Large Bowl Benign Flashcards
what are the common benign conditions of the large bowl
- Crohn’s colitis and ulcerative colitis
- Diverticular disease
- Functional disorders
- benign polyps
- ischaemic colitis
what are the less common bening conditions of the large bowl
- Colonic volvulus
- Colonic angiodysplasia
- Ischaemic colitis
- Pseudo-obstruction
what is diverticular disease
Mucosal herniation through muscle coat
where is diverticular disease most common
in the sigmoid colon
what is the difference between a true and a false diverticula
True diverticula of the GI tract contain all layers of the GI wall. Esophageal diverticula and Meckel diverticula are true diverticula. False or pseudo-diverticula are mucosal and submucosal protrusions through the muscular wall of the bowel.
what can cause a diverticulum
congenital, low fibre diet
what causes the symptoms
complication of diverticulum- most often no problems and is an incidental finding
what is diverticulosis
the presence of an acquired diverticula
what is diverticulitis
diverticulum associated with inflammation
what investigations can be done into a diverticulosis
barium enema, colon/sigmoidoscopy
what are the clinical features of diverticulitis
left iliac fossa pain/ tenderness (can mimic appendicitis if moves to RIF)
septic
altered bowl habits
what are the possible complications of diverticular disease
pericolic abscess, perforation, haemorrhage, fistula, stricture
what is a fistula
abnormal communication between two epithelial lined surfaces
what types of fistula can occur from diverticular disease
colovesical (bowl and bladder)
colovaginal
colocutaneal (bowl and abdominal wall)
what is the presentation of a colovesical fistula
recurring UTIs, pneumaturia (passing air)
when is a colovaginal fistula more common
in patients who have had a hysterectomy
what classification is used for acute diverticulitis
hinchey classification
how is an uncomplicated diverticulitis treated
oral or no antibiotics
how is a complex diverticulitis treated
hartmann’s procedure (surgical resection creating colostomy)
primary resection/ anastomosis
percutaneous drainage
laproscopic lavage and drainage
what stage of a complex diverticulitis should get an emergency operation
stage 4- faecal peritonitis
what are the causes of acute and chronic colitis
infective colitis
ulcerative colitis
crohns colitis
ischaemic colitis
what organisms can cause infective colitis
Shigella, Salmonella, Campylobacter, Escherichia coli, Clostridium difficile
what are the symptoms in acute and chronic colitis
diarrhoea +/- blood, abdo cramps, dehydration, sepsis
chronic= weight loss, anaemia
what investigations can be done into acute and chronic colitis
x ray, sigmoidoscopy + biopsy, stool cultures, barium enema
what is seen on an x ray of acute/ chronic colitis
featureless left colon (lead piping), ‘thumb-printing’ of right colon (sign of severe mucosal inflammation)
what patients are likely to get infective colitis from C. diff
people on broad range antibiotics or who are immunosuppressed
what is the treatment for ulcerative/ crohns colitis
IV fluids (fluid resus), IV steroids (once infective/ ischaemic colitis ruled out), GI rest
what are the signs of failure to settle of ulcerative/ crohns colitis
obs- tachycardia, stool chart, re- image, inflammatory response/ markers, how patients feels
what should be when UC/ crohns colitis fails to settle after treatment
rescue medical therapy, surgery
what are the risk factors for atherosclerosis
obesity, diabetes, hyperlipidaemia, smoking, hypertension,
how is acute bowl ischaemia treated
emergency surgery
how does bowl ischaemia kill
as bodys inflammatory response is overwhelming
what are the three main arteries that supply the colon
inferior mesenteric, middle colic (transverse), ileocolic (cecum and terminal ileum)
what is a watershed stroke
when area naturally has less blood supply so is more prone to ischaemia- e.g. splenic flexure in the bowl
where does ulcerative colitis affect
starts in rectum and moves proximally
where is the most common place affected by crohns
terminal ileum
what is colonic angiodysplasia
vascular malformation in the colon, submucosal lakes of blood- obscure cause of rectal bleeding
how is colonic angiodysplasia treated
embolisation, endoscopic ablation and surgical resection
what are three causes of large bowl obstruction
colorectal cancer, benign stricture (diverticular diverticular disease), UC), volvulus
where are common sites of a volvulus
sigmoid, transverse, caecum- in neonates whole small bowl can twist
what are the symptoms of large bowl obstruction
absolute constipationm distended abdomen, pain, vomiting
how are large bowl
obstructions treated
resuscitate, operate, possible stenting
what is the most common volvulus
sigmoid- when it twists on the mesentery
how is a sigmoid volvulus treated
flatus tube- to deflate, surgical resection
what is a pseudo-obstruction
when theres all the symptoms of a volvulus but no real mechanical obstruction- usually organ failure due to ill health in elderly/ debilitated
what is chronic constipation a type of
functional bowel disorder
what are causes of chronic constipation
most= dietary, laxatives
few= motility disorders
what is obstructive defecation
pelvic floor inability, autonomic nerve problem
what is faecal impaction
a solid, immobile bulk of faeces that can develop in the rectum as a result of chronic constipation
what can cause faecal impaction
bed ridden, eldery, strong analgesics, thyroid and parathyroid hormonal problems
how is faecal impaction treated
enemas, laxatives, manual evacuation
