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Y1 GASTROENTEROLOGY > The colon > Flashcards

The colon Flashcards

1
Q

which parts of the colon are

1) mobile
2) immobile

A

1) mobile
- ceacum (intraperitoneal) = quite mobile
- transverse colon = very mobile
- sigmoid colon = quite mobile

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2
Q

what are paracolic gutters

A

They are spaces between the colon and the abdominal wall. They are potential sites of pus collection

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3
Q

what are taeniae coli

A

3 distinct longitudinal bands of smooth muscle, running from caecum to distil end of sigmoid colon

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4
Q

where does the caecum and appendix normally lie

A

Both lie in the right iliac fossa

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5
Q

where does the sigmoid colon lie

A

lies in the left iliac fossa

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6
Q

what does the pancreas lie posterior to

A

stomach

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7
Q

what does the pancreas have

A
  • head (with uncinate process)
  • neck
  • body
  • tail
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8
Q

what type of a structure is the abdominal aorta

A

midline retroperitneal structure and anterior to the vertebral bodies

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9
Q

what are the 3 midline branches

A
  • celiac truck = foregut organs
  • superior mesenteric artery = midgut organs
  • inferior mesenteric artery = hindgut
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10
Q

what are the branches of the superior mesenteric artery

A
  • inferior pancreaticoduodenal
  • middle colic
  • right colic
  • ileocolic
  • appendicular
  • jejunal and ileal
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11
Q

what are the branches of the inferior mesenteric artery

A
  • left colic
  • sigmoid colic
  • superior rectal
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12
Q

what is the relevance of the arterial anastomoses between the superior mesenteric artery and the inferior mesenteric artery

A

Forms predominantly one artery called the marginal artery of Drummond. Collateral blood supply means structures towards the end of the colon can still get blood supply

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13
Q

what is haematemesis

A

vomiting blood

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14
Q

what are the 2 main venous systems of the body

A
  • hepatic portal venous system - drains venous blood from absorptive parts of the GI tract and associated organs to the liver for cleaning
  • systemic venous system - drains venous blood from all other organs and tissues into the superior or inferior vena cava
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15
Q

where does the inferior mesenteric vein drain blood

A

Drains blood from the hindgut structures to the splenic vein

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16
Q

where does the superior mesenteric vein drain blood

A

Drains blood from the midgut structures to hepatic portal vein

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17
Q

where does the splenic vein drain blood

A

Drains blood from foregut structures to hepatic portal vein

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18
Q

where does the hepatic portal vein drain blood

A

Drains blood from foregut, midgut and hindgut structures to the liver for first pass metabolism (cleaned)

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19
Q

where does the inferior vena cava (retroperitoneal) drain blood

A

Drains cleaned blood from the hepatic veins into the right atrium

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20
Q

what is the function of portal systemic anastomoses

A

at these sites the presence of small collateral veins means blood can flow both ways

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21
Q

where are the 3 portal systemic anastomoses

A
  • distil end of oesophagus
  • skin around umbilicus
  • rectum/anal canal
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22
Q

what are clinical presentations of portal hypertension

A
  • oesophageal varices
  • “caput medusae”
  • rectal varices
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23
Q

what are the 2 main types of idiopathic inflammatory bowel disease

A

Crohn’s disease and Ulcerative Colitis

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24
Q

what is Crohn’s disease

A

Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus.

Most common in the terminal ileum and colon

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25
Q

what are the sites for Crohns

A
  • 2/3 have small bowel involvement only
  • 1/6 have colonic/anal disease only
  • 1/6 have both
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26
Q

how does Crohns disease present

A
  • abdominal pain
  • small bowel obstruction
  • diarrhoea
  • bleeding PR
  • anaemia
  • weight loss
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27
Q

what is seen microscopically in Crohns disease

A
  • chronic active colitis with granuloma formation
  • increased chronic inflammatory cells in the lamia propria and crypt branching with granulomas
  • large non-caseating granulomas
  • patchy chronic active colitis
    inflammation involves all layers of the wall
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28
Q

what denotes severe Crohn’s disease

A

deep fissuring produces “cobblestoning” of mucosa

29
Q

summarise the pathology of Crohn’s disease

A
  • segmental disease (patchy)
  • Ileal and/or colonic chronic active mucosal inflammation including:
    • Cryptitis
    • Crypt abscesses

Transmural inflammation

Deep knife-like fissuring ulcers

Granulomas, 50%, Non- caseating

30
Q

what are complications of Crohn’s disease

A
  • Malabsorption
  • Fistulas
  • Anal disease
  • Intractable disease
  • Bowel obstruction
  • Perforation
  • Malignancy
  • Amyloidosis

etc lots of complications

31
Q

what genetic factors are associated with Crohn’s disease

A
  • susceptibility locus on chromosome 16 … NOD2

- Association with HLA-DR1 and HLA-DQw5

32
Q

what is the aberrant immune response of Crohn’s disease

A

Persistent activation of T-cells and macrophages (failure to switch off)

Excess proinflammatory cytokine production

Maybe alterable by changing intestinal microflora…”Probiotics”

33
Q

what is the definition of Ulcerative Colitis

A

Chronic inflammatory disorder confined to colon and rectum

Mucosal and submucosal inflammation

Unknown aetiology

34
Q

what sites is Ulcerative Colitis seen

A

Confined to the colon and rectum. Nearly always involves the rectum. Continuous and confluent extending proximally for varying lengths

35
Q

what is the clinical presentation of Ulcerative colitis

A
  • Diarrhoea
  • Mucus
  • Blood PR
36
Q

Describe a pathological summary of Ulcerative Colitis

A

Continuous, diffuse disease

Rectal involvement, almost always

Superficial ulceration and inflammation

Chronic active colitis

- Cryptitis
- Crypt abscess

No granulomas

37
Q

what are the complications of Ulcerative Colitis

A
  • Intractable disease
  • Toxic megacolon
  • Colorectal carcinoma
  • Blood loss
  • Electrolyte disturbance
  • Anal fissures
38
Q

What is the aberrant immune response

A

Persistent activation of T-cells and macrophages

Autoantibodies eg ANCA present

Excess proinflammatory cytokine production and bystander damage due to neutrophillic inflammation

Maybe alterable by changing intestinal microflora…”Probiotics”

39
Q

what are comparisons of Crohns Disease and Ulcerative Colitis

A 
Chronic diseases
Unknown aetiology
Ulceration
Inflammation
Relapsing and remitting course
Bloody diarrhoea
Both increase risk of cancer
40
Q

what are differences between Crohns disease and Ulcerative Colitis

A 
Ulcerative Colitis is diffuse, continuous disease 
Colon and rectum
Rarely skips
Mucosal ulceration and thin wall
Superficial  inflammation
No granulomas
Fistulae rare
Cancer risk high
Extra GI common
Crohns disease is patchy, segmental disease 
Anywhere in GI tract
Skip lesions common
Thickened bowel and stricture
Transmural inflammation
Granulomas present
Fistulae common
Cancer risk moderate
Extra GI rare
41
Q

what are the 3 zones in the liver used to describe patterns of liver injury

A
  • periportal
  • mid acinar
  • pericentral
42
Q

what can happen in the liver due to insult

A
  • some liver insults can produce severe parenchymal necrosis but heal entirely by restitution
  • some types of injury leave permanent damage
  • some types of injury produce predictable pathological patterns
43
Q

what is cirrhosis

A

severe scarring

44
Q

what is the pathogenesis of liver disease

A

Insult to hepatocytes by viral, drug, toxin, antibody etc

leads to grading… degree of inflammation

leads to staging… degree of fibrosis

cirrhosis

45
Q

what are consequences of acute liver failure

A
  • complete recovery
  • chronic liver disease
  • death from liver failure
46
Q

what are the 3 types of jaundice

A
  • pre hepatic
  • hepatic
  • post hepatic
47
Q

what is pre hepatic jaundice

A

Too much haem to break down

  • haemolysis of all causes
  • haemolytic anaemias
  • unconjugated bilrubin
48
Q

what is hepatic jaundice

A

Liver cells injured or dead

  • Acute liver failure (viruses, drugs, alcohol)
  • Alcoholic hepatitis
  • Cirrhosis (decompensated)
  • Bile duct loss (astresia, PBC,PSC)
  • Pregnancy
49
Q

what is post hepatic jaundice

A

Bile cannot escape into the bowel

  • congenital biliary astresia
  • gallstones block CBDuct
  • strictures of CBDuct
  • Tumours (Ca head of pancreas)
50
Q

what is cirrhosis of the liver

A

Final common endpoint for liver disease

Irreversible

Defined by bands of fibrosis separating regenerative nodules of hepatocytes

Macronodular or micronodular (alcoholic)

Alteration of hepatic microvasculature

Loss of hepatic function

51
Q

what are complications of cirrhosis

A

portal hypertension

ascites

liver failure

52
Q

how is the toxic affect of alcohol brought about

A

The toxic effect of alcohol is mediated through altered fat metabolism and acetaldehyde production

53
Q

what effect does continued heavy drinking have on the liver (weeks to months)

A

Leads to hepatocyte death and an inflammatory response including neutrophils

54
Q

what effect does continued heavy drinking have on the liver (months to years)

A

eventually collagen is layed down, hepatocytes are ballooned, inflammation continues and remodelling of the intrahepatic blood flow occurs

55
Q

what are some outcomes of alcoholic liver disease

A
  • Cirrhosis
  • Portal hypertension .. varices and ascites
  • malnutrition
  • hepatocellular carcinoma
  • social disintergration
56
Q

what is Non-alcoholic steatohepatitis (NASH)

A

Non-drinkers

Pathologically identical to alcoholic liver disease

Occurs in patients with diabetes, obesity, hyperlipidaemia

Now a severe problem overtaking alcohol in importance

Many patients of course have both

May lead to fibrosis and cirrhosis

57
Q

what is hepetitis

A

inflammation of the liver

58
Q

what are common causes of hepatitis

A

Hepatitis A,B,C,E

59
Q

What is hepatitis A

A
  • faecal oral spread
  • short incubation period
  • sporadic or endemic
  • directly cytopathic
  • no carrier state
  • mild illness, usually full recovery
60
Q

what is hepatitis B

A
  • spread by blood, blood products, sexually
  • long incubation period
  • liver damage is by antiviral immune response
  • carriers exist
  • outcome is variable
61
Q

what is hepatitis C

A
  • spread by blood, blood products, possibly sexually
  • short incubation period
  • often asymptomatic
  • disease waxes and wanes
  • tends to become chronic
62
Q

what is primary biliary cirrhosis

A

Rare autoimmune disease, unknown aetiology

Associated with autoantibodies to mitochondria

Females (90%)

Indication for biopsy: Stage the disease

May see granulomas and bile duct loss

Outcome: Unpredictable

Bile ducts are targets for inflammation

63
Q

what is primary sclerosing cholangitis

A

Chronic inflammatory process affecting intra - and extra-hepatic bile ducts

Leads to periductal fibrosis, duct destruction, jaundice and fibrosis

Associated with Ulcerative Colitis

Males

Increased risk of malignancy in bile ducts and colon

64
Q

what is cholangitis

A

inflammation of the bile ducts

65
Q

what is haemochromatosis

A

Haemochromatosis is an inherited condition where iron levels in the body slowly build up over many years. Excess iron within the liver. Iron accumulates in hepatocytes

66
Q

what is Wilsons disease

A

Inherited autosomal recessive disorder of copper metabolism

Copper accumulates in liver and brain (basal ganglia)

Kayser-Fleischer rings at corneal limbus

Low serum caeruloplasmin

Causes chronic hepatitis and neurological deterioration

67
Q

what is alpha-1-antitrypsin deficiency

A

Inherited autosomal recessive disorder of production of an enzyme inhibitor

Causes empysema and cirrhosis

Cytoplasmic globules of unsecreted globules of protein in liver cells

68
Q

what are examples of primary tumours of the liver (rare)

A
  • Hepatocellular adenoma

- Hepatocellular carcinoma (Hepatoma)

69
Q

what are examples of secondary tumours in the liver (common)

A
  • Multiple

- Metastases from colon, pancreas, stomach, breast, lung, others….

Y1 GASTROENTEROLOGY (42 decks)

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