Large bowel pathology

Question 1

Colonic diverticulosis definition and pathogenesis

Answer 1

Diverticula are pouches in the colon that are inflamed. The mucosa and submucosa penetrate the colonic muscle layer.

Originate due to weakness in muscle layer of intestine

More frequent in descending colon specially sigmoid !

Question 2

Colonic diverticulosis: clinical manifestations

Answer 2

Normally no symptoms! –> until it becomes diverticulitis

Symptoms can be same as appendicitis but on opposite side (sigmoid)

Question 3

Can be divided into 3 groups

Answer 3

Acute diverticulitis = most frequent due to 1 small diverticulum

Non-complicated: moderate inflammation only

Complicated diverticulitis: perforation to peritoneal cavity –> 2% generates fistula

Question 4

Diagnostic methods

Answer 4

Endoscopy

X-ray = Barium CT scan will show black dots which is the diverticula

Question 5

Lower intestinal bleeding has different forms of manifestations

Answer 5

Occult bleeding = hidden blood in feces

Rectorrhagia = rectal bleeding not associated with feces

Hematochezia = fresh blood through anus in or with stool

Question 6

Cause of lower intestinal bleeding (LIB)

Answer 6

Most common: Diverticulosis due to artery destruction from the diverticulum that has formed (hematochezia)

Angiodisplasia = small vascular malformation of the gut

Question 7

Other causes of LIB

Answer 7

Tumors
Hemorrhoids 
Meckels diverticlulum
Colitis
Ischemic colitis

Question 8

Colon cancer

Answer 8

Second cause of cancer death worldwide.

Question 9

Colon cancer: Clinical manifestation comes in advanced stage and depends on location.

Diagnosis?

Answer 9

Right sided colon tumor grow slowly before showing symptoms

Left sided tumors cause obstruction and symptoms earlier as the last portion of colon is narrower!

Diagnostic methods: Colonoscopy, X-ray and biopsy!