Benign bowel disorders

Question 1

What is diverticular disease?

Answer 1

Mucosal herniation through the muscle coat of the large bowel

Question 2

Which part of the colon is usually affected by diverticular disease?

Answer 2

The sigmoid colon. The highest pressures are probably generated here as it is on the left side.

Question 3

What type of diet would predispose to getting diverticular disease?

Answer 3

A low fibre diet

Question 4

What are the clinical features of diverticulitis?

Answer 4

Left iliac fossa pain/tenderness
Septic
Altered bowel habit- some people get diarrhoea, some people get constipation

Question 5

How is diverticular disease diagnosed?

Answer 5

Clinically
Barium enema
Sigmoidoscopy
Could confirm the diagnosis with a CT scan

Question 6

What is the treatment for diverticulitis?

Answer 6

IV fluids
Bowel rest
IV antibiotics

Surgery- mostly no improvement or complications- only for those who do not improve with other treatment.

Question 7

What type of antibiotics are used?

Answer 7

Broad spectrum- there is usually a mix of aerobic and anaerobic organisms causing the symptoms

Question 8

What are complications of diverticular disease?

Answer 8

Pericolic abscess - a bit of leakage of one of the diverticuli and it causes an abscess
Perforation
Haemorrhage- occurs when an inflammatory/infective process erodes a blood vessel in the wall of the bowel
Fistula
Stricture- from repeated bouts of infection, causing chronic inflammation

Question 9

What surgical procedures can be used to treat diverticulitis?

Answer 9

Hartmaann’s procedure- colostomy

Primary resection and anastamosis

Question 10

What are the causes of acute and chronic colitis?

Answer 10

Infective colitis
Crohn’s colitis
Ulcerative colitis
Ischaemic colitis

Question 11

What are the symptoms of acute and chronic colitis?

Answer 11

Diarrhoea with or without blood
Abdominal cramps
Dehydration
Sepsis
Weight loss
Anaemia

Question 12

What investigations can be done to diagnose the colitis?

Answer 12

X-ray
Sigmoidoscopy and biopsy
Stool cultures
Barium enema

Question 13

What is the immediate treatment for a patient with Crohn’s or UC?

Answer 13

IV fluids - to rehydrate after diarrhoea
IV steroids- once infective and ischaemic colitis have been ruled out
GI rest

Question 14

Which patients tend to get ischaemic colitis?

Answer 14

The elderly

Arteriopaths

Question 15

What is the most common cause for ischaemic colitis?

Answer 15

An acute or chronic occlusion of the inferior mesenteric artery.

Question 16

When do patients with ischaemic colitis get pain?

Answer 16

After eating

Question 17

What is colonic angiodysplasia?

Answer 17

Abnormal blood vessels have developed beneath the mucosa.
The abnormal vessels can get eroded and bleed.
There will be submucosal lakes of blood.
This is an obscure cause of rectal bleeding.
It is usually on the right side of the colon.

Question 18

How is colonic angiodysplasia diagnosed?

Answer 18

Angiography: if you catch the patient when they are bleeding. Cannulate a mesenteric artery, when the vessel which is bleeding is found something can be injected to stop the bleeding.
Colonoscopy: examine the entire colon to see where the bleeding is coming from.
Surgical resection: May be faced with this if the patient continues to bleed.

Question 19

How can the bleeding be stopped in colonic angiodysplasia?

Answer 19

Embolisation using fibrin glue
Endoscopic ablation
Surgical resection if there is no success with the first two options

Question 20

What causes a large bowel obstruction?

Answer 20

Colorectal cancer (most common)
Sigmoid or caecal volvulus
Pseudosbtruction
Faecal impaction

Question 21

What causes a sigmoid volvulus?

What could happen to this bit of bowel?

Answer 21

The bowel twists on its mesentery

It may become gangrenous

Question 22

What does the patients abdomen look like with a sigmoid volvulus?

Answer 22

Very distended and timpinic

Question 23

How is sigmoid volvulus diagnosed?

Answer 23

X ray

Rectal contrast

Question 24

What is the treatment for sigmoid volvulus?

Answer 24

Initially, try a flatus tube: a big plastic malleable tube is inserted into the rectum. Try to get it into the distended loop of bowel.
If unsuccesful: surgical resection

Question 25

What is a pseudo obstruction?

Answer 25

When the patient presents with all the signs and symptoms of an obstruction, but there is no mechanical obstruction present.
The bowel has simply become atonic and dilated.

Question 26

How is a pseudoobstruction investigated?

Answer 26

CT scan or X ray to confirm there is no mechanical obstruction.
Can do colonoscopy to take gas, fluid and stool out of the bowel. May have to do that repeatedly.

Question 27

Who may get a pseudo-obstruction?

Answer 27

The elderly or debilitated.

There is often a pharmacological or biochemical cause.

Question 28

Who tends to get faecal impaction?

Answer 28

The elderly and the bedridden

Those on strong analgesics

Question 29

How is faecal impaction treated?

Answer 29

Enemas, laxatives

Manual evacuation

Question 30

What is spureus diarrhoea?

Answer 30

Liquid stool above the big solid bolus that finds its way around it. The patients are chronically incontinent of this watery stool.