Benign Conditions of Large Bowel Flashcards
Common diseases of the large bowel?
Carcinoma of colon/rectum Colonic polyps Crohn's colitis Ulcerative colitis Diverticular disease Functional disorders
Less common disease of large bowel?
Colonic volvulus
Colnic angiodysplasia
Ischaemic colitis
Pseudo-obstruction
Diverticular disease. What happens?
Muscle herniation through muscle coat which occurs in sigmoid colon
What is used to classify acute diverticulitis?
Hinchey Classification for acute diverticulitis
What is true diverticula opposed to false?
True= includes all layers of bowel wall False= Includes serosa and mucosal layer
Complications with diverticulitis?
Pericolic abscess Perforation Haemorrhage (colocolic, colocutaneous, colovesical, colovaginal (with hysterectomy)) Fistula Structure
What is a fistula?
Abnormal communications between 2 epithelial surfaces
How to get a diagnosis of diverticulitis?
Clinical
Barium enema
Sigmoidoscopy
Clinical features of diverticulitis?
- Left Iliac Fossa Pain/tenderness
- Septic
- Altered bowel habit
Treatment for uncomplicated diverticulitis?
IV or oral antibiotics
Treatment for complex diverticulitis?
- Primary Resection/ anastamosis
- Hartmann’s procedure
- Percutaneous drainage
- Laparoscopic lavage and drainage
Causes of acute/chronic colitis?
Infective colitis
Ulcerative colitis
Crohn’s and ischaemic colitis
Where does ulcerative colitis begin?
Begins in rectum and moves proximally
Where can Crohn’s be?
Anywhere but most commonly in terminal ileum
Symptoms of acute/chronic colitis?
Diarrhoea+-blood. abdominal cramps, dehydration, sepsis, weight loss, anaemia
How to test for colitis?
AXR
Sigmoidoscopy + biopsy
Stool cultures
Barium enema
What would an AXR of colitis show?
Smoothing of colon (lack of haustrations)
Thumb printing on ascending colon
Treatment of Colitis?
IV fluids
IV steroids (when isch/infect colitis ruled out)
GI rest
If this doesn’t work then rescue medical therapy and surgery
Who does ischaemic colitis happen in?
Elderly people
Arteriopaths
What is ischaemic colitis?
Acute or chronic occlusion of IMA
What is colonic angiodysplasia?
Submucosal lakes of blood
Usually right sided colon
Diagnosis of colonic angiodysplasia?
Difficult
CT angiography
Colonoscopy
Treatment of colonic angiodysplasia?
Embolization (risk of ischaemic bowel)
Endoscopic ablation
Surgical resection
Cause of Large bowel obstruction?
Colorectal cancer
Benign stricture
Volvulus
Hernia
What is a volvulus?
Sigmoid bowel twist
May become gangrenous
Treatment for large bowel obstruction?
Resuscitation
Operate
Stenting (for cancer-palliative)
Treatment of volvulus?
Flatus tube + resection
Diagnosis of large bowel obstruction?
AXR
Rectal contrast
Treatment for chronic constipation?
Usual diet change
Laxatives
Pseudo-obstruction?
No real mechanical obstruction (elderly, debilitated)
