Small intestine/Colon Disorders Flashcards
What is constipation?
Constipation is a common gastrointestinal issue characterised by infrequent or difficult bowel movements.
If severe, it can lead to faecal impaction, where hardened stool accumulates in the rectum or colon, making natural evacuation unlikely.
How is constipation assessed?
History:Ask about bowel habits, stool consistency (Bristol Stool Chart), duration of symptoms, diet, fluid intake, exercise, medication use, and associated symptoms (e.g., abdominal pain, bloating).
Physical Examination:Check for abdominal distension, tenderness, and perform a digital rectal examination to assess for hard stools or masses.
Red Flags:Unintentional weight loss, rectal bleeding, persistent change in bowel habits, anaemia, or a family history of colorectal cancer require further investigation.
What are the primary causes of constipation?
Low-fiber diet
Inadequate fluid intake
Sedentary lifestyle / lack of exercise
Ignoring the urge to defecate
Slow transit constipation (reduced colonic motility)
Pelvic floor dysfunction / dyssynergia
Irritable Bowel Syndrome (IBS) - constipation predominant (IBS-C)
What are the secondary causes of constipation?
- Medications:
Opioids (morphine, codeine)
Anticholinergics (e.g., antihistamines, tricyclic antidepressants)
Calcium channel blockers (verapamil)
Iron supplements
Antacids (especially those containing aluminum or calcium)
Diuretics
Antipsychotics
Antidepressants (TCAs, SSRIs)
- Metabolic and Endocrine Disorders e.g
Hypothyroidism
Diabetes mellitus
- Neurological Disorders e.g
Parkinson’s disease
Multiple sclerosis (MS)
- Gastrointestinal/Structural Causes:
Colorectal cancer / strictures
Anal fissures or hemorrhoids (pain leading to avoidance)
Rectal prolapse
Megacolon / Hirschsprung’s disease
- Psychological Factors:
Depression
Anxiety
Eating disorders (e.g., anorexia nervosa)
“DIMES” for Secondary Causes:
Drugs (opioids, anticholinergics)
Immobility / neurological
Metabolic (hypothyroidism, diabetes, hypercalcemia)
Endocrine / psychological
Structural / mechanical obstruction
What is the general management of constipation?
General Measures
Dietary Advice:Encourage a balanced diet rich in fibre (fruit, vegetables, whole grains).
Hydration:Ensure sufficient fluid intake.
Physical Activity:Promote regular exercise to aid gut motility.
What is the pharmacological treatment of constipation?
First-Line: Bulk-Forming Laxatives
- Examples: Ispaghula husk, methylcellulose.
- Mechanism: Increase stool bulk, stimulating peristalsis.
Note to patient : Ensure adequate fluid intake to prevent intestinal obstruction.
Second-Line: Osmotic Laxatives
-Examples: Macrogols (polyethylene glycol), lactulose.
-Mechanism: Draw water into the bowel, softening stools.
Note to patient: Macrogols are preferred for their effectiveness.
Third-Line: Stimulant Laxatives
Examples: Senna, bisacodyl.
Mechanism: Stimulate colonic nerves to enhance motility.
Note to patient: Use for short periods to avoid dependency.
What is the management of feacal impactions?
Assessment:
Confirm impaction through history and examination
Treatment approach:
Oral Macrogols:First-line treatment, starting with a low dose and increasing until disimpaction occurs.
Add Stimulant Laxatives:If no response to macrogols, add a stimulant laxative after a few days.
Rectal Interventions:If oral treatments fail, consider suppositories (e.g., glycerol, bisacodyl) or enemas (e.g., phosphate enema).
Monitoring: Regularly assess treatment effectiveness and adjust as needed.
How is this prevented for recurrence?
Education:Patients should understand the importance of diet, hydration, and regular bowel habits
Medication Review:Adjust or discontinue constipating medications where possible.
Regular Follow-Up:Monitor symptoms and adjust treatment plans accordingly
What is irritable bowel syndrome (IBS)?
IBS is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain associated with altered bowel habits (diarrhea, constipation, or both), without any structural or biochemical abnormalities.Pain normally goes after defecation.
It is a diagnosis of exclusion after ruling out other organic causes.
What are the signs and symptoms of IBS?
Recurrent abdominal pain (crampy) (improves or worsens with defecation)
Altered bowel habits:
IBS-C: Constipation-predominant
IBS-D: Diarrhea-predominant
IBS-M: Mixed (alternating constipation & diarrhea)
IBS-U: Unclassified
Bloating and gas and distension
Mucus in stool (may be present and will look whiteish)
Sensation of incomplete evacuation
Symptoms are chronic, often worsen with stress and food intake, and vary in intensity.
What are the red flags of IBS which suggests organic disease?
Urgent referral if:
Unintentional weight loss
Persistent diarrhoea (>6 weeks) in patients >50
Rectal bleeding/melena
Severe nocturnal symptoms e.g diarrhoea that wakes you up from sleep
Family history of colorectal cancer or IBD
Anemia
What are the investigations and diagnosis of IBS?
Clinical diagnosis using Rome IV criteria
Exclude organic disease:
Full blood count (FBC)
C-reactive protein (CRP)
Coeliac serology
Faecal calprotectin (if IBD suspected)
Colonoscopyonly if red flags present
What is the Rome IV criteria?
Abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following:
- Related to defecation
- Change in stool frequency
- Change in stool form (appearance)
(Symptoms should have started at least 6 months before diagnosis)
If Yes to any of above, IBS diagnostic criteria is met and the predominant stool form is asked using Bristol stool chart to determine the type of IBS. e.g IBS-D is Bristol type 5 or 6 (Diarrhea)
What is the lifestyle and dietary management of IBS?
- Fibre modification:
Increase if constipated, reduce insoluble fibre if diarrhoea-predominant - Low FODMAP diet
- Regular meals, avoid caffeine/alcohol
- Yoga, Hypnosis and CBT for symptom management
What is the pharmacological treatment of IBS?
Diarrhoea-predominant IBS:Loperamide
Constipation-predominant IBS:Laxatives (not lactulose)
Abdominal pain/bloating:
- Antispasmodics (mebeverine, hyoscine)
- Tricyclic antidepressants (amitriptyline)
When must you refer with an IBS patient?
To gastroenterology if:
Red flag symptoms
Uncontrolled symptoms despite primary care treatment
What is infectious diarrhoea?
Diarrhoea caused by bacterial, viral, or parasitic pathogens, usually self-limiting but can lead to dehydration and complications.
History:Travel, food history, sick contacts, antibiotic use.
Red Flags:Bloody diarrhoea, dehydration, immunosuppression, prolonged symptoms (>1 week).
Investigations:Stool culture,C. difficiletoxin, faecal calprotectin (if IBD suspected).
What are the causes and risk factors of infectious diarrhoea?
Bacterial:Campylobacter, Salmonella, Shigella, E. coli
Viral:Norovirus, Rotavirus
Parasitic:Giardia, Cryptosporidium
Risk factors:Travel, food poisoning, immunosuppression, recent antibiotics
What are the signs and symptoms of Infectious diarrhoea?
Acutewatery or bloody diarrhoea
Fever, nausea, vomiting
Abdominal cramps
Dehydration (dry mucous membranes, hypotension)
What are the red flags of infectious diarrhoea?
Urgent referral if:
Severe dehydration(tachycardia, hypotension, confusion)
Bloody diarrhoea + fever (dysentery)
Recent travel + persistent diarrhoea (>14 days)
Immunosuppression (HIV, chemotherapy, steroids)
What is the difference between non inflammatory and inflammatory diarrhoea syndromes?
Non-inflammatory diarrhea is typically caused by pathogens that do not invade the intestinal wall but instead disrupt normal fluid absorption, leading to large-volume, watery stools. It is usually secretory or osmotic in nature, often caused by viruses like Norovirus or Rotavirus, bacteria like Enterotoxigenic E. coli (ETEC) or Vibrio cholerae, and parasites like Giardia lamblia. Patients usually do not have a fever or blood in the stool, and abdominal pain is mild. The primary concern is dehydration due to significant fluid loss. Stool cultures are often unnecessary unless symptoms are prolonged. Absence of fecal leukocytes. Traveller’s Diarrhoea
In contrast, inflammatory diarrhea is caused by invasive pathogens that damage the intestinal mucosa, triggering inflammation. This results in bloody, mucous-filled stools, lower abdominal pain, and fever. Common causes include Shigella, Salmonella, Campylobacter, Enterohemorrhagic E. coli (EHEC), Clostridioides difficile, and Entamoeba histolytica. Patients may experience tenesmus (a constant urge to pass stool) and systemic symptoms. Stool tests and cultures are often required to identify the specific pathogen and guide treatment. Presence of fecal leukocytes.
Hospital-Acquired Diarrhoea
What are the investigations of Infectious diarrhoea?
Stool culture(if febrile, bloody diarrhoea, prolonged symptoms (>1/52))
C. difficile toxin(if recent antibiotics)
Electrolytes & renal function (U&Es) if severe dehydration
What is the management of infectious diarrhoea?
- Examine, observe patient ?admission ?safe for home management
Refer if severe dehydration or shock, suspected sepsis or failure of outpatient management. - Rehydration:
Oral rehydration (ORS); IV fluids if severe - Empirical antibiotics only if:
-severe bacterial infection ( e.g. C difficile, cholera)
-Immunocompromised patients
How to prevent infectious diarrhoea?
Prevention of infectious diarrhea includes:
✅ Hand hygiene – Wash hands regularly with soap.
✅ Safe food and water – Eat well-cooked food, drink clean or bottled water, and avoid raw foods.
✅ Vaccination – Get vaccines like rotavirus (for children) and cholera if needed.
✅ Travel precautions – Follow the rule: “Boil it, cook it, peel it, or leave it.”
✅ Good sanitation – Proper waste disposal and avoiding contact with infected individuals.Prevention of infectious diarrhea includes:
✅ Hand hygiene – Wash hands regularly with soap.
✅ Safe food and water – Eat well-cooked food, drink clean or bottled water, and avoid raw foods.
✅ Vaccination – Get vaccines like rotavirus (for children) and cholera if needed.
✅ Travel precautions – Follow the rule: “Boil it, cook it, peel it, or leave it.”
✅ Good sanitation – Proper waste disposal and avoiding contact with infected individuals.
What is Appendicitis?
Appendicitis is the inflammation of the appendix, a small, finger-like pouch attached to the large intestine. It is a common surgical emergency.
What is the classical presentation of appendicitis?
Abdominal pain:
Starts around the umbilicus (belly button) and then shifts to the right lower abdomen (specifically at McBurney’s point, about 1/3rd of the way from the anterior superior iliac spine to the navel).
Nausea and vomiting:
Often follows the onset of abdominal pain.
Loss of appetite (anorexia).
Fever:
Typically low-grade, but can increase if the condition worsens.
Tenderness in the right lower abdomen, especially with rebound tenderness (pain upon releasing pressure).
What are the key signs of appendicitis?
McBurney’s point tenderness (classic location of pain)
Rovsing’s sign: Pain in the right lower abdomen when pressure is applied to the left lower abdomen.
Psoas sign: Pain with right hip flexion, indicating irritation of the psoas muscle.
Obturator sign: Pain with internal rotation of the right hip, suggesting pelvic appendix irritation
What causes appendicitis?
Blockage of the appendix by fecal matter (fecalith), lymphoid hyperplasia, parasites, or tumors, leading to infection and inflammation.
What are the risk factors of appendicitis?
Young male
What are the symptoms of appendicitis?
Periumbilical pain → migrates to right iliac fossa
Nausea, vomiting, anorexia
Fever, tachycardia
McBurney’s point tenderness
Rovsing’s sign:Pain in RLQ when palpating LLQ
Psoas sign:Pain on hip extension (retrocaecal appendix)
What are the red flags of appendicitis?
Urgent referral if:
Severe localised pain + guarding(perforation risk)
High fever, sepsis signs
Rebound tenderness (peritonitis)
What are the investigations of appendicitis?
Clinical examination + history
Bloods:Raised WBC, CRP
Ultrasound:Preferred in children/pregnancy
CT Abdomen:Gold standard in adults
What is the management of appendicitis?
Definitive:Appendicectomy (laparoscopic)
Pre-op:IV antibiotics (Check local trust guidelines - e.g might be cefuroxime + metronidazole)
Supportive:IV fluids, analgesia
When should a case of appendicitis be referred?
If you see patient in GP with suspected appendicitis / ED :
Surgical referral ASAPif appendicitis suspected
What are the complications of appendicitis if left untreated?
Perforation (rupture)
Peritonitis
Abscess formation
What is Bowel obstruction?
A mechanical or functional blockage of the intestines preventing passage of contents.
Classic Presentation:
Abdominal pain, distension, vomiting, constipation.
Diagnosis:X-ray (dilated loops, air-fluid levels), CT for cause.
Management:NG tube decompression, fluids, surgery if strangulation.
What are the causes and risk factors of bowel obstruction?
Mechanical:
Small bowel: Adhesions, hernia, malignancy
Large bowel: Tumours, volvulus, strictures
Functional:
Paralytic ileus (temporary paralysis of the bowel, often after surgery, trauma, or infections)
What are the signs and symptoms of bowel obstruction?
Colicky abdominal pain
Distension
Vomiting (bilious if small bowel, faeculent if large bowel)
Absolute constipation (no flatus, no stool)
Absence bowel sounds
Fecal odour in vomit
Fever and tachycardia (if complications like perforation occur)
When is an urgent referral required in Bowel obstruction?
Severe pain + tachycardia (suggests strangulation/perforation)
Peritonitis signs (rigid abdomen, absent bowel sounds)
Severe dehydration (hypotension, tachycardia)
What are the investigations of bowel obstruction?
Abdominal X-ray: Dilated bowel loops, air-fluid levels
CT scan:Confirms cause/location
What is the management of bowel obstruction?
Conservative (if partial obstruction):
NBM (nil by mouth)
NG tube decompression
IV fluids
Surgical intervention:If complete obstruction, strangulation, or perforation
Emergency surgical referralfor suspected complete obstruction
What is inflammatory bowel disease?
IBD refers to a group of chronic inflammatory conditions affecting the gastrointestinal (GI) tract, with two main types:
1. Crohn’s disease
2. Ulcerative Colitis
What is Ulcerative colitis?
Ulcerative colitis (UC) is achronic, relapsing-remittinginflammatory bowel disease (IBD) that causesdiffuse inflammation of the colonic mucosa. Affects only the mucosal layer of the bowel wall.
It typically starts in therectumand extendsproximally in a continuous manner, affecting part or all of the colon.
What are the causes and pathophysiology of UC?
UC results from adysregulated immune responseto intestinal microbiota in genetically susceptible individuals.
Key Factors:
Genetic predisposition(first-degree relatives have higher risk)
Environmental triggers(e.g., diet, stress, infections)
Dysbiosis(altered gut microbiota)
Loss of immune tolerance, leading to excessive inflammation in the colonic mucosa
Key inflammatory mediatorsincludeTNF-α, IL-13, and IL-17, causing crypt abscesses, mucosal ulceration, and increased permeability of the intestinal barrier.
Characterized by ulcers and sores in the colon.
What are the risk factors of UC?
Age:Common onset between15–30 years
Family historyof IBD
Non-smoker(unlike Crohn’s, where smoking worsens disease, smoking appears to be protective in UC)
Recent infections(e.g., gastroenteritis)
Western diet(low in fibre, high in processed foods)
What are the signs and symptoms of UC?
Typical Presentation:
1. Bloody diarrhoea(hallmark symptom)
2. Mucus in stool
3. Abdominal pain(typically lower left quadrant)
4. Tenesmus(urgency to defecate with incomplete evacuation)
5. Nocturnal diarrhoea
Fatigue, weight loss, anaemia (in severe cases)
Severe Disease Features:
>6 bloody stools/day
Tachycardia, fever, dehydration
Significant weight loss
When does UC need to be referred?
Urgent referral to secondary care if:
Severe diarrhoea (>6 bloody stools/day)
Systemic signs of sepsis(fever, tachycardia, hypotension)
Abdominal distension, tenderness, or guarding(risk of toxic megacolon)
Failure to respond to treatment
What are the investigations of UC?
Blood Tests:
(FBC):Anaemia (low Hb), leukocytosis in flares
C-reactive protein (CRP) & ESR:Raised in active inflammation
U&E:Assess for dehydration and electrolyte disturbances
Stool Tests:
1. Faecal calprotectin(elevated in UC, differentiates IBD from IBS)
2. Stool culture & Clostridium difficile toxin(rule out infective causes)
Imaging & Endoscopy:
- Flexible Sigmoidoscopy / Colonoscopy(gold standard)
Findings:Diffuse, continuous mucosal erythema, loss of vascular pattern, ulceration, contact bleeding, and pseudopolyps - Abdominal X-ray (AXR):
Indicated in severe disease to check fortoxic megacolon(>6 cm colonic dilation) - CT/MRI Abdomen (if complications suspected)
How is the severity of Ulcerative colitis classified?
The Truelove and Witts criteria assess the severity of ulcerative colitis based on symptoms and lab results:
Mild: < 4 stools/day, no fever or tachycardia, normal ESR, and hemoglobin.
Moderate: 4-6 stools/day, blood in stool, low-grade fever, mild tachycardia, elevated ESR.
Severe: > 6 stools/day, severe blood in stool, fever > 37.8°C, tachycardia, anemia, and significantly elevated ESR.
These criteria help guide treatment decisions and determine if hospitalization is needed.
What are the complications of UC if left untreated?
Toxic megacolon: a life-threatening condition with massive colonic dilation. >6cm with sepsis and requires emergency surgery
Colon perforation
Strictures can case bowel obstruction
Increased risk of colon cancer (long-term disease)
Dehydration due to fluid loss from diarrhea
Malnutrition due to reduced absorption
Anemia due to chronic blood loss
What is the first line management of UC?
- Mild-Moderate Disease:
Oral mesalazine (5-ASA)± topical mesalazine suppository
If no response:Add oral prednisolone (40mg daily, taper over 4–8 weeks) - Severe Disease:
- IV hydrocortisone or methylprednisolone
- IV fluids & thromboprophylaxis
- If no improvement in 72 hours →Infliximab or ciclosporin
-If refractory →Urgent colectomy
What is the second line management of UC?
- First-line:Oralmesalazine (5-ASA)
- If frequent relapses or steroid dependence:
- Azathioprine or mercaptopurine(immunosuppressants) - If severe or refractory disease:
- Biologic therapy (Infliximab, Adalimumab, Vedolizumab)
What is the surgical management of UC?
Indications:Toxic megacolon, perforation, fulminant colitis, refractory disease
Procedure:Total proctocolectomy with ileal pouch-anal anastomosis (IPAA)
What is Crohn’s disease?
Crohn’s disease (CD) is achronic, relapsing-remittinginflammatory bowel disease (IBD) characterised bytransmural inflammationthat can affectany part of the gastrointestinal tract from mouth to anus.
It often presents withskip lesions(areas of inflammation interspersed with normal tissue) andgranuloma formationon histology.
What causes Crohn’s disease and what are the key pathological features?
Crohn’s disease is caused by adysregulated immune responseto gut microbiota in genetically predisposed individuals, leading to chronic inflammation.
Key Pathological Features:
Transmural inflammation(affects the full thickness of the bowel wall)
Skip lesions(patchy involvement with normal areas in between)
Non-caseating granulomas(hallmark histological feature)
Strictures and fistulae formationdue to fibrosis
Cobblestone appearanceon endoscopy
What are the risk factors of Crohn’s disease?
Age:Peak incidence between15–30 years
Family historyof IBD
Smoking(increases risk and severity, unlike UC)
Western diet(high processed foods, low fibre)
Hygiene hypothesis(reduced early childhood infections may increase risk)
What are the signs and symptoms of Crohn’s?
Typical Presentation:
- Chronic diarrhoea(often non-bloody)
- Right lower quadrant abdominal pain(common due to ileal involvement)
- Weight loss and malnutrition
- Fatigue and malaise
- Fever in active disease
Complications-Specific Symptoms:
- Strictures:Postprandial cramping, nausea, vomiting, bloating
- Fistulae (e.g., enteroenteric, enterovesical):Recurrent UTIs, faecaluria, passage of gas in urine
- Perianal disease:Anal pain, drainage, perianal abscesses
When should Crohn’s be referred?
Urgent referral to secondary care if:
- Severe symptoms (weight loss, malnutrition, dehydration)
- Bowel obstruction symptoms (vomiting, abdominal distension, no bowel movements)
- Perianal complications (abscesses, fistulae, strictures)
- Failure to respond to treatment
What are the investigations of Crohn’s?
Blood Tests:
(FBC):Anaemia (iron or B12 deficiency due to malabsorption)
CRP & ESR:Raised in active inflammation
LFTs:Albumin may be low due to malnutrition
U&E:Check for dehydration and electrolyte imbalance
Stool Tests:
Faecal calprotectin(elevated, differentiates IBD from IBS)
Stool culture & Clostridium difficile toxin(rule out infections)
Imaging & Endoscopy:
Colonoscopy with biopsy(gold standard)
Findings:Cobblestone mucosa, deep ulcers, skip lesions
MR Enterography / Small Bowel Imaging
Indicated insmall bowel Crohn’s
Findings: Bowel wall thickening, strictures, fistulae
Abdominal X-ray (AXR)
Indicated if obstruction is suspected
How is Crohn’s disease classified according to NICE?
NICE guidelines generally categorize Crohn’s disease severity into mild, moderate, and severe based on:
Mild: Occasional abdominal pain, mild diarrhea (< 4 stools/day), no significant weight loss or systemic symptoms. Managed with oral 5-ASA or steroids if needed.
Moderate: Frequent abdominal pain, blood in stool, fatigue, weight loss. Managed with oral corticosteroids, immunosuppressants, or biologics.
Severe: Severe symptoms (e.g., > 6 stools/day, weight loss > 10%, fever), with complications like fistulas or abscesses. Managed with hospitalization, high-dose corticosteroids, biologics, and possible surgery.
What is the first line of management of Crohn’s?
1st Line: Inducing Remission
Mild-to-Moderate Disease:
- Oral budesonide (for ileocaecal Crohn’s) or prednisolone (40mg daily, taper over 8 weeks)
- If no response →Immunomodulators (azathioprine, mercaptopurine, methotrexate)
Severe Disease:
- IV hydrocortisone or methylprednisolone
- Biologic therapy (infliximab, adalimumab) if steroid-refractory
- If no improvement →Surgical intervention
What is the second line of management of Crohn’s?
2nd Line: Maintenance Therapy (Preventing Relapse)
- First-line:Azathioprine or mercaptopurine
- Alternative:Methotrexate (if thiopurine-intolerant)
- Biologic therapy:Infliximab, adalimumab, vedolizumabif frequent relapses - Surgical Management (For Severe or Refractory Crohn’s)
- Indications:Strictures, fistulae, obstruction, failure of medical therapy
- Common procedure:Resection of affected bowel with anastomosis(e.g., ileocaecal resection)
- Unlike UC,surgery is not curativeand recurrence is common
What are the complications of Crohn’s disease?
Strictures:
Narrowing of the bowel leading to obstruction
Fistulae:
Abnormal connections (e.g., enterocutaneous, enteroenteric)
Malabsorption:
Deficiencies iniron, B12, folate, vitamin D
Perianal Disease:
Abscesses, fissures, fistulae
Small Bowel Cancer:
Increased risk with long-standing disease
What are the differences between UC and Crohn’s?
- Affected Areas:
Ulcerative Colitis (UC): Affects only the colon and rectum, starting from the rectum and extending proximally in a continuous pattern.
Crohn’s Disease: Can affect any part of the gastrointestinal tract from the mouth to the anus, often affecting the terminal ileum and right colon. The inflammation is typically discontinuous, with areas of healthy tissue between inflamed sections (skip lesions). - Depth of Inflammation:
UC: Involves only the mucosal layer (the inner lining of the bowel).
Crohn’s Disease: Can involve all layers of the bowel wall (transmural inflammation), leading to complications like fistulas, abscesses, and strictures. - Pattern of Inflammation:
UC: Continuous inflammation starting from the rectum and moving upward.
Crohn’s Disease: Patchy or discontinuous inflammation (skip lesions) throughout the GI tract. - Symptoms:
UC: Typically presents with bloody diarrhea, abdominal cramps, and rectal bleeding.
Crohn’s Disease: Often causes non-bloody diarrhea, abdominal pain, weight loss, and fatigue, with potential for complications like fistulas or abscesses. - Complications:
UC: Can lead to toxic megacolon and an increased risk of colon cancer with long-term disease.
Crohn’s Disease: Can cause strictures, fistulas, abscesses, and malnutrition due to involvement of the small intestine. - Surgery:
UC: Colectomy (removal of the colon) is often curative.
Crohn’s Disease: Surgery is not curative because the disease can recur in other parts of the GI tract after surgery.
What are the differences between IBS and IBD?
IBS (Irritable Bowel Syndrome) and IBD (Inflammatory Bowel Disease) are both gastrointestinal disorders, but they differ in key ways:
Cause: IBS is a functional disorder without inflammation, often linked to gut motility and stress. IBD is an autoimmune condition causing chronic inflammation in the digestive tract.
Symptoms: IBS causes abdominal pain, bloating, and altered bowel habits (diarrhea/constipation), with no visible damage with mucus in stool. IBD, including Crohn’s Disease and Ulcerative Colitis, involves inflammation, and can lead to tissue damage, bleeding, and more severe symptoms.
Treatment: IBS is managed with dietary changes, stress management, and medications to relieve symptoms. IBD requires anti-inflammatory drugs, immunosuppressants, and sometimes surgery due to the inflammation and tissue damage.
What is Diverticulitis?
Diverticulitis isinflammation and/or infectionof colonicdiverticula(small pouches that form in the bowel wall, usually in the sigmoid colon). It can range frommild inflammationtosevere complicationssuch as perforation or abscess formation.
What is diverticulosis?
Diverticulosis is a condition where small, bulging pouches (called diverticula) form in the walls of the colon, usually in the sigmoid colon. These pouches develop due to increased pressure within the colon and are typically asymptomatic.
What is the difference between diverticulitis and diverticulosis?
Diverticulosis is the presence of non-inflamed diverticula in the colon, often asymptomatic but may cause mild discomfort. It typically results from increased pressure in the colon, often due to a low-fiber diet.
Diverticulitis occurs when one or more of the diverticula become inflamed or infected, causing symptoms like severe abdominal pain, fever, nausea, and changes in bowel habits. It can lead to complications like abscesses or perforation.
In short, diverticulosis is the condition of having diverticula, while diverticulitis is the inflammation or infection of those pouches.
What are the risk factors of diverticular disease?
Age
Low fiber diet (can lead to hard stools and constipation which can increase the pressure in the colon)
Obesity
Lack of Exercise
Genetic predisposition
Smoking
alcohol
NSAIDS, steroids
What are the signs and symptoms of diverticular disease?
Fever
bloating
Mucus or blood in faeces
Lack of appetite
Lower abdominal pain and cramping- left lower quadrant common in western populations
changes in bowel habits ( diarrhoea/constpation)
Nausea and vomiting
Right sided pain (asian populations)
What are the red flags of severe or complicated diverticulitis?
Perforation→ Generalised peritonitis, rigidity, guarding
Abscess→ Localised mass, persistent fever
Fistula→ Pneumaturia (colovesical), faecaluria
Obstruction→ Distension, vomiting, absent bowel movements
What is the management of diverticulitis?
Uncomplicated Diverticulitis(mild, no systemic symptoms):
Oral antibiotics(e.g., co-amoxiclav or ciprofloxacin + metronidazole)
Clear fluids or low-residue diet
Analgesia(paracetamol, avoid NSAIDs)
Outpatient follow-up
Complicated Diverticulitis(perforation, abscess, obstruction, or fistula):
Hospital admission
IV antibiotics
IV fluids & analgesia
Surgical intervention(for severe cases) – Hartmann’s procedure (resection + stoma)
What are the investigations of diverticulitis?
Blood tests– ↑ WCC, CRP, U&Es (dehydration)
CT Abdomen/Pelvis (gold standard)– Look for diverticula, inflammation, abscess, perforation
Abdominal X-ray– Look for free air (if perforation suspected)
Colonoscopy (after acute phase)– To rule out malignancy
