Pathology associated with Constipation

Question 1

What causes anal fissures?

Answer 1

• 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

Question 2

What are the causes of interssusception ?

Answer 2

• Intestinal adhesions — bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery
• Colon cancer

Question 3

what are the symptoms of interssusception?

Answer 3

• 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

Question 4

What is a sigmoid volvulus?

Answer 4

• This is when the sigmoid colon twists on its mesentery.
• Produces severe, rapid strangulated obstruction.
• “Coffee bean” sign on AXR

Question 5

Who gets a sigmoid volvulus?

Answer 5

Elderly, constipated and comorbid patients

Question 6

What is the management of a Sigmoid volvulus?

Answer 6

• Sigmoidoscopy and insertion of a flatus tube.
• Sigmoid colectomy
• Can result in perforation and fatal peritonitis.

Question 7

What is a gastric volvulus?

Answer 7

A rare, typically left to right rotation of the stomach fixed by the pylorus and oesophagus.

Question 8

What are the 4 cardinal features of intestinal obstruction?

Answer 8

• Vomiting
• Colicky pain
• Constipation
• Distention

Question 9

Name 2 causes of small bowel obstruction?

Answer 9

• Adhesions

* Hernias

Question 10

Name 4 causes of large bowels obstruction?

Answer 10

• Colon Cancer
• Constipation
• Diverticular stricture
• Volvulus

Question 11

Name 5 rare causes of Large bowel obstruction?

Answer 11

• Crohns stricture
• Gallstone ileus
• Interssusception
• Volvulus

Question 12

What is a crohn’s disease stricture?

Answer 12

Crohn’s disease can cause scar tissue to form, leading to the affected areas becoming narrowed. This is known as stricture

Question 13

What is Peritonitis?

Answer 13

• 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

Question 14

What are the classifications of peritonitis

Answer 14

• primary → normally because of an immune compromised state
• Secondary → Perforation, trauma
• Tertiary →Persistent or recurrent

Question 15

What is a gallstone ileus?

Answer 15

This is when a gallstone erodes through the gallbladder into the deuodenum where it may then obstruct the terminal ileum

Question 16

What is a proximal gallstone ileus called?

Answer 16

bouveret syndrome (super rare)

Question 17

What is diverticular disease?

Answer 17

• 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.

Question 18

Where do diverticular tend to occur?

Answer 18

• 95% occur in the sigmoid rectum

* 30% of westerners have diverticular by age 60

Question 19

What are the symptoms diverticulosis?

Answer 19

• Altered bowel habit
• Left sided colic relieved by defecation
• nausea
• Flatulence

Question 20

What are the symptoms of diverticulitis?

Answer 20

• Altered bowel habit, Left sided colic relieved by defecation, nausea, flatulence

+ Pyrexia, ↑ WCC, ↑ CRP/ESR, Tender colon and localised peritonism.

Question 21

What are the complications of diverticulitis?

Answer 21

• PERFORATION
• Haemorrhage
• Fistullae
• Abscesses
• Post infective strictures

Question 22

What is Colorectal Cancer?

Answer 22

• 3rd most common cancer
• 2nd most common cause of UK cancer deaths
• Usually adenocarcinoma

Question 23

What are the main predisposing factors?

Answer 23

• Neoplastic colonic polyps
• IBD → UC + Crohns
• Genetic predisposition → FAP, HNPCC (Hereditary nonpolyposis colorectal cancer, autosomal dominant)
• Diet → ↓fibre, ↑ red meat
• Smoking and alcohol

Question 24

What is the treatment of Colorectal carcinoma?

Answer 24

• Surgery if possible → ↑ survival time by ~50%
• Radiotherapy
• Chemotherapy