Benign conditions of the large bowel

Question 1

what are 5 common diseases of the large bowel?

Answer 1

1) carcinoma of the colon and rectum
2) colonic polyps
3) diverticulum disease
4) Crohn’s colitis & ulcerative colitis
5) functional disease

Question 2

what are 4 less common diseases of the large bowel?

Answer 2

1) colonic volvulus
2) colonic angiodysplasia
3) ischaemic colitis
4) pseudo-obstruction

Question 3

what is diverticular disease?

Answer 3

= mucosal herniation through the muscle coat

Question 4

where is diverticular disease most common?

Answer 4

= sigmoidal colon

Question 5

what is a high risk factor for developing diverticular disease?

Answer 5

= low fibre diet

Question 6

describe diverticulosis and diverticulitis.

Answer 6

= Diverticulosis occurs when small, bulging pouches (diverticula) develop in your digestive tract.
- When one or more of these pouches become inflamed or infected, the condition is called diverticulitis.

Question 7

what are 3 ways to diagnose diverticulosis?

Answer 7

1) clinical
2) barium enema
3) sigmoidoscopy

Question 8

what are 3 clinical features of diverticulitis?

Answer 8

• Left iliac Fossa pain/tenderness
• septic
• altered bowel habit

Question 9

what are 5 complications of diverticular disease?

Answer 9

1) peri-colic abscess
2) perforation
3) haemorrhage
4) fistula
5) stricture

Question 10

describe hinchey classification for acute diverticulitis?

Answer 10

Stage 0 = clinically mild

Stage Ia = confided pericolic inflammation and phlegmonous inflammation

Stage Ib = abscess formation (<5cm) in proximity of primary inflammatory process

Stage II = intra-abdominal abscess, pelvic or retro-peritoneal abscess, abscess distant from primary inflammatory process

Stage III = generalised purulent peritonitis

Stage IV = fecal peritonitis

Question 11

what 3 things would you use to treat uncomplicated diverticulitis?

Answer 11

1) IV fluids
2) bowel rest
3) IV antibiotics

Question 12

describe how you would treat complicated diverticulitis?

Answer 12

1) NO IV fluids
2) NO bowel rest
3) IV antibiotics = oral or none

Question 13

what 4 treatments could you use for complex diverticulitis?

Answer 13

1) Percutaneous drainage
2) Hartmann’s Procedure
3) Laparoscopic lavage and drainage
4) Primary resection/anastomosis

Question 14

what are 4 causes of acute and chronic colitis?

Answer 14

1) infective colitis
2) ulcerative colitis
3) Crohn’s colitis
4) ischaemic colitis

Question 15

what are symptoms of acute and chronic colitis?

Answer 15

1) diarrhoea +/- blood
2) abdominal cramps
3) dehydration
4) sepsis
5) weight loss, anaemia

Question 16

how would you diagnose acute and chronic colitis?

Answer 16

1) Plain x-ray
2) sigmoidoscopy + biopsy
3) stool culture
4) barium enema

Question 17

how would you treat ulcerative colitis/crohn’s colitis?

Answer 17

1) IV fluids
2) IV steroids - once infective/ischaemic colitis is ruled out
3) GI rest

Question 18

if ulcerative colitis/Crohn’s colitis fails to settle, how would you treat it?

Answer 18

1) rescue medical therapy

2) surgery

Question 19

who is likely to acquire ischaemic colitis?

Answer 19

1) elderly

2) arteriopaths

Question 20

what 2 things can cause ischaemic colitis?

Answer 20

1) acute or chronic occlusion

2) inferior mesenteric artery

Question 21

what is colonic angiodysplasia?

Answer 21

= sub-mucosal lakes of blood

Question 22

what is angiodyasplasia an obscure cause of?

Answer 22

= obscure cause of rectal bleeding

Question 23

where does colonic angiodysasplia usually occur?

Answer 23

= right side of colon

Question 24

how would you diagnose colonic angiodyasplasia?

Answer 24

1) angiography
2) colonoscopy
3) injection or surgical resection

Question 25

how would you treat colonic angiodysplasia? (3)

Answer 25

1) embolisation
2) endoscopic ablation
3) surgical resection

Question 26

what are 3 causes of bowel obstruction?

Answer 26

1) colorectal cancer
2) benign structure
3) volvulus

Question 27

usually, how would you treat large bowel obstruction?

Answer 27

1) resuscitate
2) operate
3) stenting

Question 28

what are 2 causes of sigmoidal volvulus, a cause of bowel obstruction?

Answer 28

1) bowel twists on mesentery

2) may become gangrenous

Question 29

how would you diagnose sigmoidal volvulus?

Answer 29

1) plain x-ray abdo

2) rectal contrast

Question 30

how would you treat sigmoidal volvulus?

Answer 30

= flatus tube

= surgical resection

Question 31

what is psuedo-obstruction?

Answer 31

1) no real mechanism of obstruction

Question 32

who often gets pseudo-obstruction?

Answer 32

1) elderly patients

2) those who are debilitated

Question 33

what are 2 potential causes of pseudo-obstruction?

Answer 33

1) hypoxia

2) bio-chem

Question 34

what is an example of function bowel disorder?

Answer 34

= chronic constipation

Question 35

what would be the cause of the majority of people with chronic constipation?

Answer 35

= dietary or laxatives

Question 36

what would be the cause of minority of people with chronic constipation?

Answer 36

= motility disorders

Question 37

what is a 2nd example of functional bowel disorder?

Answer 37

= faecal impaction

Question 38

who is likely to get faecal impaction?

Answer 38

= bed ridden, elderly

Question 39

what is a common cause of faecal impaction?

Answer 39

= strong analgesics

Question 40

how would you treat faecal impaction?

Answer 40

= enemas
= laxatives
= manual evacuation