Diseases Of The Large Intestine Non Cancerous Diseases Flashcards
(23 cards)
Functions of the large intestine
Reabsorb water and compact material into feces
• Absorb vitamins produced by bacteria
• Store fecal matter prior to defeacation
Anatomy of the
Large Intestine
The Colon or large intestine is 90 cm to 150 cm long
• Diameter is 4 to 6 cm
• Extends from the ileocecal valve ( a sphincter muscle valve that
separates the small intestine and the large intestine.)to the anus and
is divided into five section
The areas of the colon are:
• Ascending
• Transverse
• Descending
Sigmoid
• Rectum
• Anal canal
Diverticular Disease of the large
intestine
Diverticulum is a sacciform protrusion of all layers of the intestinal wall (true
or congenital diverticulum) or only of the mucous membrane through the
defects in the muscular layer (false or acquired diverticulum).
Diverticulosis means the presence of multiple diverticula.
most frequently localized in the
descending colon and sigmoid colon (70-85%), more
rarely – in the transverse colon and caecum.
TYPES OF DIVERTICULA
/ETHIOPATHOGENESIs
1 Congenital. All three coats of the bowel are present
in the wall of the diverticulum, e.g. Meckel’s
diverticulum.
Acquired. The wall of the diverticulum lacks a proper
muscular coat in most cases. Most alimentary
diverticula are thought to be acquired.
PULSION DIVERTICULA: develop at a site of weakness as a result of chronic
pressure against an obstruction.eg, Epiphrenic diverticula, Zenker,s diverticula,
most colonic diverticula
TRACTION DIVERTICULA:Fibrotic healing of the lymph nodes exerts traction on
the oesophageal wall and produces a focal outpouching,
Diverticula pathphysiology
• False diverticula (pulsion)
• Herniation through colonic wall
• Mucosa
• Muscularis
• Occur between tenia coli
• Points of weakness
• High intraluminal pressure
• Bleeding is self limiting
• True diverticula
• Rare and usuall congenital
• Comprise all layers of bowel wall
Factors of false diverticula development
Complications of D
Obstruction
• Bleeding
• Inflammation “itis”
• Fistula
• Sepsis
• Perforation
Uncomplicated and complicated Diverticulitis
UNCOMPLICATED DIVERTICULOSIS
(A) ASYMPTOMATIC DIVERTICULOSIS
(B) SYMPTOMATIC UNCOMPLICATED DIVERTICULAR DISEASE
(SUDD) •
• COMPLICATED DIVERTICULOSIS (A)DIVERTICULITIS –
UNCOMPLICATED DIVERTICULITIS - localized phlegmon –
COMPLICATED DIVERTICULITIS - abscess, free perforation with
peritonitis, fistula, or obstruction (B)BLEEDI
Clinical symptoms of diverticulitis
Symptoms
• Generally unwell
• Pain localising to left iliac fossa*
• Abdominal distension
• Altered bowel habit e.g. diarrhoea
• Nausea/Fever
• Signs
• LIF tenderness
• *Beware RIF pain-in right sided diverticulitis and where
sigmoid crosses midline
• Systemic signs (T/HR/BP/WCC)
• May be palpable on pR at anterior rectal wall
Management of D
Resuscitation
• Analgesia
• Bloods
• ECG/Catheter/Urine
• Rectal examination (+/-sigmoidoscopy)
• CXR
• AXR
• USS
• CT Scan
• Operative intervention
Treatment Complicated
Diverticulitis: Abscess
Stage I Diverticulitis with associated pericolic abscess
• Stage II Diverticulitis associated with distant abscess (retroperitoneal
or pelvic)
• Stage III Diverticulitis associated with purulent peritonitis
• Stage IV Diverticulitis associated with fecal peritonitis
Treatment Complicated Diverticulitis: Abscess
Small <5 cm abscesses may resolve with
antibiotic therapy
Patient with larger abscesses or those who falls
to improve with antibiotics should undergo CT
guided percutaneous drainage
Colonic resection is indicated for those who
develop either recurrent diverticulitis
Non-specific ulcerous colitis disease 2
It is a recurring inflammatory disease characterized by the
development of ulcerous -necrotic changes in the large intestine
(with obligatory impairment of the rectum), mainly in the mucous
and submucous layers.
Non-specific ulcerous colitis Factors of occurrence
Infectious
• Ecological
• Genetic
These factors Eventually lead to the damage of the mucous membrane and food allergy
Classification
Non-specific ulcerous colitis
According to localization and spread
• proctitis, proctosigmoiditis
• left-sided colitis
• total colitis
According to the severity of the clinical course
• a slight form
• a form of moderate severity
Sever form
According to the forms of the clinical
course
• immediate ( signs of a severe form of the disease occur immediately)
• acute (the first attack of the disease)
• recurring chronic (exacerbations occur once in 6 – 8 months)
• continuous chronic (exacerbation continues for more than 6 months
According to complications
local - perforation of the large intestine;
- stricture of the large intestine;
- toxic dilatation (toxic megacolon);
- massive intestinal hemorrhage;
- perianal complications (paroproctites, fissures);
- pseudopolyposis;
- malignization
According to complications
General
• - adrenal insufficiency;
• - sepsis;
• - arthrites;
• - damages of the skin, eyes;
• - amyloidosis;
Clinical Picture Non-specific ulcerous colitis
Markedness of clinical symptomatics depends on the degree of
severity and spread of the inflammatory process.
• A slight form (more frequently in proctitis and proctosigmoiditis)
• A form of moderate severity (more frequently in a left –sided
impairment)
• A severe form
• (more frequently in a total impairmen
Diagnostics of non specific ulcerous colitis
Endoscopic investigation (rectoroma-noscopy, colonoscopy)- It allows
to reliably evaluate the extent and severity degree of the damage, to
take the material for morphological study (possibility of
malignization).
• Roentgeno-logical investigation- It allows to verify the diagnosis and
to determine complications - toxic megacolon, perforation.
• Laboratory analyses of blood and microbiological investgation of
feces allow to determine the intoxication degree and to exclude
infectious origin of colitis (viruses, Chlamydiae, Staphylococcus,
Proteus,
Treatment of non colitis
Treatment of non-complicated forms of NUC starts with conservative
methods.
• The course of slight and moderate severity- Protein diet, excluding
food fibers. Aminosalicylates:mesalazinum
• (pentasa, salofalk) up to 4 g/day or sulfasalazin (sulfasalazin-EN) up
to 8 g/day; corticosteroids (prednizolone), up to 60 mg/
Surgery
• Palliative:
• ileostomy (to unload the large intestine) in patients’ severe condition
as the 1-st step of surgical treatment
• Radical: single-moment coloproctectomy with ileostomy,if possible-
ileorectostomy ( it is
Definition of Polyp
A polyp is defined as any growth or mass protruding from the mucous membrane
into the lumen.
• Classification:
• Stalked or pedunculated polyp
• Sessile polyp
Non-neoplastic & Neoplastic
Polyps
Non-neoplastic Polyps 90%
Hyperplastic polyps- most common left colon
Hamartomatous polyps
Juvenile polyps
Peutz-Jeghers polyps
Inflammatory polyps
Neoplastic Epithelial Lesions
• Benign polyps
• Adenomas
• Malignant lesions
Adenocarcinoma
