Diverticula disease and colonic and anal disorders Flashcards
Define diverticular disease and diverticulitis
A diverticulitum refers to an out-pouching of the mucosa through the muscular wall with the peritoneum still intact. Diverticulitis refers to the inflammation of these diverticula.
Clinical features of diverticular disease and diverticulitis
Diverticular disease
- Most patients are asymptomatic
- Altered bowel habit
Diverticulitis
- Left iliac fossa pain and pyrexia
- Abrupt intermittent PR bleeding may occasionally occur
Investigations for diverticulitis
- Bloods - ↑WCC, ↑CRP
- Contrast enhanced CT - best modality to look for abscess formation or active inflammation
- Flexible sigmoidoscopy - may be necessary to exclude a more sinister cause
Management of asymptomatic divertcular disease
- Encourage a high fibre diet
- Relieve constipation with laxatives
Management of mild diverticulitis
- Encourage oral hydration and bowel rest
- 7-day course of oral co-amoxiclav and metronidazole
Management of severe diverticulitis
- Patients should be admitted and made NBM from admission
- IV fluids, analgesia and supportive therapy should be offered
- Commence IV antibiotics promptly (based on local guidance)
- Consider surgery if indicated
Management of complications of diverticulitis
- Perforation - urgent surgical resection
- Major haemorrhage - radiologically guided embolisation
- Abscess - IV antibiotics and US/CT guided drainage
- Strictures - surgical resection or stent insertion
What are polyps?
Polyps are abnormal growths that protrude from a membranous surface. They may occur anywhere in the body that has a mucus membrane, from the nasal cavity or uterine cavity to the colon.
Definition of adenomas
How can adenomas be subdivided?
Adenomas are composed of benign, dysplasia tissue and arise from columnar epithelium or glandular tissue. They can be subdivided based on their glandular morphology, into tubular, tubulovillous or villous subtypes.
Features of adenomas which are associated with a higher risk of malignant transformation
- Size >1.5cm
- Multiple polyps >5
- Sessile and villous nature
NICE recommends regular colonoscopic surveillance after the initial polypectomy.
What should be the frequency of follow up?
- Annually: ≥5 polyps or ≥3 with at least one >1cm
- Every 3 years: >3 polyps or at least one >1cm
- Every 5 years: 1-2 polyps, all of which <1cm
Familial adenomatous polyposis
Inheritance?
Genetics?
- Inheritance: autosomal dominant
- Genetics: APC gene on chromosome 5
Clinical features of familial adenomatous polyposis
Presents with hundreds to thousands of adenomas, which develop predominantly in the colon and rectum. They can also arise in the small bowel and stomach.
Management of familial adenomatous polyposis
- 90% of patients with FAP will eventually develop cancer if untreated
- Early prophylactic colectomy and lifelong follow-up is the best treatment option to prevent cancer development
- First-degree relatives should be offered genetic testing
Define colorectal cancer
Colorectal cancer refers to a carcinoma that arises from the mucosa of the colon or rectum. About two-thirds of CRCs occur in the colon and the remaining third in the rectum. The majority are adenocarcinomas (95%), typically developing from a polyp.