Benign conditions of the large bowel Flashcards
Common large bowel disease
Carcinoma of colon and rectum Colonic polyps Crohn's colitis and Ulcerative colitis Diverticular disease Functional disorders
Less common bowel disease
Colonic volvulus
Colonic angiodysplasia
Ischaemic colitis
Pseudo-obstruction
What is diverticular disease
Mucosal herniation through the muscle coat (inner lining of intestine being squeezed through the muscle coat wall)
Happens in the sigmoid colon
Often due to low fibre intake
Either diverticulosis or diverticulitis
What is the difference between diverticulosis and diverticulitis
Diverticulosis - mucosal herniation through muscle wall
Diverticulitis- infection of the mucosal herniation
Complications of diverticular disease
Pericolic abscess Perforation Haemorrhage Fistula Stricture (narrowing/tightening)
Hinchey classification for acute diverticulitis
Stage 0 - clinically mild diverticulitis (oral antibiotics)
Stage 1a - confined pericolic inflammation and (IV antibiotics) phlegmonous inflammation
Stage 1b - abscess formation (<5cm) (IV antibiotics)
Stage 2- intra-abdominal abscess, pelvic or retroperitoneal abscess, abscess distant from the primary inflammatory process (percutaneous drainage)
Stage 3 - generalized purulent peritonitis (laprascopic drainage)
Stage 4 - faecal peritonitis (primary resection)
Treatment for uncomplicated diverticulitis
IV antibiotics
Treatment for complex diverticulitis
Percutaneous drainage
Laprascopic lavage and drainage
Causes of acute and chronic colitis
Infective colitis
Ulcerative colitis
Crohn’s colitis
Ischaemic Colitis
Symptoms of acute and chronic colitis
Diarrhoea +- blood Abdominal cramps Dehydration Sepsis Weight loss, anaemia
How to diagnose acute and chronic colitis
Plain x-ray
Sigmoidoscopy + biopsy
Stool cultures
Barium enema
Treatments for UC/ crohns
IV fluids
IV steroids - once infective/ischemic colitis is ruled out
GI rest
What treatment if UC/crohns fails to settle
rescue medical therapy
surgery
What causes ischaemic colitis
Acute or chronic occlusion of the inferior mesenteric artery
What is colonic angiodysplasia
submucosal lakes of blood
Obscure cause of rectal bleeding
Usually right side of colon
How is colonic angiodyplasia diagnosed
Angiography
Colonoscopy
Injection or surgical resection
Treatment for colonic angiodysplasia
embolization
endoscopic ablation
surgical resection
Causes of large bowel obstruction
Colorectal cancer
Begin stricture
Volvulus
Treatment for large bowel obstruction
Resusitate
Operate
Stenting
Causes of sigmoid volvulus
Bowel twists on mesentery
May become gangrenous
How do you diagnose a sigmoid volvulus
Plain x-ray abdomen
rectal contrast
Treatment fort sigmoid volvulus
Flatus tube
Surgical resection
What is pseudo-obstruction
No real mechanism of obstruction
Happens in the eldery/debilitated - general illness
Hyppoxia
Functional bowel disorders
Chronic constipation
Faecal Impaction
