Benign conditions of the large bowel Flashcards
Name 5 common diseases of the large bowel
Carcinoma of the colon and rectum Colonic polyps Crohns colitis and UC Diverticular disease Functional disorders
Define diverticular disease
mucosal herniation through the muscle coat
What part of the colon is affected in diverticular disease
Sigmoid
What type of diet causes diverticular disease
Low fibre and high fat - western diet
What is the difference between diverticulitis and diverticulosis
Diverticulitis - the presence of diverticular disease with inflammation or infection
Diverticulosis is the presence of diverticular disease without any inflammation or infection
What are the findings of diverticular disease
Outpouching of the epithelial lined track
What is the difference between true and pseudodiverticula diverticular disease
True diverticula contain all layers of the parent structure. False or pseudodiverticula are mucosal projections through the muscular layer.
What type of condition are true diverticular disease
Congenital disease
How can we diagnose diverticular disease
Using a barium enema or an endoscopy
Describe the onset of diverticulitis
Gradual onset becoming increasingly severe.
What are the signs of diverticulitis
tenderness in the left ileac fossa
generally feeling unwell
altered bowel habit
How do we treat uncomplicated diverticulitis
Nothing - oral antibiotics if anything
What are the complications of diverticulitis
Pericolic abscess which can perforate, bleed or fistulate
How do we treat complicated diverticulitis
Hartmann’s procedure (removal of part of the bowel)
Primary resection
anastomosis
drainage
Describe colitis
Inflammation of the lining of the colon
What 2 types of colitis can we get
Acute and chronic
What 5 things can cause colitis
Infective colitis Ulcerative colitis Crohn's colitis Iscaemic colitis Infective colitis - usually campyylobacter
What are the 4 signs of colitis
Pain
Blood in stool
Diarrhoea
History of feeling unwell
What 5 tests can we do for colitis
Stool sample Blood tests Plain X ray Sigmoidoscopy and biopsy Barium enema
What specific blood tests would be requested in colitis
WBC
CRP
Hb
Why would we not perform a full colonoscopy in an acute situation
Due to the high risk of perforation if there is extensive inflammation
What 4 things can we use to treat colitis
IV steroids - first line
IV fluids
Iron supplement
GI rest
Who is most likely to get ischaemic colitis
Elderly
Those with previous arteriopathy
What 3 types of arteriopathy should we suspect ischaemic colitis with
Coronary artery disease
Cerebral artery disease (stroke)
Peripheral vascular disease
Define colonic angiodysplasia
Angiodysplasia of the colon occurs when blood vessels in the colon enlarge. They may become fragile and result in occasional bleeding in the gastrointestinal (GI) tract.
How can we treat colonic angiodysplasia
Angioplasty - embolise blood vessels using coil or chemicals
What are the 4 symptoms of large bowel obstruction?
Abdominal pain
constipation
abdominal distension
vomiting
What are 5 causes of bowel obstruction
Colorectal cancer Benign stricture Sigmoid or caecal voluvulus (twist in the bowel) Pseudo-obstruction Faecal impaction
How do we treat bowel obstruction
Resuscitate
Operate
Stent
Define pseudo-obstruction
clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterised by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen.
Is pseudo-obstruction pathological or functional
Functional
Who is most likely to present with pseudo-obstruction?
Elderly / debilitated patients
How do we treat pseudo-obstruction
We cant.
We can only check that it is not a medication causing it and that there is no electrolyte imbalance causing it
How do we determine if the patient has chronic constipation?
Determining what is normal for them
What usually treats chronic constipation
Diet
Laxatives
What is a small cause of chronic constipation?
Motility disorder
