Large bowel disease Flashcards
What is diverticulosis?
Asymptomatic finding of diverticular disease; encourage a high fibre diet.
How does diverticulasr disease present?
Intermittent lower left quadrant pain that is relived by the passage of stool or flat is.
Are small amounts of bleeding likely to be divertciualr disease?
No, divertciular disease usually presents with episodes of large bleeding due to erosion of blood vessels.
Typical diverticula disease patient?
Elderly woman with LLq pain.
Investigation and management of diverticular disease?
1) Colonscopy
2) CT colonography
Rx = analgesia and high fibre diet.
How does diverticulitis present?
Severe constant LIF pain.
Altered bowel habit +/- rectal bleeding
Fever, tachycardai
What would a swinging fever and high WCC suggest?
An abscess
Investigation of diverticulitis?
Erect CXR (rule out perforation) AXR (assess for obstruction)
If no history of diverticular disease, CT abdo/USS
Colonoscopy CI’d due to risk of perforation.
Management of diverticulitis?
Fluid
Amox met and gent
If perforate and obstructed - most likely a hartmann’s procedure.
What part of the colon is usually affected by diverticular disease?
Sigmoid colon.
How does ischamia of the large bowel tend to present?
Ischaemia of the large bowel tends to be due to chronic Lowe flow which differed from small bowel which tends to be ana cute presentation.
Most likely to occur at splenic flexure due to this being a watershed area of blood supply.
Presentation: intermittent lower/upper left quadrant pain with rectal bleeding, diarrhoea, history of PVD.
What does an AXR/barium need a show in large bowel ischaremia?
Mucosal thumb printing.
Diagnostic tests for large bowel ischaemia?
Sigmoidoscopy + biopsy = withering crypts.
Mesenteric angiography.
What is angiodysplasia?
Submucosal AVM of unknown origin,majority develop on R side of colon.
How does angiodysplasia present?
Fresh, intermittent, PR bleeding.
Detecting of anaemia on FBC.
No mass on PR.
