Benign conditions of the large bowel Flashcards
Define what diverticular disease is
- 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.
What are the risk factors for diverticulosis development ?
- increasing age
- low-fibre diet
What are the 2 main ways in which diverticulosis can present ?
- Diverticular disease
- Diverticulitis
What are the presenting features of diverticular disease ?
- 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
How is diverticular disease diagnosed ?
By Colonoscopy or CT colonography
What complications can develop in patients with diverticular disease ?
- Diverticulitis
- Haemorrhage
- Development of fistula
- Perforation and faecal peritonitis
- Perforation and development of abscess
- Development of diverticular phlegmon
What is the treatment of diverticular disease ?
Increase dietry fibre
What is diverticulitis ?
It is the infection of a diverticulum, an out-pouching of the intestinal mucosa.
What are the risk factors for developing diverticulitis ?
- Age - usually 50-70
- Lack of dietary fibre
- Obesity: especially in younger patients
- Sedentary lifestyle
- Smoking
- NSAID use
What are the presenting features of diverticulitis ?
- 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.
How is diverticulitis diagnosed ?
- Bloods - inflam markers
- CT abdo & pelvis the best invesitgation
- AXR may also be done to investigation for signs of obstruction
Why is colonoscopy avoided in patients with acute diverticulitis ?
Increases risk of perforation
What is the treatment of diverticulitis ?
- 1st line = Oral antibiotics
- 2nd line = IV antibiotics if symptoms dont settle after 72hrs
What may recurrent attacks of acute diverticulitis require treatment with ?
Segmental ressection
What is the treatment of peri-colonic abscess formation in patients with diverticular disease ?
Percutaneous Drainage
What do Hinchey IV perforations (generalised faecal peritonitis) for people with diverticular disease require ?
Surgical ressection and stoma (Hartmann’s procedure)
Less severe perforations (< IV hicheny) may be managed via what for diverticular disease ?
Laparoscopic Lavage and Drainage
What are the 4 main causes of acute & chronic colitis ?
- 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
Define what angiodysplasia is
- 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
What are the characteristic presenting features of angiodysplasia ?
- PR bleeding (usually painless and chronic) and anaemia
- Note it can cause actue bleeding tho
How is angiodysplasia diagnosed ?
- 1st line = Colonoscopy - will see submucosal lakes of blood
- Do mesenteric angiography if acutely bleeding
What is the treatment of angiodysplasia ?
- 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
