*Intestinal Problems (lecture 5 and 6)

Question 1

What is GI diverticulum?

Answer 1

Mucosal herniation through muscle coat

Question 2

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

Answer 2

Diverticulum means they are present
Divertiular disease means they are symptomatic
Diverticulitis means they are inflamed

Question 3

Where do diverticulum most often occur?

Answer 3

Sigmoid colon

Question 4

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

Answer 4

Low fibre intake

Question 5

How are diverticulum diagnosed?

Answer 5

Barium enema

Sigmoidoscopy

Question 6

Symptoms of diverticular disease?

Answer 6

Altered bowel habit
Left sided colic relieved by deification
Flatulence
Nausea

Question 7

Symptoms of diverticulitis?

Answer 7

LIF pain/ tenderness
Septic
Altered bowel habit

Question 8

Complications of diverticular disease? (5)

Answer 8

Pericolic abscess
Perforation
Haemorrhage (if it ruptures through a blood vessel)
Fistula
Stricture

Question 9

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

Answer 9

Pain relief
Management in the community
Oral antibiotics

Question 10

Treatment of complicated diverticulitis?

Answer 10

Hartmann’s procedure (proctosigmoidectomy)
Primary resection/ anastomosis
Precutaneous drainage - access around the bowel
Laparoscopic lavage and drainage - peritonitis

Question 11

Causes of acute and chronic colitis?

Answer 11

Infective colitis
Ulcerative colitis
Crohns colitis
Ischaemic colitis

Question 12

Causes of acute and chronic colitis?

Answer 12

Infective colitis
UC
Crohns colitis
Ischaemic colitis

Question 13

Symptoms of acute and chronic colitis?

Answer 13

Diarrhoea with/ without blood
Abdominal cramps
Dehydration
Sepsis
Weight loss
Anaemia

Question 14

Diagnosis of acute and chronic colitis?

Answer 14

Plain x-ray
Stool culture
Sigmoidoscopy + biopsy
Barium enema (Not usually in acute colitis in order to prevent irritating the bowel)

Question 15

What sign on an AXR is suggestive of colitis?

Answer 15

Thumb-printing - mucosal oedema

Question 16

Treatment for UC/ Crohns colitis?

Answer 16

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

Question 17

3 main types of bowel ischaemia?

Answer 17

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

Question 18

Cause of ischaemic colitis?

Answer 18

Low flow in the inferior mesenteric artery

Question 19

presentation of ischaemic colitis?

Answer 19

Lower left sided abdominal pin

+/- bloody diarrhoea

Question 20

Tests for ischaemic colitis?

Answer 20

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

Question 21

What is colonic angiodysplasia?

Answer 21

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.

Question 22

How is colonic angiodysplasia diagnosed?

Answer 22

Can do a colonoscopy but would see much

Do a angiography and look for bleeding into the colon

Question 23

How is colonic angiodysplasia treated?

Answer 23

Embolisation
Endoscopic ablation
Surgical resection

Question 24

Causes of a large bowel obstruction? (3)

Answer 24

Colorectal cancer
Benign obstruction
Volvolus

Question 25

Symptoms of a bowel obstruction?

Answer 25

Abdominal pain Distension Vomiting Constipation

Question 26

Treatment of a large bowel obstruction?

Answer 26

Resuscitate | Operate

Question 27

What is a sigmoid volvulus?

Answer 27

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

Question 28

How is a sigmoid volvulus diagnosed?

Answer 28

Plain AXR Rectal contrast may need to be added Can use CT non-invasively assess for ischaemia

Question 29

Treatment of sigmoid volvulus?

Answer 29

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

Question 30

What is pseudo-obstruction?

Answer 30

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)

Question 31

What is a functional bowel disorder?

Answer 31

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.

Question 32

What patients tend to get faecal impaction?

Answer 32

Elderly bed ridden patients on strong analgesics

Question 33

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

Answer 33

Left side

Question 34

What heart condition can lead to ischaemia of the bowel?

Answer 34

A. fibrillation

Question 35

Histopathological clues of ischaemic colitis?

Answer 35

Withering of crypts Pink smudgy lamina propria Fewer chronic inflammatory cells

Question 36

Complications of ischaemic colitis?

Answer 36

Massive bleeding Rupture Stricture

Question 37

What is pseudomembranous colitis?

Answer 37

acute, exudative colitis usually caused by Clostridium difficile

Question 38

What antibiotics are used to treat severe pseudomembranous colitis/

Answer 38

Vancomycin and metronidzole (may need colectomy)

Question 39

What toxins are involved with pseudomembranous colitis?

Answer 39

Toxins A and b - attack endothelium and epithelium

Question 40

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

Answer 40

Collagenous colitis

Question 41

Features of collagenous colitis?

Answer 41

Thickened basement membrane Disease is patchy Associated with intraepithelial inflammatory cells No chronic architectural changes

Question 42

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

Answer 42

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

Question 43

Features of lymphocytic colitis?

Answer 43

No chronic architectural changes in crypts Intraepithelial lymphocytes are raised No thickening of BM

Question 44

What is microscopic colitis?

Answer 44

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

Question 45

What is radiation colitis?

Answer 45

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

Question 46

Features of radiation colitis?

Answer 46

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

Question 47

Features of acute infective colitis?

Answer 47

Busy epithelium but no crypt irregularity | Florid diffuse acute cryptitis in otherwise unremarkable colonic mucosa

Question 48

Is acute colitis always infective?

Answer 48

No, it could be the onset of IBD