Large Bowel - Benign Conditions Flashcards
Common Conditions of the Large Bowel
Carcinoma of colon and rectum Colonic polyps Crohn's colitis and Ulcerative colitis Diverticular disease Functional disorders
Less Common conditions of the Large Bowel
Colonic volvulus
Colonic angiodysplasia
Ischaemic colitis
Pseudo-obstruction
What is diverticular disease?
Muscle herniation through the muscle coat
Diverticular Disease - Common Site
Sigmoid colon
Diverticular Disease - Common Cause
Low fibre intake
Diverticulitis - Clinical Features
LIF pain/tenderness
Septic
Altered bowel habit
Diverticulitis - Diagnosis
Clinical
Barium enema
Sigmoidoscopy
Diverticular Disease - Treatment
IV fluids
Bowel rest
IV antibiotics
Surgery = No improvement or complications
Diverticular Disease - Complications
Pericolic Abscess Perforation Haemorrhage Fistula Stricture
Diverticular Disease - Surgical Operation
Hartmann’s procedure
Primary resection/anastamosis
Acute and Chronic Colitis - Causes
Infective colitis
Ulcerative colitis
Crohn’s colitis
Ischaemic colitis
Acute and Chronic Colitis - Symptoms
Diarrhoea +/- blood Abdominal cramps Dehydration Sepsis Weight loss, anaemia
Acute and Chronic Colitis - Diagnosis
Plain X-Ray
Sigmoidoscopy + biopsy
Stool cultures
Barium enema
Ulcerative Colitis/Crohn’s - Treatment
IV fluids
IV steroids (once infective/ischaemic colitis is ruled out)
GI rest
Features of Ischaemic Colitis
Elderly
Arteriopaths
Acute or chronic occlusion
Commonly inferior mesenteric artery
Colonic Angiodysplasia - Features
Submucosal lakes of blood
Obscure cause of rectal bleeding
Usually right side of colon
Colonic Angiodysplasia - Diagnosis
Difficult
Angiography
Colonoscopy
Injection or surgical resection
Colonic Angiodysplasia - Treatment
Embolisation
Endoscopic ablation
Surgical resection
Large Bowel Obstruction - Causes
Colorectal cancer
Sigmoid or caecal volvulus
Pseudo-obstruction
Faecal impaction
Large Bowel Obstruction - Treatment
Usually:
Resuscitate
Operate
Sigmoid Volvulus - Cause
Bowel twists on mesentery
May become gangrenous
Sigmoid Volvulus - Diagnosis
Plain Abdo X-Ray
Rectal contrast
Sigmoid Volvulus - Treatment
Flatus tube
Surgical resection
Features of Pseudo-Obstruction
No real mechanical obstruction
Elderly/debilitated
Hypoxia
Biochemistry
Functional Bowel Disorders - Most Cases of Chronic Constipation
Dietary causes
Laxatives to treat
Functional Bowel Disorders - Rarer Cases of Chronic Constipation
Motility Disorders
Functional Bowel Disorders - Faecal Impaction
Be ridden, elderly
May be on strong analgesics
Treat with enemas, laxatives
May need manual evacuation
A 70-year-old woman with a history of atrial fibrillation presents with central abdominal pain and diarrhoea. A metabolic acidosis is found on the arterial blood gas
Mesenteric ischaemia
