Session 7 Part 2 Flashcards by Ellie Matthews

What does CCK do

Make bile sac move
Released from I cells in duodenum and jejenum
Stimulated by fats in chyme

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CKK causes

Pancreas to release enzyme rich secretions
GB contraction and sphincter of Oddi relaxation
Production of bile
Inhibits gastric emptying

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Features of LI

Ascending colon retro peritoneal
Transverse colon has its own mesentary (transverse mesocolon)
Descending colon is retro-peritoneal
Sigmoid colon has its own mesentary

Rectum:
Upper 1/3 intra peritoneal
Middle 1/3 retroperitoneal
Lower 1/3 no peritoneum

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Large intestine vs small intestine

Large = shorter and wider, has crypts not villi

External longitudinal muscle is incomplete - 3 distinct bands (teniae coli), Haustra are sacculations caused by contraction of teniae coli

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How does water absorption happen in colon

Facilitated by ENaC
Induced by aldosterone
Approx 1500mls of water enter each day and <100mls excretes in faeces
Most absorption in proximal colon
Much tighter junctions allows bigger gradient and less back diffusion

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What is inflammatory bowel disease

Group of conditions characterised by idiopathic inflammation of the GI tract
Affect function of the gut

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2 common types of inflammatory bowel disease

Crohn’s disease
Ulcerative colitis

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3 uncommon types of inflammatory bowel disease

Diversion colitis
Pouchitis
Microscopic colitis

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features of Crohn’s disease

Affects anywhere in GI tract
Ileum usually involved
Transmural
Skip lesions

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Features of Ulcerative colitis

Begins in rectum
Can extend to involve entire colon
Continuous pattern
Mucosal inflammation

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Extra-intestinal problems linked with IBD

MSK pain (up to 50%)- arthritis
Skin (up to 30%)- erythema nodosum/pyoderma gangrenosum/psoriasis
Liver/biliary tree - Primary sclerosing cholangitis (PSC)
eye problems (5%)

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Causes of IBD

Genetic, 1st degree relative
Gut organisms altered interaction
Immune response

Trigger? - smoking, diet, infections antibiotics

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Smoking and IBD

Smoking makes ulcerative colitis better
Makes crohn’s worse or more likely

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Gross pathological in Crohns

Cobblestone appearance
Fistulae

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Extensive list of gross pathological signs in Crohns

Skip lesions
Hyperaemia
Mucosal oedema
Discrete superficial ulcers
Deeper ulcers
Transmural inflammation (thickening of bowel wall and narrowing of lumen)

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Microscopic pathology of Crohns

Granuloma formation (pathognomonic)
Organised collection of epithelioid macrophages

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Investigating Crohn’s

Bloods- anaemia
CT/MRI scans - bowel wall thickening, obstruction, extramural problems
Barium enema- used less, strictures fistulae
Colonoscopy

Findings on crohn’s surgery

Gross pathological changes seen in endoscopy
Skip lesions
Cobblestone appearance
Fistulae
Strictures

Pathological changes in Ulcerative colitis

Pathological changes over time in ulcerative colitis

Investigating UC

Bloods- anaemia/serum markers
Stool cultures
Colonoscopy
Plain abdominal radiographs
Barium enema
CT/MRI - less useful in uncomplicated

Endoscope risks in UC

Perforation

Features of difficulty distinguishing IBD

10% have disorders that can’t be classified- indeterminate colitis

Distinguishing characteristics of Crohn’s and UC

Distinguishing pathological features of Crohns and UC

Pathological feature differences Crohns and UC

Endoscopic changes Crohns vs UC

What does friable mucosa mean

Light touch = bleed

What can you sometimes see on barium follow through in Crohns

Long strictures- string sign of kantour

Radiological features of UC

Lost Haustra- featureless descending and sigmoid colon Lead pipe colon Continuous lesions without skipping Whole colon Mucosal inflammation causes granular appearance

Treatment options for IBD medical

Surgical treatment options for Crohns

Not curative Stricture/fistulas As little bowel removed as possible

Surgical treatment options for UC

Curable (colectomy) Inflammation not settling Precancerous changes Toxic megacolon

What can too much surgical treatment of Crohns or UC cause

Adhesions, hernias, bowel obstruction, pain

typical presentation of Crohns

Multiple non-bloody loose stools a day Weight loss Right lower quadrant pain 15-30 year old

Typical presentation of UC

Multiple bloody stools a day Mild abdominal pain 20-30 year old

Most diverticula are

Pseudo-diverticula where mucosa and submucosa herniate through the external muscle layers of colon

Diverticula occur at sites of the

Major branches of vasa recta

Average size of diverticula

3-10mm

Difference in supply above and below dentate line

Proximal = sympathetic and parasympathetic Distally = somatic

Which type of haemorrhoids are more likely to be damaged by trauma

Prolapsed

External haemorrhoids are usually

Asymptomatic without bleeding