4: Benign conditions of the large bowel

Question 1

What is a diverticulum?

Answer 1

Mucosal herniation through muscle coat

Question 2

Are diverticulae, seen in diverticular disease, false or true?

Answer 2

False

Not a true outpouching of GI tract - herniation of mucosa

Question 3

What dietary deficiency is diverticular disease associated with?

Answer 3

Low fibre

Question 4

Where do diverticulae tend to appear?

Answer 4

Sigmoid colon

Question 5

What is the difference between diverticulosis and diverticulitis?

Answer 5

Diverticulitis is inflammation

Question 6

Which investigation can be used to view diverticular disease?

Answer 6

Barium enema

Endoscopy

Question 7

Are people with diverticulosis guaranteed to get diverticulitis?

Answer 7

No

Question 8

Diverticulosis tends to be (symptomatic / asymptomatic).

Answer 8

asymptomatic

Question 9

Where does pain associated with diverticulitis appear?

Answer 9

Left iliac fossa

Question 10

What is a fistula?

Answer 10

Communication between two visceral surfaces

Question 11

Do patients with uncomplicated diverticulitis need to be managed in hospital?

Answer 11

No

Question 12

What are patients with uncomplicated diverticulitis treated with?

Answer 12

Oral antibiotics

Question 13

How is complicated diverticulitis (e.g abcesses, peritonitis) treated?

Answer 13

Drainage

Surgery

Question 14

What causes colitis?

Answer 14

Crohn’s disease

Ulcerative colitis

Infection

Ischaemia

Question 15

cxr slide 16 - right colon is lumpy bumpy, left colon is smooth and featureless

on left side, characteristics features of the colon have been lost due to colitis

Question 16

What imaging modality can be used to view the colon?

Answer 16

Abdominal X-ray

Question 17

What is used to treat patients with severe Crohn’s / UC once they have been resuscitated with IV fluids?

Answer 17

IV steroids (if infective/ischaemic ruled out)

Question 18

Which type of colitis is caused by occlusion of the arteries?

Answer 18

Ischaemic colitis

Question 19

The risk factors of which disease process increase your chances of developing ischaemic colitis?

Answer 19

Atherosclerosis

Question 20

Ischaemic colitis tends to appear in the (young / elderly).

Answer 20

elderly

Question 21

What is an uncommon cause of rectal bleeding, caused by arterial/venous malformation?

Answer 21

Colonic angiodysplasia

Question 22

Which investigation is used to diagnose colonic angiodysplasia?

Answer 22

CT angiogram

Question 23

How would you be able to tell that a patient had colonic angiodysplasia from a CT angiogram?

Answer 23

Leakage

Question 24

Colonic angiodysplasia can be treated by cauterising the haemorrhaging blood vessels. What complication may this cause?

Answer 24

Ischaemia

Question 25

What can cause **large bowel obstruction**?

Answer 25

**Colorectal cancer** **Benign strictures** **Volvulus** **Hernia**

Question 26

What causes **small bowel obstruction**?

Answer 26

**Adhesions** **Hernia** **Caecal cancer**

Question 27

slide 24 - small bowel mainly with bits of large bowel, very dilated due to obstruction - omental appendices coming off colon, white stripes are teniae coli

Question 28

What are the four cardinal symptoms of GI obstruction?

Answer 28

Constipation Distension Pain Vomiting

Question 29

What palliative procedure can be used to alleviate symptoms of large bowel obstruction, e.g in cancer with metastasis?

Answer 29

**Stenting**

Question 30

Which part of the colon has the most mesentery and is therefore the most mobile?

Answer 30

**Sigmoid colon**

Question 31

When the sigmoid colon twists around its mesentery and the blood supply is blocked, what is this called? What are the complications?

Answer 31

**Sigmoid volvulus** **Ischaemia, infarction, gangrene**

Question 32

slide 27 - coffee bean distension pointing into LIF

Question 33

Which disease mimics large bowel obstruction but, upon investigation, yields no actual cause?

Answer 33

**Pseudo-obstruction**

Question 34

Who gets pseudo-obstruction?

Answer 34

Those with underlying medical probs (elderly/dehabilitated)

Question 35

What is a **true diverticulum**?

Answer 35

**Diverticulum** involving all layers of bowel wall, proper outpouching

Question 36

What is a **false** diverticulum?

Answer 36

**Herniation** of mucosa through muscle wall, only mucosa and serosa are involved