Flashcards in *Intestinal Problems (lecture 5 and 6) Deck (48)
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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 present
Divertiular disease means they are symptomatic
Diverticulitis 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 enema
Sigmoidoscopy
6
Symptoms of diverticular disease?
Altered bowel habit
Left sided colic relieved by deification
Flatulence
Nausea
7
Symptoms of diverticulitis?
LIF pain/ tenderness
Septic
Altered bowel habit
8
Complications of diverticular disease? (5)
Pericolic abscess
Perforation
Haemorrhage (if it ruptures through a blood vessel)
Fistula
Stricture
9
Treatment of uncomplicated (bacterial infection with possible sepsis) diverticulitis?
Pain relief
Management in the community
Oral antibiotics
10
Treatment of complicated diverticulitis?
Hartmann's procedure (proctosigmoidectomy)
Primary resection/ anastomosis
Precutaneous drainage - access around the bowel
Laparoscopic lavage and drainage - peritonitis
11
Causes of acute and chronic colitis?
Infective colitis
Ulcerative colitis
Crohns colitis
Ischaemic colitis
12
Causes of acute and chronic colitis?
Infective colitis
UC
Crohns colitis
Ischaemic colitis
13
Symptoms of acute and chronic colitis?
Diarrhoea with/ without blood
Abdominal cramps
Dehydration
Sepsis
Weight loss
Anaemia
14
Diagnosis of acute and chronic colitis?
Plain x-ray
Stool culture
Sigmoidoscopy + biopsy
Barium 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 fluids
IV 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 ischaemia
Ischaemic 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 much
Do a angiography and look for bleeding into the colon
23
How is colonic angiodysplasia treated?
Embolisation
Endoscopic ablation
Surgical resection
24
Causes of a large bowel obstruction? (3)
Colorectal cancer
Benign obstruction
Volvolus
25
Symptoms of a bowel obstruction?
Abdominal pain
Distension
Vomiting
Constipation
26
Treatment of a large bowel obstruction?
Resuscitate
Operate
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 AXR
Rectal contrast may need to be added
Can use CT non-invasively assess for ischaemia
29
Treatment of sigmoid volvulus?
Flatus tube to decompress colon
Surgical resection (especially in younger patients when it has happened a few times
30
