Diseases of the Colon + Rectum

Question 1

What is diverticular disease?

Answer 1

Out-pouching of bowel epithelial lining

Question 2

Cause of diverticular disease

Answer 2

Low fibre diet -> increased intraluminal pressure

Question 3

Who is usually affected by diverticular disease?

Answer 3

> 50 (usually even older)

Question 4

What area of colon does diverticular disease affect the most?

Answer 4

Sigmoid colon

Question 5

Symptoms of diverticulitis

Answer 5

LIF pain, altered bowel habit, nausea, sepsis, PR bleeds

Question 6

Complications of diverticular disease and diverticulitis

Answer 6

Fistula, obstruction (stricture), perforation, peritonitis, haemorrhage

Question 7

Investigations of diverticular disease/diverticulitis

Answer 7

1. CT scan
2. Sigmoidscopy, colonoscopy
3. Gastrografin enema
4. Barium enema

Question 8

Treatment of diverticulitis

Answer 8

1. Percutaneous Drainage + ANTIBIOTICS
2. Hartmann’s procedure
3. Laparoscopic Lavage + Drainage
4. Primary resection/anastomosis

Question 9

How is diverticulitis classified?

Answer 9

Hinchey classification

Question 10

Hinchey Stage 0

Answer 10

Mild

Question 11

Hinchey Stage Ia

Answer 11

Confined to pericolic

Question 12

Hinchey Stage Ib

Answer 12

Proximal/distant abscess formation

Question 13

Hinchey Stage II

Answer 13

Intra-abdominal/pelvic/retroperitoneal abscess

Question 14

Hinchey Stage III

Answer 14

Purulent peritonitis

Question 15

Hinchey Stage IV

Answer 15

Faecal peritonitis

Question 16

Causes of infective colitis

Answer 16

C.diff, campylobacter, shigella, E.coli 0157

Question 17

Causes of ischaemic colitis

Answer 17

Obstruction (cancer, volvulus, faeces), atherosclerosis of mesenteric vessels

Question 18

Colitis symptoms

Answer 18

Weight loss, bloody diarrhoea, dehydration, cramp

Question 19

Investigations of colitis

Answer 19

AXR, stool culture, sigmoid/colonoscopy, barium swallow

Question 20

What gender does IBS more commonly affect?

Answer 20

Women

Question 21

What criteria is used for IBS

Answer 21

Rome IV criteria

Question 22

Rome IV criteria

Answer 22

Recurrent abdo pain for 3 days/month for 3 months + 2 of (in last 6 months)

• Relief on defecation
• Change in stool freq
• Change in stool appearance

Question 23

Causes of IBS

Answer 23

Diet, infection, drugs, menstruation, stress

Question 24

Symptoms of IBS

Answer 24

Bloating, abdo pain, increased freq, mucus stool, incomplete emptying

Question 25

Alarms that suggest a deeper cause

Answer 25

> 50, recent onset, woken from sleep to poo, rectal bleeding

Question 26

Investigations of IBS

Answer 26

FBC (normal), CRP (normal), ESR (raised?), tTTG IgM for Coeliac, Colonoscopy if > 50

Question 27

Treatment of IBS

Answer 27

1. Better diet, smaller meals 3 a day 2. FODMAP diet 3. Pharmacological therapy - anti-spasmodics, anti-diarhhoeals, anti-depressants (for pain)

Question 28

Antibiotics used for diverticulitis

Answer 28

Metronidazole + Co-trimoxidole