Benign conditions of the large bowel Flashcards
what are some of the common disease of the large bowel
carcinoma of the colon and rectum colonic polyps crohns colitis, ulcerative colitis diverticular disease functional disorders
what are the less common diseases of the large bowel
colonic volvulus
colonic angiodysplasia
ischaemic colitis
pseudo-obstruction
what is diverticular disease
mucosal herniation through muscle coat
what is diverticular disease most common
sigmoid colon
how is diverticulosis diagnosed
clinical
barium enema
sigmoidoscopy
what are the clinical features of diverticulitis
LIF pain/tenderness
septic - confusion, hypotension, low urine output
altered bowel habit
what are the complications of diverticular disease
pericolic abscess perforation haemorrhage fistula (communications between two epithelialed structures which isnt normal) stricture
how does fistulation into the bladder present
urine is bubbly, recurrent UTIs in men
how is acute diverticulitis classified
Hinchey classification
stage 0 (clinical mild)
stage 1a (confined pericolic inflammation and phlegmonous inflammation)
stage 1b - abscess formation less 5cm in the proximity of primary inflammatory process
stage2- intraabdominal abscess,pelvic, retroperitoneal
stage3- generalised purulent peritonitis
stage 4 - fecal peritonitis
how is simple diverticulitis treated
antibiotics
how is complex diverticulitis treated
Hartmann’s procedure
primary resection/
anastomosis
percutaneous drainage
laparoscopic lavage and drainage
what are the causes of acute and chronic colitis
infective colitis
ulcerative colitis
crohns colitis
ischaemic colitis
what are the symptoms of acute and chronic colitis
diarrhoea ± blood abdominal cramps dehydration sepsis wt loss, anaemia
how do you diagnose acute and chronic colitis
plain xray
sigmoidoscopy +biopsy
stool cultures
barium enema
what are the treatments for ulcerative colitis/crohns colitis
IV fluids
IV steroids - once infection is rules out
GI rest
if failure to settle - rescue medical therapy, surgery
who is affected by ischaemic colitis
elderly
arteriopaths
how does ischaemic colitis occur
acute or chronic occulsion
inferior mesenteric artery blocked off supply to colon
what is colonic angiodysplasia
submucosal lakes of blood
obscure cause of rectal bleeding
usually right side of colon
how is colonic angiodysplasia diagnosed
angiography
colonscopy
injection or surgical resection
what is the treatment for colonic angiodysplasia
embolisation
endoscopic ablation
surgical resection
what are the causes of large bowel obstruction
colorectal cancer
benign strictures
volvulus
what is the treatment for large bowel obstruction
usually resusitate
operate
stenting?
what is the cause of sigmoid volvulus
bowel twists on mesentery
may become gangrenous
how is sigmoid volvulus diagnosed
plain xray abdo
rectal contrast
