SCOPE OF DISEASE

SCOPE OF DISEASE

• A functional diagnosis is usually made when routine investigations - fail to find an easy explanation (e.g. a structural or biochemical - cause) for a combination of typical symptoms. For instance, in a patient with lower abdominal pain, constipation and bloating if routine investigation finds a morphological abnormality , e.g. sigmoid diverticulosis, then the patient will be given a diagnosis of diverticular disease. However, if all usual tests, including colonoscopy , yield no findings then the same patient might be described as having IBS – a functional intestinal disorder. Like much of medicine, there are however grey areas. Further, understanding is not aided by historic nomenclature where - terms such as pseudo-obstruction describe di ff erent entities in the small and large intestine ( Table 73.2 ). This chapter consid - ers the main disorders using this classification with a focus on those most pertinent to the surgical reader.

History of onset Visceral diameter Region predominantly affected Acute Dilated Small intestine Large intestine Chronic Dilated Small intestine Large intestine Chronic Normal Intestine