Intestinal Problems 5 and 6 - Benign conditions of large intestines, colorectal pathology Flashcards Preview

1st Year - Gastroenterology > Intestinal Problems 5 and 6 - Benign conditions of large intestines, colorectal pathology > Flashcards

Flashcards in Intestinal Problems 5 and 6 - Benign conditions of large intestines, colorectal pathology Deck (48):
1

What is GI diverticulum?

Mucosal herniation through muscle coat

2

What is the difference between diverticulum, diverticular disease, and diverticulitis?

Diverticulum means they are presentDivertiular disease means they are symptomaticDiverticulitis means they are inflamed

3

Where do diverticulum most often occur?

Sigmoid colon

4

Do patients who develop diverticular disease tend to have a low or high fibre diet?

Low fibre intake

5

How are diverticulum diagnosed?

Barium enemaSigmoidoscopy

6

Symptoms of diverticular disease?

Altered bowel habitLeft sided colic relieved by deificationFlatulenceNausea

7

Symptoms of diverticulitis?

LIF pain/ tendernessSepticAltered bowel habit

8

Complications of diverticular disease? (5)

Pericolic abscessPerforationHaemorrhage (if it ruptures through a blood vessel)FistulaStricture

9

Treatment of uncomplicated (bacterial infection with possible sepsis) diverticulitis?

Pain reliefManagement in the communityOral antibiotics

10

Treatment of complicated diverticulitis?

Hartmann's procedure (proctosigmoidectomy)Primary resection/ anastomosisPrecutaneous drainage - access around the bowelLaparoscopic lavage and drainage - peritonitis

11

Causes of acute and chronic colitis?

Infective colitisUlcerative colitisCrohns colitisIschaemic colitis

12

Causes of acute and chronic colitis?

Infective colitisUCCrohns colitisIschaemic colitis

13

Symptoms of acute and chronic colitis?

Diarrhoea with/ without bloodAbdominal crampsDehydrationSepsisWeight lossAnaemia

14

Diagnosis of acute and chronic colitis?

Plain x-rayStool cultureSigmoidoscopy + biopsyBarium enema (Not usually in acute colitis in order to prevent irritating the bowel)

15

What sign on an AXR is suggestive of colitis?

Thumb-printing - mucosal oedema

16

Treatment for UC/ Crohns colitis?

IV fluidsIV steroids (once infective/ ischaemic colitis ruled out)GI rest

17

3 main types of bowel ischaemia?

Acute mesenteric ischaemia (almost always small bowel)Chronic mesenteric ischaemiaIschaemic colitis

18

Cause of ischaemic colitis?

Low flow in the inferior mesenteric artery

19

presentation of ischaemic colitis?

Lower left sided abdominal pin+/- bloody diarrhoea

20

Tests for ischaemic colitis?

CT may be useful but colonoscopy and biopsy is the gold standard

21

What is colonic angiodysplasia?

angiodysplasia is a small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia. Lesions are often multiple, and frequently involve the cecum or ascending colon, although they can occur at other places.

22

How is colonic angiodysplasia diagnosed?

Can do a colonoscopy but would see muchDo a angiography and look for bleeding into the colon

23

How is colonic angiodysplasia treated?

EmbolisationEndoscopic ablationSurgical resection

24

Causes of a large bowel obstruction? (3)

Colorectal cancerBenign obstructionVolvolus

25

Symptoms of a bowel obstruction?

Abdominal painDistensionVomitingConstipation

26

Treatment of a large bowel obstruction?

ResuscitateOperate

27

What is a sigmoid volvulus?

An obstruction caused by the bowel twisting on it mesentery - may become gangrenous, can also cause ischaemia and subsequent perforation

28

How is a sigmoid volvulus diagnosed?

Plain AXRRectal contrast may need to be addedCan use CT non-invasively assess for ischaemia

29

Treatment of sigmoid volvulus?

Flatus tube to decompress colonSurgical resection (especially in younger patients when it has happened a few times

30

What is pseudo-obstruction?

a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterized by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen - like a mechanical obstruction but no cause found (in comparison to paralytic ileus when there is absence of normal peristaltic contractions (tends to be in elderly/ debilitated)

31

What is a functional bowel disorder?

In medicine, the term functional colonic disease (or functional bowel disorder) refers to a group of bowel disorders which are characterised by chronic abdominal complaints without a structural or biochemical cause that could explain symptoms.

32

What patients tend to get faecal impaction?

Elderly bed ridden patients on strong analgesics

33

What side does ischaemia of the large bowel tend to occur?

Left side

34

What heart condition can lead to ischaemia of the bowel?

A. fibrillation

35

Histopathological clues of ischaemic colitis?

Withering of cryptsPink smudgy lamina propriaFewer chronic inflammatory cells

36

Complications of ischaemic colitis?

Massive bleedingRuptureStricture

37

What is pseudomembranous colitis?

acute, exudative colitis usually caused by Clostridium difficile

38

What antibiotics are used to treat severe pseudomembranous colitis/

Vancomycin and metronidzole (may need colectomy)

39

What toxins are involved with pseudomembranous colitis?

Toxins A and b - attack endothelium and epithelium

40

What causes normal mucosa and watery diarrhoea?Biopsy showing large bands of collagen laid down?

Collagenous colitis

41

Features of collagenous colitis?

Thickened basement membraneDisease is patchyAssociated with intraepithelial inflammatory cellsNo chronic architectural changes

42

What causes watery diarrhoea with no mucosal change - normal crypt archicgeuctre but massive increase in intraepithelial lymphocytes on biopsy?

Lymphocytic colitis (in children this may be associated with coeliac disease)

43

Features of lymphocytic colitis?

No chronic architectural changes in cryptsIntraepithelial lymphocytes are raisedNo thickening of BM

44

What is microscopic colitis?

Used to describe colitis that has features of both Collagenous colitis and lymphocytic colitis on biopsy - normal endoscopic appearance

45

What is radiation colitis?

Inflammation of large bowel due to radiation in that area e.g. cervix, prostate, etc.

46

Features of radiation colitis?

Telangectasia - small dilated blood vessels near the skin or mucous membrane surfaceBizarre stromal cells and vessels

47

Features of acute infective colitis?

Busy epithelium but no crypt irregularityFlorid diffuse acute cryptitis in otherwise unremarkable colonic mucosa

48

Is acute colitis always infective?

No, it could be the onset of IBD