Benign conditions of the Large bowel Flashcards
what are some less common diseases of the large bowel?
Colonic volvulus
Colonic angiodysplasia
Ischaemic colitis
Pseudo-obstruction
what is the most common endoscopically diagnosed disease in >50s?
diverticulitis disease
what is a diverticulum?
out-pouching of viscera through its coat
mucosa and organ pertrudes through muscle coat
where is diverticular disease most common?
sigmoid colon
as most affected by low fibre diet
what is the difference between diverticulosis and diverticulitis?
colonoscopy finding
inflammation of diverticular disease
how can diverticulosis be diagnosed?
barium enema
sigmoidoscopy
can the diverticulum be bigger than the actual lumen?
yes
risk as scope could go down wrong lumen rather than the true lumen
what are the clinical features of diverticulitis?
LIF pain/tenderness
septic (high RR/HR, fever)
altered bowel habit
may mirror appendicitis
what are the possible complications of diverticular disease?
pericolic abscess
performation (faeces in abdominal cavity, pain, “at deaths door”)
haemorrhage
fistula (communication between 2 epithelial surfaces - eg between colon and bladder = coloviscical fistula, colovaginal fistula)
stricture
what preceeds a fistula usually?
pericolonic abscess
how might a coloviscical fistula present?
recurrent UTI
passing bubbles when peeing (pneumaturia)
how might a colovaginal fistula present?
recurrent infections
apart from diverticular disease, what can cause colonic strictures?
chronic colitis
tumours
how is diverticulitis staged?
Hinchey classification
Stage 0 = clinically mild = oral antibiotics
Stage Ia = IV
Stage Ib = IV
Stage II = percutaneous drainage
Stage III = laparoscopic lavage/drainage
Stage IV = faecal peritonitis = primary resection
how is uncomplicated diverticulitis treated?
oral or no antibiotics
how is complex diverticulitis treated?
percutaneous drainage
Hartmanns procedure
Laparoscopic lavage and drainage
primary resection/anastamosis
what is colitis?
inflammation of the colon
what are the most common causes of colitis?
infective colitis (campylobacter = gap year, E.coli)
ulcerative colitis
crohns colitis
ischaemic colitis
what are the symptoms of colitis?
diarrhoea with blood abdominal pain dehydration sepsis chronic: - weight loss - anaemia
what happens to haemoglobin levels in large blood loss?
stays the same
blood isn’t diluted just less of it so same concentration of Hb
how is colitis diagnosed?
plain X ray sigmoidoscopy + biopsy stool culture barium enema (not common) show: - featureless left colon (lead piping) - thumb printing on right side = severe mucosal inflammation
who tends to get C. Diff colitis?
if taking one of the 4 antibiotics of C diff
how is ulcerative/crohns colitis treated?
IV fluids IV steroids - once infective colitis ruled out GI rest If failure to settle in 4/5 days: - rescue medical therapy - surgery
how can you tell if a patient has settled?
monitor stool habits
monitor vital signs (HR, inflammatory markers etc)
what causes ischaemic colitis?
elderly arteriopaths acute/chronic occlusion inferior mesenteric artery vascular problem so same risks as CVD
what is a watershed infarct?
grey areas between 3 arteries of supply to an organ
Commonest site of colitis in ischaemic colitis as not receiving immediate blood flow
where does ulcerative colitis begin?
rectum
where can crohns affect?
anywhere in GI tract
most commonly in terminal ileum
what is colonic angiodysplasia?
submucosal lakes of blood, usually in right side of colon
obscure cause of rectal bleeding
how is colonic angiodysplasia investigated?
angiography (usually CT)
colonoscopy
injection or surgical resection (rare)
how is colonic angiography treated?
embolization
endoscopic ablation
surgical resection
what can cause a large bowel obstruction?
volvulus (twisting of bowel on mesentery - common in sigmoid, can become gangrenous)
benign stricture
colorectal cancer
how is large bowel obstruction treated?
rescusitate
operate
stenting
how can you tell the small and large intestine apart?
small = more red large = more whitish, has fatty appendages
what are the signs of large bowel obstruction?
abdominal distension complete constipation abdominal pain vomiting (faecal vomiting?) order in which symptoms appear can help tell where obstruction is
who is sigmoid volvulus common in? how is it treated?
elderly
constipated
surgical resection or flatus tube or possibly via coloscopy if unsuitable
how is sigmoid volvulus diagnosed?
AXR
rectal contrast
what is a pseudo-obstruction?
has all the signs and symptoms of complete obstruction but no actual obstruction
common in elderly/debilitated
how are most cases of chronic constipation treated?
diet
laxatives
more rarely = motility disorders
who is likely to get faecal impaction?
how is it treated?
elderly, bed ridden
people on strong analgesics
enemas, laxatives
manual evacuation
