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Y4 Gastrointestinal > Benign conditions of the large bowel > Flashcards

Benign conditions of the large bowel Flashcards

1
Q

Define what diverticular disease is

A
  • Diverticulosis is an extremely common disorder characterised by multiple outpouchings of the bowel wall, most commonly in the sigmoid colon.
  • Strictly speaking the term diverticular disease is reserved for patients who are symptomatic - diverticulosis is the more accurate term for diverticula being present.
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2
Q

What are the risk factors for diverticulosis development ?

A
  • increasing age
  • low-fibre diet
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3
Q

What are the 2 main ways in which diverticulosis can present ?

A
  1. Diverticular disease
  2. Diverticulitis
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4
Q

What are the presenting features of diverticular disease ?

A
  • Colicky LLQ abdo pain - may be triggered by eating and may be relieved by the passage of stool or flatus.
  • Constipation, diarrhoea, or occasional large rectal bleeds.
  • Bloating and the passage of mucus rectally.
  • Abdo tenderness in the LLQ
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5
Q

How is diverticular disease diagnosed ?

A

By Colonoscopy or CT colonography

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6
Q

What complications can develop in patients with diverticular disease ?

A
  • Diverticulitis
  • Haemorrhage
  • Development of fistula
  • Perforation and faecal peritonitis
  • Perforation and development of abscess
  • Development of diverticular phlegmon
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7
Q

What is the treatment of diverticular disease ?

A

Increase dietry fibre

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8
Q

What is diverticulitis ?

A

It is the infection of a diverticulum, an out-pouching of the intestinal mucosa.

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9
Q

What are the risk factors for developing diverticulitis ?

A
  • Age - usually 50-70
  • Lack of dietary fibre
  • Obesity: especially in younger patients
  • Sedentary lifestyle
  • Smoking
  • NSAID use
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10
Q

What are the presenting features of diverticulitis ?

A
  • Severe abdo pain in the LLQ in particular the LIF (sometimes RLQ in asians)
  • Nausea and vomiting
  • Change in bowel habit: constipation or diarrhoea
  • Urinary frequency, urgency or dysuria
  • PR bleeding sometimes
  • Pyrexia, tachycardia
  • Guarding, rigidity and rebound tenderness may suggest complicated diverticulitis with perforation
  • Stricture and fistula formation — the presence of faecaluria, pneumaturia, or pyuria may suggest colovesical fistula.
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11
Q

How is diverticulitis diagnosed ?

A
  • Bloods - inflam markers
  • CT abdo & pelvis the best invesitgation
  • AXR may also be done to investigation for signs of obstruction
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12
Q

Why is colonoscopy avoided in patients with acute diverticulitis ?

A

Increases risk of perforation

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13
Q

What is the treatment of diverticulitis ?

A
  • 1st line = Oral antibiotics
  • 2nd line = IV antibiotics if symptoms dont settle after 72hrs
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14
Q

What may recurrent attacks of acute diverticulitis require treatment with ?

A

Segmental ressection

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15
Q

What is the treatment of peri-colonic abscess formation in patients with diverticular disease ?

A

Percutaneous Drainage

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16
Q

What do Hinchey IV perforations (generalised faecal peritonitis) for people with diverticular disease require ?

A

Surgical ressection and stoma (Hartmann’s procedure)

17
Q

Less severe perforations (< IV hicheny) may be managed via what for diverticular disease ?

A

Laparoscopic Lavage and Drainage

18
Q

What are the 4 main causes of acute & chronic colitis ?

A
  • Infective colitis - covered in gastroenteritis and infections decks
  • Ulcerative colitis - covered in IBD deck
  • Crohn’s colitis - covered in IBD deck
  • Ischaemic colitis - covered in IBD deck
19
Q

Define what angiodysplasia is

A
  • It is vascular deformity of the GI tract most commonly occuring between the caecum and ascending colon (right side of colon)
  • It is caused by the formation of arteriovenous malformations
20
Q

What are the characteristic presenting features of angiodysplasia ?

A
  • PR bleeding (usually painless and chronic) and anaemia
  • Note it can cause actue bleeding tho
21
Q

How is angiodysplasia diagnosed ?

A
  • 1st line = Colonoscopy - will see submucosal lakes of blood
  • Do mesenteric angiography if acutely bleeding
22
Q

What is the treatment of angiodysplasia ?

A
  • For mild cases 1st line = IV fluids + Tranexamic acid (oestrogens may also be used)
  • For severe or persistent cases 1st line = endoscopic cautery or argon plasma coagulation

Y4 Gastrointestinal (28 decks)

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