*Intestinal Problems (lecture 5 and 6) Flashcards
What is GI diverticulum?
Mucosal herniation through muscle coat
What is the difference between diverticulum, diverticular disease, and diverticulitis?
Diverticulum means they are present
Divertiular disease means they are symptomatic
Diverticulitis means they are inflamed
Where do diverticulum most often occur?
Sigmoid colon
Do patients who develop diverticular disease tend to have a low or high fibre diet?
Low fibre intake
How are diverticulum diagnosed?
Barium enema
Sigmoidoscopy
Symptoms of diverticular disease?
Altered bowel habit
Left sided colic relieved by deification
Flatulence
Nausea
Symptoms of diverticulitis?
LIF pain/ tenderness
Septic
Altered bowel habit
Complications of diverticular disease? (5)
Pericolic abscess Perforation Haemorrhage (if it ruptures through a blood vessel) Fistula Stricture
Treatment of uncomplicated (bacterial infection with possible sepsis) diverticulitis?
Pain relief
Management in the community
Oral antibiotics
Treatment of complicated diverticulitis?
Hartmann’s procedure (proctosigmoidectomy)
Primary resection/ anastomosis
Precutaneous drainage - access around the bowel
Laparoscopic lavage and drainage - peritonitis
Causes of acute and chronic colitis?
Infective colitis
Ulcerative colitis
Crohns colitis
Ischaemic colitis
Causes of acute and chronic colitis?
Infective colitis
UC
Crohns colitis
Ischaemic colitis
Symptoms of acute and chronic colitis?
Diarrhoea with/ without blood Abdominal cramps Dehydration Sepsis Weight loss Anaemia
Diagnosis of acute and chronic colitis?
Plain x-ray
Stool culture
Sigmoidoscopy + biopsy
Barium enema (Not usually in acute colitis in order to prevent irritating the bowel)
What sign on an AXR is suggestive of colitis?
Thumb-printing - mucosal oedema
Treatment for UC/ Crohns colitis?
IV fluids
IV steroids (once infective/ ischaemic colitis ruled out)
GI rest
3 main types of bowel ischaemia?
Acute mesenteric ischaemia (almost always small bowel)
Chronic mesenteric ischaemia
Ischaemic colitis
Cause of ischaemic colitis?
Low flow in the inferior mesenteric artery
presentation of ischaemic colitis?
Lower left sided abdominal pin
+/- bloody diarrhoea
Tests for ischaemic colitis?
CT may be useful but colonoscopy and biopsy is the gold standard
What is colonic angiodysplasia?
angiodysplasia is a small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia. Lesions are often multiple, and frequently involve the cecum or ascending colon, although they can occur at other places.
How is colonic angiodysplasia diagnosed?
Can do a colonoscopy but would see much
Do a angiography and look for bleeding into the colon
How is colonic angiodysplasia treated?
Embolisation
Endoscopic ablation
Surgical resection
Causes of a large bowel obstruction? (3)
Colorectal cancer
Benign obstruction
Volvolus
Symptoms of a bowel obstruction?
Abdominal pain
Distension
Vomiting
Constipation
Treatment of a large bowel obstruction?
Resuscitate
Operate
What is a sigmoid volvulus?
An obstruction caused by the bowel twisting on it mesentery - may become gangrenous, can also cause ischaemia and subsequent perforation
How is a sigmoid volvulus diagnosed?
Plain AXR
Rectal contrast may need to be added
Can use CT non-invasively assess for ischaemia
Treatment of sigmoid volvulus?
Flatus tube to decompress colon Surgical resection (especially in younger patients when it has happened a few times
What is pseudo-obstruction?
a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterized by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen - like a mechanical obstruction but no cause found (in comparison to paralytic ileus when there is absence of normal peristaltic contractions (tends to be in elderly/ debilitated)
What is a functional bowel disorder?
In medicine, the term functional colonic disease (or functional bowel disorder) refers to a group of bowel disorders which are characterised by chronic abdominal complaints without a structural or biochemical cause that could explain symptoms.
What patients tend to get faecal impaction?
Elderly bed ridden patients on strong analgesics
What side does ischaemia of the large bowel tend to occur?
Left side
What heart condition can lead to ischaemia of the bowel?
A. fibrillation
Histopathological clues of ischaemic colitis?
Withering of crypts
Pink smudgy lamina propria
Fewer chronic inflammatory cells
Complications of ischaemic colitis?
Massive bleeding
Rupture
Stricture
What is pseudomembranous colitis?
acute, exudative colitis usually caused by Clostridium difficile
What antibiotics are used to treat severe pseudomembranous colitis/
Vancomycin and metronidzole (may need colectomy)
What toxins are involved with pseudomembranous colitis?
Toxins A and b - attack endothelium and epithelium
What causes normal mucosa and watery diarrhoea?
Biopsy showing large bands of collagen laid down?
Collagenous colitis
Features of collagenous colitis?
Thickened basement membrane
Disease is patchy
Associated with intraepithelial inflammatory cells
No chronic architectural changes
What causes watery diarrhoea with no mucosal change - normal crypt archicgeuctre but massive increase in intraepithelial lymphocytes on biopsy?
Lymphocytic colitis (in children this may be associated with coeliac disease)
Features of lymphocytic colitis?
No chronic architectural changes in crypts
Intraepithelial lymphocytes are raised
No thickening of BM
What is microscopic colitis?
Used to describe colitis that has features of both Collagenous colitis and lymphocytic colitis on biopsy - normal endoscopic appearance
What is radiation colitis?
Inflammation of large bowel due to radiation in that area e.g. cervix, prostate, etc.
Features of radiation colitis?
Telangectasia - small dilated blood vessels near the skin or mucous membrane surface
Bizarre stromal cells and vessels
Features of acute infective colitis?
Busy epithelium but no crypt irregularity
Florid diffuse acute cryptitis in otherwise unremarkable colonic mucosa
Is acute colitis always infective?
No, it could be the onset of IBD
