Session 7- Large Intestine and IBS

Question 1

what is IBS

Answer 1

a group of conditons characterised by idiopathic inflammation of th GI tract

Question 2

extraintestinal problems

Answer 2

MSK pain
-arthiritis

Skin
-erythma nodusum

Liver
-primary sclerosing cholangitis

eye problems

Question 3

which is more likely to have blood in stool

Answer 3

UC

Question 4

where does crohns affect

Answer 4

terminal ileum hence RLQ pain

Question 5

pathology of crohns

Answer 5

skip lesions 
hyperaemia
mucosal oedema
discrete superficial ulcers
deeper ulcers 
transmural inflammation
-thickening of bowel wall
-narrowing of lumen

Question 6

appearance of crohns

Answer 6

cobblestone appearance

fistulae- bowel/ bladder, bagina and skin

Question 7

microscopic pathology - crohns

Answer 7

granuloma formation

-organised collection of epitheliod macrophages

Question 8

how do we investigate crohns - CT MRI

Answer 8

CT/MRI

• thickened bowel wall
• obstruction
• extramural problems

Question 9

how would crohns present on a blood test

Answer 9

anaemia

Question 10

what is present in stool of UC

Answer 10

mucus- large intestine

blood - involves mucosa

Question 11

pathogical changes of UC

Answer 11

Chronic inflamation infiltrate of lamina propria 
crypt abcesses 
crypt distortion 
-irregular shaped glands
-darker crowded nuclei 
reduced goblet cells
pseudoplyps
loss of haustra

Question 12

how does uc present in blood work

Answer 12

anaemia

serum markers increased

Question 13

where does UC affect compared to crohns

Answer 13

uc- rectum colon

crohns- anywhere

Question 14

are there fistulas in uc or crohns

Answer 14

just crohns

Question 15

string sign of kantour

Answer 15

long strictures in crohns

Question 16

how does mucosal inflammation appear on doubke contrast enema

Answer 16

granular apparance `

Question 17

how do we treat uc

Answer 17

curative

remove colon- colectomy

Question 18

in classic presentation of appendicitis which of the following causes the pain to be felt in the right iliac fossa

Answer 18

the first stage of pain is caused by the distension of the inflamed appendix triggering visceral afferents (by irritation and distension of the visceral peritoneum surrounding the appendix) to relay info back to the T10 dermatome

the brain interprets this as peri-umbilical pain

once the appendix is inflamed enough to come into contact with parietal peritoneum the pain will be felt in right iliac fossa which approximats the location of the appendix