Benign Conditions of the Large Bowel ***

Question 1

Describe the clinical features of diverticular disease.

Answer 1

• Generally asymptomatic
• Episodic colicky abdominal pain - sometimes constipation/diarrhoea
• Can progress to lower GI haemorrhage - in sudden, painless and severe bleeding from colonic diverticula
• Chronic blood loss leads to anaemia

Question 2

Describe aetiology of diverticular disease.

Answer 2

• High intraluminal pressure within the bowel
• Thinning of the bowel wall.
• Pouches of mucosa push between muscle fibres and develop into an outpouch

Question 3

Describe the morphological appearance within diverticular disease.

Question 4

Describe the gross appearance within diverticular disease.

Question 5

Describe the histological appearance within diverticular disease.

Answer 5

• Absence of muscle layer around herniated diverticula
• Thickened muscle layer of sigmoid colon

Question 6

Describe the complications of diverticular disease.

Answer 6

• Abscess formation
• Perforation leading to peritonitis
• Sepsis
• Fistulation
• Bowel obstruction
• Bleeding

Question 7

Define fistula.

Answer 7

• Tube with opening at both ends
• Abnormal communication between two surfaces is established.

Question 8

What are the 2 main types of fistula?

Answer 8

• CONGENITAL - due to congenital abnormality
• ACQUIRED - due to trauma, inflammation and necrosis

Question 9

Give an example of a disease where fistulas form.

Answer 9

Crohn’s
- Gut inflammation can spread through all the layers in the bowel wall.
- Cause small leaks and abscesses to form
- Increased risk of UTIs