9. Disease of Large intestine - Sarm

• Diverticulum - mucosal outpouchings 
• Diverticulum can occur in through the colon

  • common in the left - sigmoid colon
• ** Diverticulum does not occur in the rectum
• • Diverticulitis inflammation of one diverticulum
• Diverticulosis - the condition of having diverticula
• Diverticulitis - at risk for

  • perforation
  • can progress to localized abscesses
• Diverticulum Risk factor

  • low fiber diet
  • high fat and beef content
  • taking corticosteroid or NSAID
• Increase in age can increase development of diverticulum due to weakening of colonic wall
• Diverticulum - development

  • asian - right side
  • western - left side
• Diverticular Disease clinical presentation

  • constipation
  • bloody diarrhea
  • fever
  • ab pain
• Diverticular Disease complication

  • colo-vesicular fistula
  • intestinal obstruction
• Diverticular Disease - most common pts presentation?


  elderly or pts taking corticosteroid
• Diverticular Disease - use upright CXR to look for free air
• What is not advise as imaging for diverticulum?

  barium
• ** if peri-diverticular abscess (> 5cm) use CT scan guided percutaneous drainage
• Diverticular Disease - optimal method of investigation?

  CT scan of the abdomen
• Volvulus - twisting of the intestine and complete obstruction with vascular compromised
• ** Risk for volvulus: long mesentery, narrow base
• ** diagnosis for volvulus?

  CT scan
• Colorectal cancer - genetic risk factor?

  polyposis

  adenocarcinoma
• CEA elevated is used to evaluate if colorectal cancer is recurrent or metastatic
• Optional colorectal cancer imaging?

  double contrast barium enema
• 2 types of inflammatory bowel disease

  • ulcerative colitis - limited to cecum to rectum - colon only
  • crohn's disease - any portion of GI tract - from mouth to anus
• Ulcerative Colitis - inflammatory changes in  colonic submucosa and mucosa only in a continuous fashion
• Crohn’s Disease - inflammation is discontinuous (“Skip Lesions”) but transmural
• Tobacco use

  • worsen Crohn
  • protective for UC
• Ulcerative colitis - clinical presentation

  • bloody diarrhea
  • fatigue
  • colicky pain
• Life threaten complication of UC?

  toxic megacolon (> 6 cm)
• ** ulcerative colitis - surveillance colonoscopy every 2 years after 8th year
• In person with UC - colonic stricture should always be presumed as malignant
• UC hepatic complication?

  sclerosing - if abnormal LFT
• Crohn’s

  • skip lesion
  • cobblestoning
• UC - the rectum is always involve
• Crohn - rectum is spared

  • common - right colonic
• ** Crohns treatment

  • First - sulfa (amino salicylates)
  • corticosteroid
  • long term - immunomodulatory
• aminosalicylates are useful for treating flares of IBD + maintain remission
• Antibiotics - metron and cipro used in IBD - Crohn
• IBD - Corticosteroids is used if inducing remission

  • use if amino salicylates fails (sulfa)
• Immunomodulatory Agents - not used for acute flares of IBD

  • 6MP
  • azathio
• Diet role in IBD

  • affected in Crohns - not UC