Flashcards in Intestinal Problems 5 and 6 - Benign conditions of large intestines, colorectal pathology Deck (48):
What is GI diverticulum?
Mucosal herniation through muscle coat
What is the difference between diverticulum, diverticular disease, and diverticulitis?
Diverticulum means they are presentDivertiular disease means they are symptomaticDiverticulitis means they are inflamed
Where do diverticulum most often occur?
Do patients who develop diverticular disease tend to have a low or high fibre diet?
Low fibre intake
How are diverticulum diagnosed?
Symptoms of diverticular disease?
Altered bowel habitLeft sided colic relieved by deificationFlatulenceNausea
Symptoms of diverticulitis?
LIF pain/ tendernessSepticAltered bowel habit
Complications of diverticular disease? (5)
Pericolic abscessPerforationHaemorrhage (if it ruptures through a blood vessel)FistulaStricture
Treatment of uncomplicated (bacterial infection with possible sepsis) diverticulitis?
Pain reliefManagement in the communityOral antibiotics
Treatment of complicated diverticulitis?
Hartmann's procedure (proctosigmoidectomy)Primary resection/ anastomosisPrecutaneous drainage - access around the bowelLaparoscopic lavage and drainage - peritonitis
Causes of acute and chronic colitis?
Infective colitisUlcerative colitisCrohns colitisIschaemic colitis
Causes of acute and chronic colitis?
Infective colitisUCCrohns colitisIschaemic colitis
Symptoms of acute and chronic colitis?
Diarrhoea with/ without bloodAbdominal crampsDehydrationSepsisWeight lossAnaemia
Diagnosis of acute and chronic colitis?
Plain x-rayStool cultureSigmoidoscopy + biopsyBarium enema (Not usually in acute colitis in order to prevent irritating the bowel)
What sign on an AXR is suggestive of colitis?
Thumb-printing - mucosal oedema
Treatment for UC/ Crohns colitis?
IV fluidsIV steroids (once infective/ ischaemic colitis ruled out)GI rest
3 main types of bowel ischaemia?
Acute mesenteric ischaemia (almost always small bowel)Chronic mesenteric ischaemiaIschaemic colitis
Cause of ischaemic colitis?
Low flow in the inferior mesenteric artery
presentation of ischaemic colitis?
Lower left sided abdominal pin+/- bloody diarrhoea
Tests for ischaemic colitis?
CT may be useful but colonoscopy and biopsy is the gold standard
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.
How is colonic angiodysplasia diagnosed?
Can do a colonoscopy but would see muchDo a angiography and look for bleeding into the colon
How is colonic angiodysplasia treated?
EmbolisationEndoscopic ablationSurgical resection
Causes of a large bowel obstruction? (3)
Colorectal cancerBenign obstructionVolvolus
Symptoms of a bowel obstruction?
Treatment of a large bowel obstruction?
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
How is a sigmoid volvulus diagnosed?
Plain AXRRectal contrast may need to be addedCan use CT non-invasively assess for ischaemia
Treatment of sigmoid volvulus?
Flatus tube to decompress colonSurgical resection (especially in younger patients when it has happened a few times
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)
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.
What patients tend to get faecal impaction?
Elderly bed ridden patients on strong analgesics
What side does ischaemia of the large bowel tend to occur?
What heart condition can lead to ischaemia of the bowel?
Histopathological clues of ischaemic colitis?
Withering of cryptsPink smudgy lamina propriaFewer chronic inflammatory cells
Complications of ischaemic colitis?
What is pseudomembranous colitis?
acute, exudative colitis usually caused by Clostridium difficile
What antibiotics are used to treat severe pseudomembranous colitis/
Vancomycin and metronidzole (may need colectomy)
What toxins are involved with pseudomembranous colitis?
Toxins A and b - attack endothelium and epithelium
What causes normal mucosa and watery diarrhoea?Biopsy showing large bands of collagen laid down?
Features of collagenous colitis?
Thickened basement membraneDisease is patchyAssociated with intraepithelial inflammatory cellsNo chronic architectural changes
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)
Features of lymphocytic colitis?
No chronic architectural changes in cryptsIntraepithelial lymphocytes are raisedNo thickening of BM
What is microscopic colitis?
Used to describe colitis that has features of both Collagenous colitis and lymphocytic colitis on biopsy - normal endoscopic appearance
What is radiation colitis?
Inflammation of large bowel due to radiation in that area e.g. cervix, prostate, etc.
Features of radiation colitis?
Telangectasia - small dilated blood vessels near the skin or mucous membrane surfaceBizarre stromal cells and vessels
Features of acute infective colitis?
Busy epithelium but no crypt irregularityFlorid diffuse acute cryptitis in otherwise unremarkable colonic mucosa