Benign conditions of the large bowel

Question 1

What are some common large bowel diseases?

Answer 1

Carcinoma of the colon and rectum 
Colonic polyps 
Crohns 
UC
Diverticular disease 
Functional disorders

Question 2

What are some less common diseases of the large bowel?

Answer 2

Colonic Volvulus
Colonic angiodysplasia
Ischaemic colitis
Pseudo-obstrction

Question 3

What is diverticular disease?

Answer 3

Out-Pouching of bowel epithelial lining, usually due to high intraluminal pressure caused by low fibre.

Mucosal herniation through the muscle coat

Common in the sigmoid colon

Question 4

What investigations would you do for someone with diverticular disease?

Answer 4

Barium enema

Sigmoidoscopy

Question 5

What clinical features might you find in someone with diverticulitis?

Answer 5

LIF pain/tenderness
Septic
Altered bowel habit

Question 6

What is diverticulitis?

Answer 6

Usually occurs when faeces obstruct the neck of the diverticulum cousin stagnation and allowing bacteria to multiply and produce inflammation.

Question 7

What might be some complications of diverticular disease?

Answer 7

Pericoli abscess
Perforation (bowel)
Haemorrhage
Fistula 
Stricture

Question 8

Describe the classification used for acute diverticulitis?

Answer 8

Hinchey classification

Stage 0,1a,1b,2,3,4

Question 9

How would you treat uncomplicated diverticulitis?

Answer 9

Uncomplicated = inflammation only

Antibiotics - then sent home

Question 10

How would you treat complex diverticulitis?

Answer 10

Hartmann’s procedure - removed affected part of the bowel and give stoma

Primary resection/anastomosis - if perforated

Percutaneous drainage - needle into the abscess

Laparoscopic lavage and drainage - keyhole and wash away infection and drain abscess

Question 11

what are the different types of colitis?

Answer 11

Infective colitis
Ulcerative colitis
Crohns colitis
Ischaemic colitis

Question 12

What are the symptoms of colitis?

Answer 12

Diarrhoea +/- blood
Abdominal cramps
Dehydration
Sepsis

Weight loss, anaemia

Question 13

What investigations would you carry out in colitis?

Answer 13

Plain X-ray
Sigmoidoscopy+biopsy
Stool cultures
Barium enema

Question 14

What actually is colitis?

Answer 14

Inflammation of the inner lining of the colon

Question 15

How would you generally treat UC and Crohns?

Answer 15

IV fluids
IV steroids - once infective/ischaemic colitis has been ruled out
GI rest

If failed to settle - rescue medical therapy, surgery

Question 16

Describe ischaemic colitis?

Answer 16

Often in the older age group
Usually have history of vascular disease

Acute or chronic occlusion of the inferior mesenteric artery

Question 17

What is colonic angiodysplasia?

Answer 17

Angiodysplasia of the colon is swollen, fragile blood vessels in the colon that occasionally result in blood loss from the gastrointestinal (GI) tract.

Abnormal arterial or venous formations in submucosa

Question 18

What side is most common of colonic angiodysplasia?

Answer 18

Usually the right side of the colon

It is an obscure cause of rectal bleeding

Question 19

How might yo diagnose colonic angiodysplasia?

Answer 19

CT angiogram - look for leaking (pools of contract)
Colonoscopy

Injection or surgical resection

Question 20

How would you treat colonic angiodysplasia?

Answer 20

Embolisation
Endoscopic ablation

Surgical resection - rare

Question 21

What are some causes of large bowel obstruction?

Answer 21

Colorectal cancer
Benign stricter
Volvulus

Question 22

What is volvulus?

Answer 22

an obstruction caused by twisting of the stomach or intestine.

Question 23

How might you treat large bowel obstruction?

Answer 23

Resuscitate
Operate
Stenting

Question 24

What might some symptoms of large bowel obstruction be?

Answer 24

Constipation
Abdominal distention
Pain
Vomiting

Depends on where the obstruction is

Question 25

Describe sigmoid volvulus?

Answer 25

When the sigmoid colon twists on the mesentery

It might become gangrenous

Question 26

How could you diagnose sigmoid volvulus?

Answer 26

Plain X ray abdomen

Rectal contrast

Question 27

How can you treat sigmoid volvulus?

Answer 27

Flatus tube

Surgical resection

Question 28

what is Pseudo-obstruction?

Answer 28

Intestinal pseudo-obstruction is a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterized by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen.

There is no real mechanical obstruction

Usually in the elderly

Can mimic large bowel obstruction

Question 29

Describe functional bowel disorders?

Answer 29

IBS, chronic functional consultation

Patients has symptoms and signs but can’t find a reason why - functional problems with their GI tract rather than a structural abnormality