Benign conditions of the Large bowel

Question 1

what are some less common diseases of the large bowel?

Answer 1

Colonic volvulus
Colonic angiodysplasia
Ischaemic colitis
Pseudo-obstruction

Question 2

what is the most common endoscopically diagnosed disease in >50s?

Answer 2

diverticulitis disease

Question 3

what is a diverticulum?

Answer 3

out-pouching of viscera through its coat

mucosa and organ pertrudes through muscle coat

Question 4

where is diverticular disease most common?

Answer 4

sigmoid colon

as most affected by low fibre diet

Question 5

what is the difference between diverticulosis and diverticulitis?

Answer 5

colonoscopy finding

inflammation of diverticular disease

Question 6

how can diverticulosis be diagnosed?

Answer 6

barium enema

sigmoidoscopy

Question 7

can the diverticulum be bigger than the actual lumen?

Answer 7

yes

risk as scope could go down wrong lumen rather than the true lumen

Question 8

what are the clinical features of diverticulitis?

Answer 8

LIF pain/tenderness
septic (high RR/HR, fever)
altered bowel habit
may mirror appendicitis

Question 9

what are the possible complications of diverticular disease?

Answer 9

pericolic abscess
performation (faeces in abdominal cavity, pain, “at deaths door”)
haemorrhage
fistula (communication between 2 epithelial surfaces - eg between colon and bladder = coloviscical fistula, colovaginal fistula)
stricture

Question 10

what preceeds a fistula usually?

Answer 10

pericolonic abscess

Question 11

how might a coloviscical fistula present?

Answer 11

recurrent UTI

passing bubbles when peeing (pneumaturia)

Question 12

how might a colovaginal fistula present?

Answer 12

recurrent infections

Question 13

apart from diverticular disease, what can cause colonic strictures?

Answer 13

chronic colitis

tumours

Question 14

how is diverticulitis staged?

Answer 14

Hinchey classification
Stage 0 = clinically mild = oral antibiotics
Stage Ia = IV
Stage Ib = IV
Stage II = percutaneous drainage
Stage III = laparoscopic lavage/drainage
Stage IV = faecal peritonitis = primary resection

Question 15

how is uncomplicated diverticulitis treated?

Answer 15

oral or no antibiotics

Question 16

how is complex diverticulitis treated?

Answer 16

percutaneous drainage
Hartmanns procedure
Laparoscopic lavage and drainage
primary resection/anastamosis

Question 17

what is colitis?

Answer 17

inflammation of the colon

Question 18

what are the most common causes of colitis?

Answer 18

infective colitis (campylobacter = gap year, E.coli)
ulcerative colitis
crohns colitis
ischaemic colitis

Question 19

what are the symptoms of colitis?

Answer 19

diarrhoea with blood
abdominal pain
dehydration
sepsis
chronic:
- weight loss
- anaemia

Question 20

what happens to haemoglobin levels in large blood loss?

Answer 20

stays the same

blood isn’t diluted just less of it so same concentration of Hb

Question 21

how is colitis diagnosed?

Answer 21

plain X ray
sigmoidoscopy + biopsy
stool culture
barium enema (not common)
show:
- featureless left colon (lead piping)
- thumb printing on right side = severe mucosal inflammation

Question 22

who tends to get C. Diff colitis?

Answer 22

if taking one of the 4 antibiotics of C diff

Question 23

how is ulcerative/crohns colitis treated?

Answer 23

IV fluids
IV steroids - once infective colitis ruled out
GI rest
If failure to settle in 4/5 days:
- rescue medical therapy
- surgery

Question 24

how can you tell if a patient has settled?

Answer 24

monitor stool habits

monitor vital signs (HR, inflammatory markers etc)

Question 25

what causes ischaemic colitis?

Answer 25

elderly
arteriopaths
acute/chronic occlusion
inferior mesenteric artery
vascular problem so same risks as CVD

Question 26

what is a watershed infarct?

Answer 26

grey areas between 3 arteries of supply to an organ

Commonest site of colitis in ischaemic colitis as not receiving immediate blood flow

Question 27

where does ulcerative colitis begin?

Answer 27

rectum

Question 28

where can crohns affect?

Answer 28

anywhere in GI tract

most commonly in terminal ileum

Question 29

what is colonic angiodysplasia?

Answer 29

submucosal lakes of blood, usually in right side of colon

obscure cause of rectal bleeding

Question 30

how is colonic angiodysplasia investigated?

Answer 30

angiography (usually CT)
colonoscopy
injection or surgical resection (rare)

Question 31

how is colonic angiography treated?

Answer 31

embolization
endoscopic ablation
surgical resection

Question 32

what can cause a large bowel obstruction?

Answer 32

volvulus (twisting of bowel on mesentery - common in sigmoid, can become gangrenous)
benign stricture
colorectal cancer

Question 33

how is large bowel obstruction treated?

Answer 33

rescusitate
operate
stenting

Question 34

how can you tell the small and large intestine apart?

Answer 34

small = more red
large = more whitish, has fatty appendages

Question 35

what are the signs of large bowel obstruction?

Answer 35

abdominal distension
complete constipation
abdominal pain
vomiting (faecal vomiting?)
order in which symptoms appear can help tell where obstruction is

Question 36

who is sigmoid volvulus common in? how is it treated?

Answer 36

elderly
constipated
surgical resection or flatus tube or possibly via coloscopy if unsuitable

Question 37

how is sigmoid volvulus diagnosed?

Answer 37

AXR

rectal contrast

Question 38

what is a pseudo-obstruction?

Answer 38

has all the signs and symptoms of complete obstruction but no actual obstruction
common in elderly/debilitated

Question 39

how are most cases of chronic constipation treated?

Answer 39

diet
laxatives
more rarely = motility disorders

Question 40

who is likely to get faecal impaction?

how is it treated?

Answer 40

elderly, bed ridden
people on strong analgesics
enemas, laxatives
manual evacuation