Diverticulosis definition
Presence of diverticular
Diverticular disease definition
Presence of diverticular and
- intermittent lower abdomen pain and bloating
- may be eased by passing stool
- new IBS in older people
- rectal bleeding, fresh
Diverticulitis definition
Presence of diverticular and
- infection and inflammation of diverticular
- constant abdo pain
- fever
- constipation or diarrhoea
- bleeding
- n+v
Diverticular aetiology
- thickend colonic muscle wall due to excess elastic tissue
- functional hypersegmentation -> increased pressure
- pockets of mucosa herniate through weak points in the bowel wall
- between the taeniae coli
- sigmoid most common
Complications of diverticular pericolic abcess
Severe diverticulitis which fails to resolve with antibiotics Pain and tenderness Fever Incomplete obstruction Purulent diarrhoea -> CT scan and antibiotics
Complications of diverticular disease, perforation
Acute abdomen and sepsis
-> colonic resection and temporary stoma
Diverticular disease complications, fistula
Inflammation-> adhesions-> rupture
Bubbles in wee/infections
Uterus
Diverticular disease complications, haemorrhage
> 50 years
Spontaneous
Fresh blood
Most common cause of large volume
Diverticular disease investigations
CT scan
Colonoscopy
Diverticular disease management
Increase dietary fibre
Resection if severe/repeated attacks
Antibiotics
Colorectal adenomas
Most common type of polyp
Glandular epithelium of large bowel
Have malignant potential so all need to be removed
Often asymptomatic and found on screening
-unexplained anaemia/rectal bleeding
-mucous
-tenesmus
Familial adenomatous polyps, what and how
Autosomal dominant -> rare-> APC gene
Commonly asymptomatic
Begin to develop in childhood and have hundreds by 30-40
Inevitably develop cancer by 45
Prevented by surveillance and removal of common
Also:
-desmoid tumours
-congenital hypertrophy of retinal pigment
-fibrous oesteomas
-sebaceous cysts
Hereditary Non-polyposis what and how
Autosomal dominant -> DNA mismatch repair gene
Increased incidence of adeoncardinomas in the ovary, endometrium and stomach
90% develop cancer
Often poorly differentiated and aggressive
Colon cancer epidemiology
6th decade
2/3 rectum
3rd commonest cause of cancer death in UK
Colon cancer risk factors
Age High red/processed meat intake Low fibre T2DM UC Inherited syndromes
Colon cancer pathophysiology
Adenocarcinoma
Initially exophytic-> protrudes in to lumen -> ulcerated
-> invade bowel wall
-stromatolites fibrosis-> obstruction
Lymph and blood mets-> para aortic and liver
Colon cancer presentation
Anaemia Change in bowel habits Large bowel obstruction Rectal bleeding Abdo pain Malaise Wt loss Tenesmus Perforation
Dukes staging
A-mucosa
B-muscle, no nodes
C- nodes
D-mets
Primary caecal cancer specific symptoms
Painless
Iron deficient an email
RIF mass
Diarrhoea
Primary descending cancer specific symptoms
Rectal blood loss Change in bowel habit Colicky pain/obstruction Increased mucous Fistula perforation
Sigmoid primary cancer specific symptoms
Tenesmus Diarrhoea Hypokalemia Local pain Incontinence
Colon cancer screening
60-70y
Test stools for blood
-> colonoscopy
Colon cancer investigations
DRE
Colonscopy
Carcinogenoembryonic antigen
CT scan
Colon cancer management
Colon-> surgical removal + adjuvant in higher stage
Rectum-> pre op chemo radio -> resection
Adjuvants
- nodes-> chemo
- palliative
