Pathology associated with Constipation Flashcards
What causes anal fissures?
- Damage to the lining of the anus or anal canal → constipation.
- Other causes include:
- persistent diarrhoea
- IBD → Crohn’s disease and ulcerative colitis
- pregnancy and childbirth
- Sexually transmitted infection (STI →syphilis or herpes( Infect and damage the anal canal)
- Anal cancer
What are the causes of interssusception ?
- Intestinal adhesions — bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery
- Colon cancer
what are the symptoms of interssusception?
- Crampy abdominal pain that comes and goes
- Loss of appetite
- Constipation
- Vomiting
- Inability to have a bowel movement or pass gas
- Swelling of the abdomen
What is a sigmoid volvulus?
- This is when the sigmoid colon twists on its mesentery.
- Produces severe, rapid strangulated obstruction.
- “Coffee bean” sign on AXR
Who gets a sigmoid volvulus?
Elderly, constipated and comorbid patients
What is the management of a Sigmoid volvulus?
- Sigmoidoscopy and insertion of a flatus tube.
- Sigmoid colectomy
- Can result in perforation and fatal peritonitis.
What is a gastric volvulus?
A rare, typically left to right rotation of the stomach fixed by the pylorus and oesophagus.
What are the 4 cardinal features of intestinal obstruction?
- Vomiting
- Colicky pain
- Constipation
- Distention
Name 2 causes of small bowel obstruction?
- Adhesions
* Hernias
Name 4 causes of large bowels obstruction?
- Colon Cancer
- Constipation
- Diverticular stricture
- Volvulus
Name 5 rare causes of Large bowel obstruction?
- Crohns stricture
- Gallstone ileus
- Interssusception
- Volvulus
What is a crohn’s disease stricture?
Crohn’s disease can cause scar tissue to form, leading to the affected areas becoming narrowed. This is known as stricture
What is Peritonitis?
- Peritonitis is defined as an inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein.
- It is often caused by the introduction of a pathogen to the peritoneal cavity via perforation.
- It can be localised or diffuse
What are the classifications of peritonitis
- primary → normally because of an immune compromised state
- Secondary → Perforation, trauma
- Tertiary →Persistent or recurrent
What is a gallstone ileus?
This is when a gallstone erodes through the gallbladder into the deuodenum where it may then obstruct the terminal ileum
What is a proximal gallstone ileus called?
bouveret syndrome (super rare)
What is diverticular disease?
- A diverticular is an out-pouching of the of the gut wall. they can be acquired or congenital.
- Clinically the most important are acquired colonic diverticular.
- a lack of dietary fibre and increased intermural pressure is thought to result in herniation through the muscles of the gut wall at weak points.
- Diverticulitis refers to inflammation of a diverticular.
Where do diverticular tend to occur?
- 95% occur in the sigmoid rectum
* 30% of westerners have diverticular by age 60
What are the symptoms diverticulosis?
- Altered bowel habit
- Left sided colic relieved by defecation
- nausea
- Flatulence
What are the symptoms of diverticulitis?
• Altered bowel habit, Left sided colic relieved by defecation, nausea, flatulence
+ Pyrexia, ↑ WCC, ↑ CRP/ESR, Tender colon and localised peritonism.
What are the complications of diverticulitis?
- PERFORATION
- Haemorrhage
- Fistullae
- Abscesses
- Post infective strictures
What is Colorectal Cancer?
- 3rd most common cancer
- 2nd most common cause of UK cancer deaths
- Usually adenocarcinoma
What are the main predisposing factors?
- Neoplastic colonic polyps
- IBD → UC + Crohns
- Genetic predisposition → FAP, HNPCC (Hereditary nonpolyposis colorectal cancer, autosomal dominant)
- Diet → ↓fibre, ↑ red meat
- Smoking and alcohol
What is the treatment of Colorectal carcinoma?
- Surgery if possible → ↑ survival time by ~50%
- Radiotherapy
- Chemotherapy
