Large Bowl Benign

Question 1

what are the common benign conditions of the large bowl

Answer 1

• Crohn’s colitis and ulcerative colitis
• Diverticular disease
• Functional disorders
• benign polyps
• ischaemic colitis

Question 2

what are the less common bening conditions of the large bowl

Answer 2

• Colonic volvulus
• Colonic angiodysplasia
• Ischaemic colitis
• Pseudo-obstruction

Question 3

what is diverticular disease

Answer 3

Mucosal herniation through muscle coat

Question 4

where is diverticular disease most common

Answer 4

in the sigmoid colon

Question 5

what is the difference between a true and a false diverticula

Answer 5

True diverticula of the GI tract contain all layers of the GI wall. Esophageal diverticula and Meckel diverticula are true diverticula. False or pseudo-diverticula are mucosal and submucosal protrusions through the muscular wall of the bowel.

Question 6

what can cause a diverticulum

Answer 6

congenital, low fibre diet

Question 7

what causes the symptoms

Answer 7

complication of diverticulum- most often no problems and is an incidental finding

Question 8

what is diverticulosis

Answer 8

the presence of an acquired diverticula

Question 9

what is diverticulitis

Answer 9

diverticulum associated with inflammation

Question 10

what investigations can be done into a diverticulosis

Answer 10

barium enema, colon/sigmoidoscopy

Question 11

what are the clinical features of diverticulitis

Answer 11

left iliac fossa pain/ tenderness (can mimic appendicitis if moves to RIF)

septic

altered bowl habits

Question 12

what are the possible complications of diverticular disease

Answer 12

pericolic abscess, perforation, haemorrhage, fistula, stricture

Question 13

what is a fistula

Answer 13

abnormal communication between two epithelial lined surfaces

Question 14

what types of fistula can occur from diverticular disease

Answer 14

colovesical (bowl and bladder)
colovaginal
colocutaneal (bowl and abdominal wall)

Question 15

what is the presentation of a colovesical fistula

Answer 15

recurring UTIs, pneumaturia (passing air)

Question 16

when is a colovaginal fistula more common

Answer 16

in patients who have had a hysterectomy

Question 17

what classification is used for acute diverticulitis

Answer 17

hinchey classification

Question 18

how is an uncomplicated diverticulitis treated

Answer 18

oral or no antibiotics

Question 19

how is a complex diverticulitis treated

Answer 19

hartmann’s procedure (surgical resection creating colostomy)

primary resection/ anastomosis

percutaneous drainage

laproscopic lavage and drainage

Question 20

what stage of a complex diverticulitis should get an emergency operation

Answer 20

stage 4- faecal peritonitis

Question 21

what are the causes of acute and chronic colitis

Answer 21

infective colitis
ulcerative colitis
crohns colitis
ischaemic colitis

Question 22

what organisms can cause infective colitis

Answer 22

Shigella, Salmonella, Campylobacter, Escherichia coli, Clostridium difficile

Question 23

what are the symptoms in acute and chronic colitis

Answer 23

diarrhoea +/- blood, abdo cramps, dehydration, sepsis

chronic= weight loss, anaemia

Question 24

what investigations can be done into acute and chronic colitis

Answer 24

x ray, sigmoidoscopy + biopsy, stool cultures, barium enema

Question 25

what is seen on an x ray of acute/ chronic colitis

Answer 25

featureless left colon (lead piping), 'thumb-printing' of right colon (sign of severe mucosal inflammation)

Question 26

what patients are likely to get infective colitis from C. diff

Answer 26

people on broad range antibiotics or who are immunosuppressed

Question 27

what is the treatment for ulcerative/ crohns colitis

Answer 27

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

Question 28

what are the signs of failure to settle of ulcerative/ crohns colitis

Answer 28

obs- tachycardia, stool chart, re- image, inflammatory response/ markers, how patients feels

Question 29

what should be when UC/ crohns colitis fails to settle after treatment

Answer 29

rescue medical therapy, surgery

Question 30

what are the risk factors for atherosclerosis

Answer 30

obesity, diabetes, hyperlipidaemia, smoking, hypertension,

Question 31

how is acute bowl ischaemia treated

Answer 31

emergency surgery

Question 32

how does bowl ischaemia kill

Answer 32

as bodys inflammatory response is overwhelming

Question 33

what are the three main arteries that supply the colon

Answer 33

inferior mesenteric, middle colic (transverse), ileocolic (cecum and terminal ileum)

Question 34

what is a watershed stroke

Answer 34

when area naturally has less blood supply so is more prone to ischaemia- e.g. splenic flexure in the bowl

Question 35

where does ulcerative colitis affect

Answer 35

starts in rectum and moves proximally

Question 36

where is the most common place affected by crohns

Answer 36

terminal ileum

Question 37

what is colonic angiodysplasia

Answer 37

vascular malformation in the colon, submucosal lakes of blood- obscure cause of rectal bleeding

Question 38

how is colonic angiodysplasia treated

Answer 38

embolisation, endoscopic ablation and surgical resection

Question 39

what are three causes of large bowl obstruction

Answer 39

colorectal cancer, benign stricture (diverticular diverticular disease), UC), volvulus

Question 40

where are common sites of a volvulus

Answer 40

sigmoid, transverse, caecum- in neonates whole small bowl can twist

Question 41

what are the symptoms of large bowl obstruction

Answer 41

absolute constipationm distended abdomen, pain, vomiting

Question 42

how are large bowl | obstructions treated

Answer 42

resuscitate, operate, possible stenting

Question 43

what is the most common volvulus

Answer 43

sigmoid- when it twists on the mesentery

Question 44

how is a sigmoid volvulus treated

Answer 44

flatus tube- to deflate, surgical resection

Question 45

what is a pseudo-obstruction

Answer 45

when theres all the symptoms of a volvulus but no real mechanical obstruction- usually organ failure due to ill health in elderly/ debilitated

Question 46

what is chronic constipation a type of

Answer 46

functional bowel disorder

Question 47

what are causes of chronic constipation

Answer 47

most= dietary, laxatives few= motility disorders

Question 48

what is obstructive defecation

Answer 48

pelvic floor inability, autonomic nerve problem

Question 49

what is faecal impaction

Answer 49

a solid, immobile bulk of faeces that can develop in the rectum as a result of chronic constipation

Question 50

what can cause faecal impaction

Answer 50

bed ridden, eldery, strong analgesics, thyroid and parathyroid hormonal problems

Question 51

how is faecal impaction treated

Answer 51

enemas, laxatives, manual evacuation