Benign conditions of the large bowel Flashcards
what are 5 common diseases of the large bowel?
1) carcinoma of the colon and rectum
2) colonic polyps
3) diverticulum disease
4) Crohn’s colitis & ulcerative colitis
5) functional disease
what are 4 less common diseases of the large bowel?
1) colonic volvulus
2) colonic angiodysplasia
3) ischaemic colitis
4) pseudo-obstruction
what is diverticular disease?
= mucosal herniation through the muscle coat
where is diverticular disease most common?
= sigmoidal colon
what is a high risk factor for developing diverticular disease?
= low fibre diet
describe diverticulosis and diverticulitis.
= 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.
what are 3 ways to diagnose diverticulosis?
1) clinical
2) barium enema
3) sigmoidoscopy
what are 3 clinical features of diverticulitis?
- Left iliac Fossa pain/tenderness
- septic
- altered bowel habit
what are 5 complications of diverticular disease?
1) peri-colic abscess
2) perforation
3) haemorrhage
4) fistula
5) stricture
describe hinchey classification for acute diverticulitis?
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
what 3 things would you use to treat uncomplicated diverticulitis?
1) IV fluids
2) bowel rest
3) IV antibiotics
describe how you would treat complicated diverticulitis?
1) NO IV fluids
2) NO bowel rest
3) IV antibiotics = oral or none
what 4 treatments could you use for complex diverticulitis?
1) Percutaneous drainage
2) Hartmann’s Procedure
3) Laparoscopic lavage and drainage
4) Primary resection/anastomosis
what are 4 causes of acute and chronic colitis?
1) infective colitis
2) ulcerative colitis
3) Crohn’s colitis
4) ischaemic colitis
what are symptoms of acute and chronic colitis?
1) diarrhoea +/- blood
2) abdominal cramps
3) dehydration
4) sepsis
5) weight loss, anaemia
how would you diagnose acute and chronic colitis?
1) Plain x-ray
2) sigmoidoscopy + biopsy
3) stool culture
4) barium enema
how would you treat ulcerative colitis/crohn’s colitis?
1) IV fluids
2) IV steroids - once infective/ischaemic colitis is ruled out
3) GI rest
if ulcerative colitis/Crohn’s colitis fails to settle, how would you treat it?
1) rescue medical therapy
2) surgery
who is likely to acquire ischaemic colitis?
1) elderly
2) arteriopaths
what 2 things can cause ischaemic colitis?
1) acute or chronic occlusion
2) inferior mesenteric artery
what is colonic angiodysplasia?
= sub-mucosal lakes of blood
what is angiodyasplasia an obscure cause of?
= obscure cause of rectal bleeding
where does colonic angiodysasplia usually occur?
= right side of colon
how would you diagnose colonic angiodyasplasia?
1) angiography
2) colonoscopy
3) injection or surgical resection
how would you treat colonic angiodysplasia? (3)
1) embolisation
2) endoscopic ablation
3) surgical resection
what are 3 causes of bowel obstruction?
1) colorectal cancer
2) benign structure
3) volvulus
usually, how would you treat large bowel obstruction?
1) resuscitate
2) operate
3) stenting
what are 2 causes of sigmoidal volvulus, a cause of bowel obstruction?
1) bowel twists on mesentery
2) may become gangrenous
how would you diagnose sigmoidal volvulus?
1) plain x-ray abdo
2) rectal contrast
how would you treat sigmoidal volvulus?
= flatus tube
= surgical resection
what is psuedo-obstruction?
1) no real mechanism of obstruction
who often gets pseudo-obstruction?
1) elderly patients
2) those who are debilitated
what are 2 potential causes of pseudo-obstruction?
1) hypoxia
2) bio-chem
what is an example of function bowel disorder?
= chronic constipation
what would be the cause of the majority of people with chronic constipation?
= dietary or laxatives
what would be the cause of minority of people with chronic constipation?
= motility disorders
what is a 2nd example of functional bowel disorder?
= faecal impaction
who is likely to get faecal impaction?
= bed ridden, elderly
what is a common cause of faecal impaction?
= strong analgesics
how would you treat faecal impaction?
= enemas
= laxatives
= manual evacuation
