Podcast
Questions and Answers
What is primarily responsible for diverticular disease in adults over 60 years old?
What is primarily responsible for diverticular disease in adults over 60 years old?
- High fiber diet
- Sedentary lifestyle
- Wall stress due to low fiber diet (correct)
- Genetic predisposition
Which systemic manifestation is NOT typically associated with ulcerative colitis?
Which systemic manifestation is NOT typically associated with ulcerative colitis?
- Ankylosing spondylitis
- Primary sclerosing cholangitis
- Asthma (correct)
- Erythema nodosum
Which complication is most commonly associated with diverticulitis?
Which complication is most commonly associated with diverticulitis?
- Intussusception
- Adhesions
- Perforation (correct)
- Herniation
What is a common clinical feature of diverticular disease?
What is a common clinical feature of diverticular disease?
What anatomical feature is a primary site for the formation of diverticula?
What anatomical feature is a primary site for the formation of diverticula?
Which of the following is NOT a type of mechanical intestinal obstruction?
Which of the following is NOT a type of mechanical intestinal obstruction?
What dietary change is recommended to potentially prevent progression of diverticular disease?
What dietary change is recommended to potentially prevent progression of diverticular disease?
Which condition is characterized by inappropriate communication between the intestine and adjacent organs?
Which condition is characterized by inappropriate communication between the intestine and adjacent organs?
What is the primary blood supply to the caecum and ascending colon?
What is the primary blood supply to the caecum and ascending colon?
Which cellular component is primarily responsible for the antimicrobial properties in the caecum and ascending colon?
Which cellular component is primarily responsible for the antimicrobial properties in the caecum and ascending colon?
What is the hallmark feature of Hirschsprung's disease?
What is the hallmark feature of Hirschsprung's disease?
Which of the following is NOT a clinical feature of Hirschsprung's disease?
Which of the following is NOT a clinical feature of Hirschsprung's disease?
Which form of intestinal infarction affects all layers of the intestinal wall?
Which form of intestinal infarction affects all layers of the intestinal wall?
What condition is characterized as a functional obstruction due to the absence of enteric ganglia?
What condition is characterized as a functional obstruction due to the absence of enteric ganglia?
In the comparison of Crohn's disease and ulcerative colitis, which statement is true?
In the comparison of Crohn's disease and ulcerative colitis, which statement is true?
Which of the following conditions is a type of colitis characterized by inflammation of specific segments of the bowel?
Which of the following conditions is a type of colitis characterized by inflammation of specific segments of the bowel?
What is a common complication associated with proximal innervated colon in patients with Hirschsprung's disease?
What is a common complication associated with proximal innervated colon in patients with Hirschsprung's disease?
What type of adhesive tissue formation can disrupt normal bowel movement and cause pain?
What type of adhesive tissue formation can disrupt normal bowel movement and cause pain?
What is the primary factor predisposing individuals to hemorrhoids?
What is the primary factor predisposing individuals to hemorrhoids?
Which clinical feature is unique to Crohn’s disease compared to ulcerative colitis?
Which clinical feature is unique to Crohn’s disease compared to ulcerative colitis?
What is the main pathological feature that differentiates ulcerative colitis from Crohn’s disease?
What is the main pathological feature that differentiates ulcerative colitis from Crohn’s disease?
What is a common complication associated with chronic ulcerative colitis?
What is a common complication associated with chronic ulcerative colitis?
Which of the following is NOT a characteristic of Crohn’s disease?
Which of the following is NOT a characteristic of Crohn’s disease?
In terms of demographic prevalence, which group is most at risk for developing inflammatory bowel disease?
In terms of demographic prevalence, which group is most at risk for developing inflammatory bowel disease?
Which type of exudate characterizes antibiotic-associated colitis?
Which type of exudate characterizes antibiotic-associated colitis?
What is a primary clinical symptom of necrotising enterocolitis in neonates?
What is a primary clinical symptom of necrotising enterocolitis in neonates?
What is often considered a risk factor for the development of diverticular disease?
What is often considered a risk factor for the development of diverticular disease?
Which type of bowel involvement is typically seen in Crohn’s disease?
Which type of bowel involvement is typically seen in Crohn’s disease?
What diagnostic method is most commonly used to identify ulcerative colitis?
What diagnostic method is most commonly used to identify ulcerative colitis?
What is a potential systemic manifestation of Crohn’s disease?
What is a potential systemic manifestation of Crohn’s disease?
Which of the following does NOT typically present with abdominal pain and bloody diarrhea?
Which of the following does NOT typically present with abdominal pain and bloody diarrhea?
What is the significance of detecting cytotoxin in stool for antibiotic-associated colitis?
What is the significance of detecting cytotoxin in stool for antibiotic-associated colitis?
Which of the following regions are part of the large intestine? (Select all that apply)
Which of the following regions are part of the large intestine? (Select all that apply)
Which artery supplies the caecum to the splenic flexure?
Which artery supplies the caecum to the splenic flexure?
Which artery supplies the remainder of the colon to the rectum?
Which artery supplies the remainder of the colon to the rectum?
Which of the following supplies the lower portion of the rectum?
Which of the following supplies the lower portion of the rectum?
Which of the following statements is true regarding the histology of the large intestine's mucosa?
Which of the following statements is true regarding the histology of the large intestine's mucosa?
Which of the following statements about the mucosa layers of the large intestine are correct? (Select all that apply)
Which of the following statements about the mucosa layers of the large intestine are correct? (Select all that apply)
What is the structure of the submucosa found in the large intestine?
What is the structure of the submucosa found in the large intestine?
What are the components of the muscularis propria in the large intestine?
What are the components of the muscularis propria in the large intestine?
What type of tissue is found in the serosa of the large intestine?
What type of tissue is found in the serosa of the large intestine?
Which type of mucosal cell is known for producing antimicrobial properties and immune mediators?
Which type of mucosal cell is known for producing antimicrobial properties and immune mediators?
Where are Paneth cells located in the human body?
Where are Paneth cells located in the human body?
Which of the following statements about endocrine cells and their products in the digestive system is correct?
Which of the following statements about endocrine cells and their products in the digestive system is correct?
Which of the following statements about goblet cells in the large intestine is true?
Which of the following statements about goblet cells in the large intestine is true?
Which of the following statements about Hirschsprung's disease is true?
Which of the following statements about Hirschsprung's disease is true?
What is the primary mechanism involved in the pathogenesis of Hirschsprung's disease?
What is the primary mechanism involved in the pathogenesis of Hirschsprung's disease?
Where is Auerbach's plexus located?
Where is Auerbach's plexus located?
Where is Meissner's plexus located?
Where is Meissner's plexus located?
What is the primary characteristic of Hirschsprung's disease?
What is the primary characteristic of Hirschsprung's disease?
What does an aganglionic (aperistaltic) narrow segment in the rectum cause?
What does an aganglionic (aperistaltic) narrow segment in the rectum cause?
Which of the following are clinical features of Hirschsprung's disease? (Select all that apply)
Which of the following are clinical features of Hirschsprung's disease? (Select all that apply)
In Hirschsprung's disease, what percentage of sporadic cases have mutations in the RET gene?
In Hirschsprung's disease, what percentage of sporadic cases have mutations in the RET gene?
In sporadic cases of Hirschsprung's disease, mutations occur in which gene?
In sporadic cases of Hirschsprung's disease, mutations occur in which gene?
Which of the following statements about ischemic bowel disease is correct? (Select all that apply)
Which of the following statements about ischemic bowel disease is correct? (Select all that apply)
What type of bowel infarction occurs due to sudden occlusion (thrombosis/embolism) of a major vessel?
What type of bowel infarction occurs due to sudden occlusion (thrombosis/embolism) of a major vessel?
Mural infarction refers to necrosis of which layers of the gastrointestinal tract?
Mural infarction refers to necrosis of which layers of the gastrointestinal tract?
Mucosal infarction is defined as necrosis of the:
Mucosal infarction is defined as necrosis of the:
Which of the following are characteristics of chronic ischemic bowel disease? (Select all that apply)
Which of the following are characteristics of chronic ischemic bowel disease? (Select all that apply)
Mural/mucosal infarction due to hypoperfusion occurs primarily in which of the following?
Mural/mucosal infarction due to hypoperfusion occurs primarily in which of the following?
Which of the following mechanisms are involved in the pathogenesis of ischaemic bowel disease? (Select all that apply)
Which of the following mechanisms are involved in the pathogenesis of ischaemic bowel disease? (Select all that apply)
What are some contributing factors to non-occlusive ischaemia in bowel disease? (Select all that apply)
What are some contributing factors to non-occlusive ischaemia in bowel disease? (Select all that apply)
Which of the following are clinical features of ischaemic bowel disease? (Select all that apply)
Which of the following are clinical features of ischaemic bowel disease? (Select all that apply)
A 75-year-old male with a history of atrial fibrillation presents with sudden-onset severe abdominal pain and bloody diarrhea. What is the most likely diagnosis in this patient?
A 75-year-old male with a history of atrial fibrillation presents with sudden-onset severe abdominal pain and bloody diarrhea. What is the most likely diagnosis in this patient?
Case-Based MCQ on Mucosal and Mural Infarction
A 60-year-old female with a history of congestive heart failure presents to the clinic with intermittent abdominal pain and episodes of bloody diarrhea over the past week. She describes the pain as crampy and notes that it often worsens after meals. On physical examination, there are no signs of peritoneal irritation, and bowel sounds are present. Basic lab results are unremarkable, and imaging studies show no evidence of bowel perforation or complete obstruction. The patient’s symptoms improve with conservative management, including intravenous fluids and bowel rest.
What is the most likely diagnosis in this patient?
Case-Based MCQ on Mucosal and Mural Infarction
A 60-year-old female with a history of congestive heart failure presents to the clinic with intermittent abdominal pain and episodes of bloody diarrhea over the past week. She describes the pain as crampy and notes that it often worsens after meals. On physical examination, there are no signs of peritoneal irritation, and bowel sounds are present. Basic lab results are unremarkable, and imaging studies show no evidence of bowel perforation or complete obstruction. The patient’s symptoms improve with conservative management, including intravenous fluids and bowel rest.
What is the most likely diagnosis in this patient?
Which of the following statements about Chronic Ischemic Colitis is true?
Which of the following statements about Chronic Ischemic Colitis is true?
What is angiodysplasia characterized by?
What is angiodysplasia characterized by?
In which part of the gastrointestinal tract is ANGIODYSPLASIA commonly found?
In which part of the gastrointestinal tract is ANGIODYSPLASIA commonly found?
What is angiodysplasia characterized by?
What is angiodysplasia characterized by?
Which of the following conditions is associated with angiodysplasia? (Select all that apply)
Which of the following conditions is associated with angiodysplasia? (Select all that apply)
Which of the following is associated with Hereditary Hemorrhagic Telangiectasia?
Which of the following is associated with Hereditary Hemorrhagic Telangiectasia?
What is true about Telangiectasia?
What is true about Telangiectasia?
What are hemorrhoids primarily characterized by?
What are hemorrhoids primarily characterized by?
Where do haemorrhoids typically occur due to increased pressure in the veins?
Where do haemorrhoids typically occur due to increased pressure in the veins?
Which of the following are common predisposing factors for haemorrhoids? (Select all that apply)
Which of the following are common predisposing factors for haemorrhoids? (Select all that apply)
HAEMORRHOIDS can be classified as which of the following? (Select all that apply)
HAEMORRHOIDS can be classified as which of the following? (Select all that apply)
Which of the following are clinical features of haemorrhoids? (Select all that apply)
Which of the following are clinical features of haemorrhoids? (Select all that apply)
Which of the following statements about necrotising enterocolitis (NEC) is true?
Which of the following statements about necrotising enterocolitis (NEC) is true?
Which of the following best describes the condition characterized by a combination of ischaemia, colonization by pathogenic organisms, excess protein in the lumen, and functional immaturity of the gut?
Which of the following best describes the condition characterized by a combination of ischaemia, colonization by pathogenic organisms, excess protein in the lumen, and functional immaturity of the gut?
What is a common characteristic of necrotising enterocolitis (NEC) in infants?
What is a common characteristic of necrotising enterocolitis (NEC) in infants?
What characterizes antibiotic-associated colitis (pseudomembranous colitis)?
What characterizes antibiotic-associated colitis (pseudomembranous colitis)?
Antibiotic-associated colitis pseudomembrane is composed of which of the following?
Antibiotic-associated colitis pseudomembrane is composed of which of the following?
What is the main cause of antibiotic-associated colitis?
What is the main cause of antibiotic-associated colitis?
What is a key component of the clinical presentation for antibiotic-associated colitis?
What is a key component of the clinical presentation for antibiotic-associated colitis?
What is a key diagnostic method for antibiotic-associated colitis?
What is a key diagnostic method for antibiotic-associated colitis?
Which of the following are classified as idiopathic inflammatory bowel diseases? (Select all that apply)
Which of the following are classified as idiopathic inflammatory bowel diseases? (Select all that apply)
What is the most common form of idiopathic inflammatory bowel disease among Caucasian and Ashkenazi Jews?
What is the most common form of idiopathic inflammatory bowel disease among Caucasian and Ashkenazi Jews?
Which statement about idiopathic inflammatory bowel disease is correct?
Which statement about idiopathic inflammatory bowel disease is correct?
Which of the following statements correctly describes the pathogenesis of idiopathic inflammatory bowel diseases (IBD) regarding mucosal immunity and genetic polymorphism?
Which of the following statements correctly describes the pathogenesis of idiopathic inflammatory bowel diseases (IBD) regarding mucosal immunity and genetic polymorphism?
Which of the following statements about Crohn's disease are correct? (Select all that apply)
Which of the following statements about Crohn's disease are correct? (Select all that apply)
Which of the following findings is associated with Crohn's disease?
Which of the following findings is associated with Crohn's disease?
Aphthous mucosal ulcers that coalesce into long, linear serpentine ulcers along the bowel axis can be associated with which of the following?
Aphthous mucosal ulcers that coalesce into long, linear serpentine ulcers along the bowel axis can be associated with which of the following?
Linear ulcers with edema of the intervening mucosa seen in Crohn's Disease can be called a:
Linear ulcers with edema of the intervening mucosa seen in Crohn's Disease can be called a:
Which of the following are specific microscopic features of Crohn's disease? (Select all that apply)
Which of the following are specific microscopic features of Crohn's disease? (Select all that apply)
Which of the following are clinical features of Crohn's disease? (Select all that apply)
Which of the following are clinical features of Crohn's disease? (Select all that apply)
Which of the following is a common diagnostic procedure for Crohn's disease?
Which of the following is a common diagnostic procedure for Crohn's disease?
Which of the following are complications associated with Crohn's disease? (Select all that apply)
Which of the following are complications associated with Crohn's disease? (Select all that apply)
In Crohn's disease, obstruction secondary to transmural fibrosis/stricture primarily occurs in which part of the digestive system?
In Crohn's disease, obstruction secondary to transmural fibrosis/stricture primarily occurs in which part of the digestive system?
Which of the following are systemic manifestations of Crohn's disease? (Select all that apply)
Which of the following are systemic manifestations of Crohn's disease? (Select all that apply)
In Ulcerative Colitis (UC), where does the gross pathology usually begin and how does it extend?
In Ulcerative Colitis (UC), where does the gross pathology usually begin and how does it extend?
Which of the following statements is true regarding the gross pathology of ulcerative colitis?
Which of the following statements is true regarding the gross pathology of ulcerative colitis?
Which of the following microscopic features are characteristic of ulcerative colitis (UC) inflammation confined to the mucosa and submucosa? (Select all that apply)
Which of the following microscopic features are characteristic of ulcerative colitis (UC) inflammation confined to the mucosa and submucosa? (Select all that apply)
Which of the following are clinical features of Ulcerative Colitis (UC)? (Select all that apply)
Which of the following are clinical features of Ulcerative Colitis (UC)? (Select all that apply)
COLITIS-ASSOCIATED NEOPLASIA risk is related to which of the following factors? (Select all that apply)
COLITIS-ASSOCIATED NEOPLASIA risk is related to which of the following factors? (Select all that apply)
Which of the following are known complications of Ulcerative Colitis (UC)? (Select all that apply)
Which of the following are known complications of Ulcerative Colitis (UC)? (Select all that apply)
What is the cause of toxic megacolon in ulcerative colitis?
What is the cause of toxic megacolon in ulcerative colitis?
Which of the following are systemic manifestations of Ulcerative Colitis? (Select all that apply)
Which of the following are systemic manifestations of Ulcerative Colitis? (Select all that apply)
What is diverticular disease?
What is diverticular disease?
In the colon, which of the following statements about diverticular disease is true?
In the colon, which of the following statements about diverticular disease is true?
What leads to the formation of diverticula in the colon?
What leads to the formation of diverticula in the colon?
The prevalence of diverticular disease approaches 50% in adults over what age in western countries?
The prevalence of diverticular disease approaches 50% in adults over what age in western countries?
Which of the following statements about diverticular disease is true? (Select all that apply)
Which of the following statements about diverticular disease is true? (Select all that apply)
Which of the following factors contribute to the pathogenesis of diverticular disease? (Select all that apply)
Which of the following factors contribute to the pathogenesis of diverticular disease? (Select all that apply)
Diverticular disease occurs almost always in which part of the colon?
Diverticular disease occurs almost always in which part of the colon?
Which factor significantly increases the risk of developing cancer in patients with ulcerative colitis after 10 years?
Which factor significantly increases the risk of developing cancer in patients with ulcerative colitis after 10 years?
What is a primary complication associated with toxic megacolon in ulcerative colitis?
What is a primary complication associated with toxic megacolon in ulcerative colitis?
Which systemic manifestation is seen in ulcerative colitis that affects the gastrointestinal tract?
Which systemic manifestation is seen in ulcerative colitis that affects the gastrointestinal tract?
What is the characteristic feature of diverticular disease?
What is the characteristic feature of diverticular disease?
What is a potential precursor to cancer in patients with ulcerative colitis?
What is a potential precursor to cancer in patients with ulcerative colitis?
What is the primary cause of diverticulosis in individuals following a low-fiber diet?
What is the primary cause of diverticulosis in individuals following a low-fiber diet?
Which complication of diverticulitis involves the development of hollow channels between the intestine and bladder?
Which complication of diverticulitis involves the development of hollow channels between the intestine and bladder?
Which of the following is least likely to be a symptom of diverticular disease?
Which of the following is least likely to be a symptom of diverticular disease?
What anatomical feature is most commonly associated with the formation of diverticula?
What anatomical feature is most commonly associated with the formation of diverticula?
What describes the type of diverticula formed in diverticular disease?
What describes the type of diverticula formed in diverticular disease?
What physiological consequence results from the twisting of a loop of bowel in volvulus?
What physiological consequence results from the twisting of a loop of bowel in volvulus?
In which demographic is sigmoid colon volvulus most commonly seen?
In which demographic is sigmoid colon volvulus most commonly seen?
Which part of the bowel is most likely to experience volvulus in younger adults?
Which part of the bowel is most likely to experience volvulus in younger adults?
What is a potential serious outcome of volvulus if not promptly addressed?
What is a potential serious outcome of volvulus if not promptly addressed?
What condition is characterized by the twisting of a segment of intestine around its mesentery?
What condition is characterized by the twisting of a segment of intestine around its mesentery?
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Study Notes
Learning Outcomes
- Understand normal large intestine anatomy, including structure and blood supply.
- Explain Hirschsprung’s disease, its causes, and clinical features.
- Discuss various types and causes of colitis and their clinical presentations.
- Compare Crohn's disease and ulcerative colitis.
- Describe diverticular disease, adhesions, and hernias.
Large Intestine – Normal Anatomy
- Length: 1-1.5 meters, comprised of the caecum, ascending, transverse, descending colon, sigmoid, and rectum.
- Blood supply:
- Superior mesenteric artery nourishes from caecum to splenic flexure.
- Inferior mesenteric artery supplies the remainder of the colon to the rectum.
- Haemorrhoidal branches supply the lower rectum.
Normal Histology
- Mucosa includes crypts, surface epithelium (no villi), and lamina propria.
- Submucosa features loose connective tissue with Meissner's plexus.
- Muscularis propria has an inner circular layer and outer longitudinal layer with Auerbach’s plexus.
- Serosa consists of mesothelial cells and fibrous tissue.
Types of Mucosal Cells
- Surface epithelium predominantly has columnar absorptive cells.
- Goblet cells are located in crypts, secreting mucus.
- Paneth cells found in the caecum and ascending colon have antimicrobial properties.
- Endocrine cells secrete hormones that regulate digestive functions.
Hirschsprung’s Disease
- Congenital megacolon occurring in 1 in 5000-8000 live births, more common in males (M:F = 4:1).
- Frequently associated with other anomalies, like Down's syndrome (10% incidence).
- Primarily affects the rectum and sigmoid colon.
Pathogenesis of Hirschsprung’s Disease
- Results from arrested migration of neural crest cells, leading to absence of ganglion cells in bowel wall.
- An aganglionic segment causes functional obstruction with proximal megacolon.
- Genetic factors: 50% familial cases and 15% sporadic cases involve RET gene mutations.
Clinical Features of Hirschsprung’s Disease
- Symptoms: failure to pass meconium, constipation, abdominal distension, vomiting.
- Complications may include megacolon leading to perforation and enterocolitis; mortality rate is 5%.
- Surgical resection of the affected bowel is the treatment.
Vascular Disorders
- Includes ischaemic bowel disease, angiodysplasia, hereditary hemorrhagic telangiectasia, and hemorrhoids.
Ischaemic Bowel Disease
- Can affect small or large intestines and present as acute or chronic disease.
- Severity relies on the vessel involved; types of infarction:
- Transmural (all layers affected).
- Mural (mucosa & submucosa).
- Mucosal (only mucosa).
Dysplasia in Ulcerative Colitis
- Can lead to colon cancer; regular surveillance is recommended.
Systemic Manifestations of Ulcerative Colitis
- Joint issues such as migratory polyarthritis, sacroiliitis, and ankylosing spondylitis.
- Skin manifestations like erythema nodosum and pyoderma gangrenosum.
- Liver involvement through primary sclerosing cholangitis and symptoms of uveitis.
Diverticular Disease
- Diverticula are blind pouches leading off the alimentary tract, commonly developing in the sigmoid colon.
- Occurs in 50% of adults over 60 in Western countries.
- Pathogenesis linked to wall stress due to low-fiber diets.
Clinical Features and Complications of Diverticular Disease
- Often asymptomatic; symptoms may include abdominal pain and constipation.
- Complications: diverticulitis, perforation, adhesion formation, and fistula.
Intestinal Obstruction and Associated Conditions
- More common in the small bowel; mechanical causes include congenital issues, adhesions, hernias, intussusception, and stenosis.
Hemorrhoids
- Variceal dilatation of submucosal venous plexi near the anus; risk factors include constipation and pregnancy.
- Symptoms include bright red stool and painful swelling.
Necrotising Enterocolitis
- Affects neonates; characterized by acute inflammation, most common in premature infants during the first three months.
Antibiotic-Associated Colitis (Pseudomembranous Colitis)
- Defined by adherent inflammatory exudates following broad-spectrum antibiotics usage.
- Symptoms include diarrhea; diagnosis through stool cytotoxin detection; treated with Metronidazole or Vancomycin.
Idiopathic Inflammatory Bowel Disease
- Includes Crohn’s disease and ulcerative colitis; incidence is rising and most common in young adults.
- Higher prevalence in Caucasians and Ashkenazi Jews.
Crohn's Disease
- Annual incidence of 1-3/100,000 in Western populations, more common in females.
- Can affect any part of the gastrointestinal tract; known for "skip lesions."
Gross and Microscopic Features of Crohn's Disease
- Characterized by transmural involvement, thickening of the bowel wall, ulcers with cobblestone appearance, and chronic mucosal damage.
- Microscopic features include inflammation, crypt abscesses, and possible non-caseating granulomas.
Clinical Features and Complications of Crohn's Disease
- Symptoms include intermittent diarrhea, abdominal pain, and malabsorption leading to weight loss.
- Complications: obstruction, fistula formation, malabsorption with deficiencies, and increased cancer risk.
Ulcerative Colitis
- Chronic inflammation limited to mucosa and submucosa; mainly affects Caucasians with equal gender distribution.
- Initial presentation in the rectum, progressing proximally without skip areas; features pseudopolyps and inflammatory changes.
Clinical Features and Complications of Ulcerative Colitis
- Symptoms include bloody diarrhea, abdominal pain, and extra-intestinal manifestations more common than in Crohn's.
- Increased cancer risk related to disease duration and extent; complications include toxic megacolon and dysplasia.
Colitis-Associated Neoplasia
- Increased cancer risk correlates with disease duration, particularly after 10 years (20 times the risk).
- Risk factors include the extent of the disease, with pan colitis presenting a higher risk than left-sided colitis.
- Higher frequency and severity of active inflammation contributes to increased cancer risk.
- Regular endoscopic surveillance with biopsy is essential for early detection.
Complications of Ulcerative Colitis (UC)
- Toxic megacolon is characterized by acute colon dilation due to toxic damage affecting muscular and neural functions.
- Cancer risk rises significantly with the duration of UC and extent of colonic involvement, often preceded by dysplasia.
- Dysplasia particularly becomes a concern if UC duration exceeds 10 years.
Systemic Manifestations of Ulcerative Colitis
- Joint Issues: Migratory polyarthritis, sacroiliitis, and ankylosing spondylitis.
- Skin Conditions: Erythema nodosum, pyoderma gangrenosum, and clubbing of fingers.
- Liver: Primary sclerosing cholangitis may develop.
- Ocular: Uveitis can occur as a complication.
Diverticular Disease
- Diverticulum: A blind pouch in the gastrointestinal tract communicating with the lumen.
- Prevalence of diverticular disease approaches 50% in adults over 60 in Western countries.
- Pathogenesis linked to wall stress, often associated with constipation, straining, and low fiber diets.
Pathogenesis of Diverticular Disease
- A low-fiber diet results in reduced stool bulk, increasing peristaltic contractions and intraluminal pressure, leading to herniation through wall weaknesses.
- Most diverticula occur in the sigmoid colon, presenting as outpouchings of the mucosa and submucosa (pseudodiverticula).
Clinical Features of Diverticular Disease
- Many cases are asymptomatic; about 20% experience abdominal cramping or pain.
- Symptoms may include constipation and a sensation of incomplete rectal emptying.
- Treatment strategies emphasize a high-fiber diet to prevent progression and surgical intervention for complications.
Complications of Diverticulosis
- Diverticulitis can ensue from obstruction, impaction, or infection of diverticula.
- Other complications include perforation, abscess formation, fistulas (e.g., to the bladder), hemorrhage, and bowel obstruction.
Intestinal Obstruction
- More prevalent in the small bowel due to its narrower lumen.
- Mechanical causes include congenital defects like atresia or imperforate anus, as well as acquired conditions such as volvulus, adhesions, hernia, intussusception, and stenosis.
Overview of Volvulus
- Volvulus refers to the twisting of a bowel loop along its mesentery.
- The condition leads to compromised blood supply, causing bowel obstruction and acute ischaemia.
Common Locations for Volvulus
- Sigmoid Colon
- Most frequently affected in elderly individuals.
- Caecum
- More commonly occurs in young adults.
Symptoms and Risks
- Twisting can result in severe pain due to obstruction.
- Ischaemia increases the risk of tissue necrosis if not treated promptly.
- Urgent medical intervention is often required to prevent complications.
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