Large Bowel - Benign Conditions

Question 1

Common Conditions of the Large Bowel

Answer 1

Carcinoma of colon and rectum
Colonic polyps
Crohn's colitis and Ulcerative colitis
Diverticular disease
Functional disorders

Question 2

Less Common conditions of the Large Bowel

Answer 2

Colonic volvulus
Colonic angiodysplasia
Ischaemic colitis
Pseudo-obstruction

Question 3

What is diverticular disease?

Answer 3

Muscle herniation through the muscle coat

Question 4

Diverticular Disease - Common Site

Answer 4

Sigmoid colon

Question 5

Diverticular Disease - Common Cause

Answer 5

Low fibre intake

Question 6

Diverticulitis - Clinical Features

Answer 6

LIF pain/tenderness
Septic
Altered bowel habit

Question 7

Diverticulitis - Diagnosis

Answer 7

Clinical
Barium enema
Sigmoidoscopy

Question 8

Diverticular Disease - Treatment

Answer 8

IV fluids
Bowel rest
IV antibiotics
Surgery = No improvement or complications

Question 9

Diverticular Disease - Complications

Answer 9

Pericolic Abscess
Perforation
Haemorrhage
Fistula
Stricture

Question 10

Diverticular Disease - Surgical Operation

Answer 10

Hartmann’s procedure

Primary resection/anastamosis

Question 11

Acute and Chronic Colitis - Causes

Answer 11

Infective colitis
Ulcerative colitis
Crohn’s colitis
Ischaemic colitis

Question 12

Acute and Chronic Colitis - Symptoms

Answer 12

Diarrhoea +/- blood
Abdominal cramps
Dehydration
Sepsis
Weight loss, anaemia

Question 13

Acute and Chronic Colitis - Diagnosis

Answer 13

Plain X-Ray
Sigmoidoscopy + biopsy
Stool cultures
Barium enema

Question 14

Ulcerative Colitis/Crohn’s - Treatment

Answer 14

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

Question 15

Features of Ischaemic Colitis

Answer 15

Elderly
Arteriopaths
Acute or chronic occlusion
Commonly inferior mesenteric artery

Question 16

Colonic Angiodysplasia - Features

Answer 16

Submucosal lakes of blood
Obscure cause of rectal bleeding
Usually right side of colon

Question 17

Colonic Angiodysplasia - Diagnosis

Answer 17

Difficult
Angiography
Colonoscopy
Injection or surgical resection

Question 18

Colonic Angiodysplasia - Treatment

Answer 18

Embolisation
Endoscopic ablation
Surgical resection

Question 19

Large Bowel Obstruction - Causes

Answer 19

Colorectal cancer
Sigmoid or caecal volvulus
Pseudo-obstruction
Faecal impaction

Question 20

Large Bowel Obstruction - Treatment

Answer 20

Usually:
Resuscitate
Operate

Question 21

Sigmoid Volvulus - Cause

Answer 21

Bowel twists on mesentery

May become gangrenous

Question 22

Sigmoid Volvulus - Diagnosis

Answer 22

Plain Abdo X-Ray

Rectal contrast

Question 23

Sigmoid Volvulus - Treatment

Answer 23

Flatus tube

Surgical resection

Question 24

Features of Pseudo-Obstruction

Answer 24

No real mechanical obstruction
Elderly/debilitated
Hypoxia
Biochemistry

Question 25

Functional Bowel Disorders - Most Cases of Chronic Constipation

Answer 25

Dietary causes

Laxatives to treat

Question 26

Functional Bowel Disorders - Rarer Cases of Chronic Constipation

Answer 26

Motility Disorders

Question 27

Functional Bowel Disorders - Faecal Impaction

Answer 27

Be ridden, elderly
May be on strong analgesics
Treat with enemas, laxatives
May need manual evacuation

Question 28

A 70-year-old woman with a history of atrial fibrillation presents with central abdominal pain and diarrhoea. A metabolic acidosis is found on the arterial blood gas

Answer 28

Mesenteric ischaemia