Small Bowel & Colonic Disease Flashcards
1
Q
Infective Colitis:
- who gets it? [3]
- presentation? [3]
- investigation? [2]
- treatment? [1]
A
- Who gets it?
- travellers
- unwell contacts
- immunocompromised
- Presentation
- short history of diarrhoea +/- vomiting
- abrupt onset +/- resolution of symptoms
- systemic upset and fevers prominent
- Investigation
- stool culture & C. difficile toxin test
- need 4 for 90% sensitivity
- stool culture & C. difficile toxin test
- Treatment
- usually conservative if immunocompetent, even if bacterial gastroenteritis confirmed (e.g. Campylobacter)
2
Q
Ischaemic Colitis
- Who gets it? [2]
- Presentation? [4]
- Features in CT scan? [1]
- Treatment? [2]
A
- Who gets it?
- more in elderly with CV comorbidity (e.g. heart failure)
- Presentation
- abrupt onset of pain and bloody diarrhoea
- +/- SIRS
- hypoperfusion > embolic
- Features in CT scan
- may show segmental colitis in watershed areas
- Treatment
- usually conservative
- IV fluids +/- antibiotics
3
Q
What features on an abdominal x-ray (AXR) would be present in a patient with colitis? [2]
A
- megacolon
- diameter >5.5cm or caecum >9cm
- toxic megacolon
- megacolon and signs of systemic toxicity
- emergent colectomy required
4
Q
What are the histological pathological features of chronic IBD?
- acute changes? [4]
- chronic changes? [5]
A
- Acute Changes
- acute inflammation
- ulceration
- loss of goblet cells
- crypt abscess formation
- Chronic Changes
- architectural changes
- paneth cell metaplasia
- chronic inflammatory infiltrates in lamina propria
- neuronal hyperplasia
- fibrosis
5
Q
Crohn’s Disease:
- Definition? [1]
- Risk factors? [2]
- Age of peak incidence? [1]
A
- chronic inflammatory condition affecting anywhere from mouth to anus
- more common in females and smokers
- peak incidence 15-25yrs
6
Q
List the symptoms of Crohn’s Disease:
- GI symptoms? [5]
- Extra-intestinal symptoms:
- in eyes? [2]
- in joints? [4]
- in skin? [2]
A
- GI symptoms:
- abdominal pain (if central think small bowel)
- diarrhoea (watery > bloody)
- weight loss
- fistulae
- abscesses
- Extra-intestinal symptoms:
- in eyes:
- episcleritis
- anterior uveitis
- in joints:
- sarcoilitis
- inflammatory arthropathy
- spondyloarthropathy
- peripheral arthritis
- in skin:
- erythema nodosum
- pyoderma gangrenosum
- in eyes:
7
Q
What investigations should you carry out on a patient with suspected Crohn’s disease? [4]
A
- Faecal Calprotectin
- MR or CT Enterography/EnterocIysis
- Ileocolonoscopy and BX
- Capsule Endoscopy/Enteroscopy
8
Q
What is faecal calprotectin and how is it used in the diagnosis of IBD/Crohn’s? [2]
A
- Calcium-binding protein, predominantly derived from neutrophil •
- ‘Normal’ <50 but studies in GGC suggest results <200 rarely indicate organic pathology
- Useful test to differentiate between IBD/IBS
9
Q
What radiological features are characterisitic of Crohn’s on:
- CT scan? [1]
- MRI scan? [1]
- Colonscopy? [2]
- MR enterography? [1]
A
- CT shows terminal ileal thickening
- MRI suggests terminal ileal Crohn’s
- Colonoscopy shows aphthous ulcers in Tl, ‘active ilieits’ on biopsies
- MR enterography shows features consistent with active terminal ileal Crohn’s disease with mucosal enhancement and some luminal narrowing
10
Q
Compare and contrast the pathological features of Crohn’s disease [6] vs. Ulcerative Colitis? [4]
A
- Crohn’s disease:
- Small and Large bowel inflammation
- Tends to involve proximal large bowel
- Patchy inflammation resulting in macroscopic ‘skip lesions’
- Transmural, deeply ulcerating inflammation
- Granulomas
- Peri-anal disease e.g. fistulas/sinus tracts
- Ulcerative Colitis
- Large bowel inflammation only
- Tends to extend from rectum to involve left side of bowel
- Confluent, diffuse inflammation
- Inflammation centred on mucosa
11
Q
Describe Rutgeerts Score [4]
A
- ≤ 5 aphthous lesions
- >5 aphthous eslons with normal mucosa between the lesions
- Diffuse aphthous ileitis
- Diffuse inflammation with larger ulcers, and/or narrowing
12
Q
Describe the features of ulcerative colitis:
- macroscopic features? [3]
- microscopic features? [3]
A
- Macroscopic features:
- diffuse involvement of the lower GIT
- terminal ileum can be involved but generally only in severe cases where the whole bowel including the caecum is involved (so-called ‘back-wash ileitis’)
- Microscopic features
- crypt architectural changes are generally very marked
- little/no fibrosis
- no granulomas
13
Q
What are the complications of ulcerative colitis?
- local complications? [2]
- systemic complications? [9]
A
- Local complications:
- haemorrhage
- toxic dilation (aka toxic megacolon)
- Systemic complications:
- Skin
- erythema nodosum
- pyoderma gangrenosum
- Liver
- sclerosing cholangitis
- cholangioCa
- Eyes
- iritis
- uveitis
- episcleritis
- Ankylosing spondylitis
- Malignancy
- Skin
14
Q
Colorectal polyps
- Definition of polyp? [1]
- Examples of bowel polyps? [4]
A
- Polyp = exophytic protruberant growth
- Example of bowel polyps include:
- hamartomatous polyps
- inflammatory polyps
- hyperplastic polyps
- adenomas
15
Q
Describe the TNM 8 Staging of Colorectal Carcinoma [9]
A
- Tumour
- T1 = invasion into submucosa
- T2 = invasion into, but not through muscularis propria
- T3 = invasion through muscularis propria, into subserosa or non-peritonealised pericolic/perirectal tissue
- T4 = invasion of visceral peritoneum (T4a) and/or other organs (T4b)
- Nodes
- N0 = no regional lymph node mets
- N1 = 1-3 regional lymph node mets
- M2 = 4+ regional lymph node mets
- Metastasis
- M0 = no distant mets
- M1 = distant mets
