Benign conditions of the large bowel Flashcards
What are some common large bowel diseases?
Carcinoma of the colon and rectum Colonic polyps Crohns UC Diverticular disease Functional disorders
What are some less common diseases of the large bowel?
Colonic Volvulus
Colonic angiodysplasia
Ischaemic colitis
Pseudo-obstrction
What is diverticular disease?
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
What investigations would you do for someone with diverticular disease?
Barium enema
Sigmoidoscopy
What clinical features might you find in someone with diverticulitis?
LIF pain/tenderness
Septic
Altered bowel habit
What is diverticulitis?
Usually occurs when faeces obstruct the neck of the diverticulum cousin stagnation and allowing bacteria to multiply and produce inflammation.
What might be some complications of diverticular disease?
Pericoli abscess Perforation (bowel) Haemorrhage Fistula Stricture
Describe the classification used for acute diverticulitis?
Hinchey classification
Stage 0,1a,1b,2,3,4
How would you treat uncomplicated diverticulitis?
Uncomplicated = inflammation only
Antibiotics - then sent home
How would you treat complex diverticulitis?
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
what are the different types of colitis?
Infective colitis
Ulcerative colitis
Crohns colitis
Ischaemic colitis
What are the symptoms of colitis?
Diarrhoea +/- blood
Abdominal cramps
Dehydration
Sepsis
Weight loss, anaemia
What investigations would you carry out in colitis?
Plain X-ray
Sigmoidoscopy+biopsy
Stool cultures
Barium enema
What actually is colitis?
Inflammation of the inner lining of the colon
How would you generally treat UC and Crohns?
IV fluids
IV steroids - once infective/ischaemic colitis has been ruled out
GI rest
If failed to settle - rescue medical therapy, surgery
Describe ischaemic colitis?
Often in the older age group
Usually have history of vascular disease
Acute or chronic occlusion of the inferior mesenteric artery
What is colonic angiodysplasia?
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
What side is most common of colonic angiodysplasia?
Usually the right side of the colon
It is an obscure cause of rectal bleeding
How might yo diagnose colonic angiodysplasia?
CT angiogram - look for leaking (pools of contract)
Colonoscopy
Injection or surgical resection
How would you treat colonic angiodysplasia?
Embolisation
Endoscopic ablation
Surgical resection - rare
What are some causes of large bowel obstruction?
Colorectal cancer
Benign stricter
Volvulus
What is volvulus?
an obstruction caused by twisting of the stomach or intestine.
How might you treat large bowel obstruction?
Resuscitate
Operate
Stenting
What might some symptoms of large bowel obstruction be?
Constipation
Abdominal distention
Pain
Vomiting
Depends on where the obstruction is
Describe sigmoid volvulus?
When the sigmoid colon twists on the mesentery
It might become gangrenous
How could you diagnose sigmoid volvulus?
Plain X ray abdomen
Rectal contrast
How can you treat sigmoid volvulus?
Flatus tube
Surgical resection
what is Pseudo-obstruction?
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
Describe functional bowel disorders?
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
