Benign bowel disorders Flashcards
What is diverticular disease?
Mucosal herniation through the muscle coat of the large bowel
Which part of the colon is usually affected by diverticular disease?
The sigmoid colon. The highest pressures are probably generated here as it is on the left side.
What type of diet would predispose to getting diverticular disease?
A low fibre diet
What are the clinical features of diverticulitis?
Left iliac fossa pain/tenderness
Septic
Altered bowel habit- some people get diarrhoea, some people get constipation
How is diverticular disease diagnosed?
Clinically
Barium enema
Sigmoidoscopy
Could confirm the diagnosis with a CT scan
What is the treatment for diverticulitis?
IV fluids
Bowel rest
IV antibiotics
Surgery- mostly no improvement or complications- only for those who do not improve with other treatment.
What type of antibiotics are used?
Broad spectrum- there is usually a mix of aerobic and anaerobic organisms causing the symptoms
What are complications of diverticular disease?
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
What surgical procedures can be used to treat diverticulitis?
Hartmaann’s procedure- colostomy
Primary resection and anastamosis
What are the causes of acute and chronic colitis?
Infective colitis
Crohn’s colitis
Ulcerative colitis
Ischaemic colitis
What are the symptoms of acute and chronic colitis?
Diarrhoea with or without blood Abdominal cramps Dehydration Sepsis Weight loss Anaemia
What investigations can be done to diagnose the colitis?
X-ray
Sigmoidoscopy and biopsy
Stool cultures
Barium enema
What is the immediate treatment for a patient with Crohn’s or UC?
IV fluids - to rehydrate after diarrhoea
IV steroids- once infective and ischaemic colitis have been ruled out
GI rest
Which patients tend to get ischaemic colitis?
The elderly
Arteriopaths
What is the most common cause for ischaemic colitis?
An acute or chronic occlusion of the inferior mesenteric artery.
When do patients with ischaemic colitis get pain?
After eating
What is colonic angiodysplasia?
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.
How is colonic angiodysplasia diagnosed?
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.
How can the bleeding be stopped in colonic angiodysplasia?
Embolisation using fibrin glue
Endoscopic ablation
Surgical resection if there is no success with the first two options
What causes a large bowel obstruction?
Colorectal cancer (most common)
Sigmoid or caecal volvulus
Pseudosbtruction
Faecal impaction
What causes a sigmoid volvulus?
What could happen to this bit of bowel?
The bowel twists on its mesentery
It may become gangrenous
What does the patients abdomen look like with a sigmoid volvulus?
Very distended and timpinic
How is sigmoid volvulus diagnosed?
X ray
Rectal contrast
What is the treatment for sigmoid volvulus?
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
What is a pseudo obstruction?
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.
How is a pseudoobstruction investigated?
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.
Who may get a pseudo-obstruction?
The elderly or debilitated.
There is often a pharmacological or biochemical cause.
Who tends to get faecal impaction?
The elderly and the bedridden
Those on strong analgesics
How is faecal impaction treated?
Enemas, laxatives
Manual evacuation
What is spureus diarrhoea?
Liquid stool above the big solid bolus that finds its way around it. The patients are chronically incontinent of this watery stool.
