

What is inflammatory bowel disease?

A

Inflammatory bowel disease is a group of clinical conditions which are characterised by the idiopathic inflammation of the GI tact and affect the overall function of the gut

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8
Q

What are the two common types of IBD?

A
  • Crohn’s disease (15-30 yr olds & 60 yr olds)
  • Ulcerative colitis (young adults)
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9
Q

Identify and describe 4 extra-intestinal problems of IBD

A
  • MSK pain — arthritis
  • Skin problems — erythema nodosum (red lumps on leg) / pyoderma gangrenosum (large painful ulcers)/ psoriasis
  • Liver/biliary tree issues — Primary Sclerosing Cholangitis (PSC)
  • Eye problems
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10
Q

Identify and describe 3 possible causes of IBD

A
  • Genetic (1st degree relative – increased risk)
  • Gut organisms (altered interaction)
  • Immune response (unknown trigger – antibiotics, infections, smoking, diet)
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11
Q

How does Crohn’s disease present?

A
  • Tender mass (RLQ)
  • Mild perianal inflammation/ulceration
  • Low grade fever
  • Mildly anaemic

terminal ileum is most commonly effected so lower right quadrant pain is common

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12
Q

Identify 6 gross pathological features of Crohn’s disease

A
  • Hyperaemia (build up blood in the blood vessels supplying an organ)
  • Cobblestone Appearance → liner ulcers and criss cross inflamed mucosa
  • Discrete superficial ulcers & deep ulcers
  • Fistulae (bowel – bowel, bladder, vagina, skin) abnormal connection between two epithelial lined organs
  • Mucosal Oedema
  • Transmural inflammation
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13
Q

What are the effects of transmural inflammation as observed in CD?

A
  • Thickening of bowel wall
  • Narrowing of lumen
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14
Q

Identify a microscopic pathological feature of Crohn’s disease

A

Granuloma formation (pathognomonic)

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15
Q

Identify 3 investigations commonly used for CD

A
  • Bloods (anaemia)
  • CT /MRI scans (bowel wall thickening & obstruction)
  • Colonoscopy (Fistulas, cobblestone appearance strictures)

hepatic flexure appears lighter due to narrowing due to crohns

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16
Q

How does Ulcerative colitis present?

A
  • Mildly tender abdomen
  • No perianal disease
  • Normal temperature
  • no localised pain as it is continuous
    *
17
Q

Identify 6 gross pathological features of UC

A
  • Chronic inflammatory infiltrate of lamina propria
  • Crypt abscesses - more common in UC that Crohns
  • Crypt distortion
  • Goblet cells
  • Pseudopolyps
  • Loss of haustra
18
Q

Identify 5 investigations commonly used for UC

A
  • Bloods (anaemia, serum markers)
  • Stool cultures
  • Plain abdominal radiographs
  • CT/MRI (only for uncomplicated UC)
  • Colonoscopy
19
Q

What is indeterminate colitis?

A

Indeterminate colitis refers to the 10% of cases of inflammatory bowel disease where there is difficulty distinguishing between ulcerative colitis and Crohn’s disease

20
Q

Describe the three steps in the medical treatment of inflammatory bowel disease

A
  1. Aminosalicylates — sulfasalazine for flares and remission
  2. Corticosteroids — prednisolone for flares only
  3. Immunomodulators — azathioprine for fistulas / maintenance of remission
21
Q

Crohn’s Disease is not curative and surgically, as little bowel must be removed as possible.

In which circumstances is this performed?

A
  • Strictures form
  • Fistulas form
22
Q

Ulcerative colitis is curable surgically through a colectomy.

In which circumstances is this performed?

A
  • Inflammation not settling
  • Precancerous changes
  • Toxic megacolon
23
Q

describe the location if each section of the colon in the peritoneum

A
  • upper ⅓: intra peritoneal
  • middle ⅓: retroperitoneal
  • lower ⅓: no peritoneum
  • ascending and descending are both retroperitoneal (during development they have mesenteries but lose them)
  • Transverse and sigmoid colon both have their own mesenteries
24
Q

describe the pathophysiology of crohns disease

A
  1. can effect anywhere in the GI tract from mouth to anus
  2. ileum mainly involved
  3. transmural - the disease goes through the wall of the mucosa so inside and outside lumen
  4. skip lesions - non effected areas between effected areas
25
Q

what is the pathophysiology of ulcerative colitis

A
  • begin in the rectum and grows up towards the colon
  • continuous
  • mucosal inflammation
  • max can go from rectum to caecum
  • very superficial so isn’t transmural
26
Q

what can’t you really use a CT when investigating Ulcerative colitis but can use it for crohns

A
  • it is a mucosal problem so its inside the gut
  • CT wont be useful for this
  • Issue goes along the width of the lumen so you can see why fistulas form
27
Q

what are pathological changes in ulcerative colitis

A
  • pseudopolyps can develop after repeated episodes (look like polyps (lump) but they’re not)
  • loss of haustra due to inflmmation (they are the bumps that give the colon a bumpy look)
28
Q

what are distinguishable features between crohns and ulcerative colitis

A
29
Q

what are some pathological difference between UC and crohns

A
30
Q

what are some endoscopic features that occur in UC and crohns

A
  • friable mucosa → if you touch it it will bleed
  • fistula → transmural element
31
Q

what are radiological features of UC

A
  • Double contrast enama
  • lack hasutral markings
  • continuous lesions without skipping
  • whole colon
  • mucosal inflammation (granular appearance)

SA gastro-intestine (19 decks)

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