Benign conditions of the large bowel

Question 1

Name 5 common diseases of the large bowel

Answer 1

Carcinoma of the colon and rectum
Colonic polyps 
Crohns colitis and UC 
Diverticular disease 
Functional disorders

Question 2

Define diverticular disease

Answer 2

mucosal herniation through the muscle coat

Question 3

What part of the colon is affected in diverticular disease

Answer 3

Sigmoid

Question 4

What type of diet causes diverticular disease

Answer 4

Low fibre and high fat - western diet

Question 5

What is the difference between diverticulitis and diverticulosis

Answer 5

Diverticulitis - the presence of diverticular disease with inflammation or infection
Diverticulosis is the presence of diverticular disease without any inflammation or infection

Question 6

What are the findings of diverticular disease

Answer 6

Outpouching of the epithelial lined track

Question 7

What is the difference between true and pseudodiverticula diverticular disease

Answer 7

True diverticula contain all layers of the parent structure. False or pseudodiverticula are mucosal projections through the muscular layer.

Question 8

What type of condition are true diverticular disease

Answer 8

Congenital disease

Question 9

How can we diagnose diverticular disease

Answer 9

Using a barium enema or an endoscopy

Question 10

Describe the onset of diverticulitis

Answer 10

Gradual onset becoming increasingly severe.

Question 11

What are the signs of diverticulitis

Answer 11

tenderness in the left ileac fossa
generally feeling unwell
altered bowel habit

Question 12

How do we treat uncomplicated diverticulitis

Answer 12

Nothing - oral antibiotics if anything

Question 13

What are the complications of diverticulitis

Answer 13

Pericolic abscess which can perforate, bleed or fistulate

Question 14

How do we treat complicated diverticulitis

Answer 14

Hartmann’s procedure (removal of part of the bowel)
Primary resection
anastomosis
drainage

Question 15

Describe colitis

Answer 15

Inflammation of the lining of the colon

Question 16

What 2 types of colitis can we get

Answer 16

Acute and chronic

Question 17

What 5 things can cause colitis

Answer 17

Infective colitis
Ulcerative colitis
Crohn's colitis
Iscaemic colitis
Infective colitis - usually campyylobacter

Question 18

What are the 4 signs of colitis

Answer 18

Pain
Blood in stool
Diarrhoea
History of feeling unwell

Question 19

What 5 tests can we do for colitis

Answer 19

Stool sample
Blood tests
Plain X ray
Sigmoidoscopy and biopsy
Barium enema

Question 20

What specific blood tests would be requested in colitis

Answer 20

WBC
CRP
Hb

Question 21

Why would we not perform a full colonoscopy in an acute situation

Answer 21

Due to the high risk of perforation if there is extensive inflammation

Question 22

What 4 things can we use to treat colitis

Answer 22

IV steroids - first line
IV fluids
Iron supplement
GI rest

Question 23

Who is most likely to get ischaemic colitis

Answer 23

Elderly

Those with previous arteriopathy

Question 24

What 3 types of arteriopathy should we suspect ischaemic colitis with

Answer 24

Coronary artery disease
Cerebral artery disease (stroke)
Peripheral vascular disease

Question 25

Define colonic angiodysplasia

Answer 25

Angiodysplasia of the colon occurs when blood vessels in the colon enlarge. They may become fragile and result in occasional bleeding in the gastrointestinal (GI) tract.

Question 26

How can we treat colonic angiodysplasia

Answer 26

Angioplasty - embolise blood vessels using coil or chemicals

Question 27

What are the 4 symptoms of large bowel obstruction?

Answer 27

Abdominal pain constipation abdominal distension vomiting

Question 28

What are 5 causes of bowel obstruction

Answer 28

``` Colorectal cancer Benign stricture Sigmoid or caecal voluvulus (twist in the bowel) Pseudo-obstruction Faecal impaction ```

Question 29

How do we treat bowel obstruction

Answer 29

Resuscitate Operate Stent

Question 30

Define pseudo-obstruction

Answer 30

clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterised by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen.

Question 31

Is pseudo-obstruction pathological or functional

Answer 31

Functional

Question 32

Who is most likely to present with pseudo-obstruction?

Answer 32

Elderly / debilitated patients

Question 33

How do we treat pseudo-obstruction

Answer 33

We cant. | We can only check that it is not a medication causing it and that there is no electrolyte imbalance causing it

Question 34

How do we determine if the patient has chronic constipation?

Answer 34

Determining what is normal for them

Question 35

What usually treats chronic constipation

Answer 35

Diet | Laxatives

Question 36

What is a small cause of chronic constipation?

Answer 36

Motility disorder