Search Results

Learning objectives To appreciate: The basic anatomy and physiology of the large intestine intestinal problems • The range of conditions that may affect the large intestine • To understand: The aetiology and pathology of common large intestinal multidisciplina...

Malignant: colorectal carcinoma Epidemiology In the UK, colorectal cancer is the second most common cause of cancer death. Approximately 42 /uni00A0 000 patients are diagnosed with colorectal cancer every year in the UK. Approximately one-third of these tumo...

Management Patients are frequently recommended a high-fibre diet and - bulk-forming laxatives, although the evidence for their e ff ec - tiveness in diverticulosis or after an attack of diverticulitis is limited. Antispasmodics may have a role if recurrent pai...

Non-infective colitides Diverticular colitis Diverticular colitis is a clinicopathological entity distinct from acute diverticulitis (see Diverticular disease ). The term refers to colonic mucosal inflammation, resembling IBD, in a segment of colon a ff ected b...

Operative procedures for diverticular disease The aim of emergency surgery is to control peritoneal infection; indications are generalised peritonitis and failure to respond to optimum medical management. Laparotomy for diverticular disease in the acute setti...

PHYSIOLOGY OF THE LARGE INTESTINE The principal function of the colon is absorption of water; approximately 1000 /uni00A0 mL of ileal content enters the caecum in faeces. Sodium absorption is e ffi ciently accomplished by an active transport system, while chl...

Polyposis syndromes Polyposis syndromes can be divided into familial adenomatous polyposis (FAP), attenuated familial adenomatous polyposis (AFAP), MUTYH -associated polyposis (MAP) and NTHL1 associated polyposis (NAP). Eldon John Gardner , 1909–1989, genetici...

TUMOURS OF THE LARGE INTESTINE Benign The term ‘polyp’ is a clinical description of any protrusion of the mucosa. It encompasses a variety of histologically di ff erent tumours ( Table 77.1 ). Polyps can occur singly , synchronously in small numbers or as par...

Treatment For sigmoid volvulus the initial management is non-operative decompression using either a rigid sigmoidoscope or a colono - scope. Direct vision allows assessment of mucosal viability and derotation. With successful derotation a well-lubricated flatu...

Types of colostomy Loop colostomy Loop stomas are most commonly used to temporarily divert the faecal stream; for instance, to protect an anastomosis (usually by a loop ileostomy) following traumatic injury to the rectum, to facilitate the operative treatment ...

VASCULAR ANOMALIES OF THE INTESTINE Angiodysplasia Angiodysplasia is a vascular malformation that commonly causes haemorrhage from the colon in patients over the age of 60. The malformations consist of dilated tortuous submucosal veins. Clinical features In th...

VOLVULUS A volvulus is a twist of the intestine and the mesentery that supplies it ( Figure 77.16 ). It is most commonly seen in the sigmoid colon, where elongation of the colon and mesentery with a narrow posterior attachment exists in some patients. can, ho...

ADYNAMIC OBSTRUCTION Paralytic ileus This may be defined as a state in which there is failure of trans mission of peristaltic waves secondary to neuromuscular failure (i.e. in the myenteric [Auerbach’s] and submucous [Meissner’s] plexuses). The resultant stas...

Acute intestinal obstruction of the newborn Neonatal intestinal obstruction has many potential causes. Congenital atresia and stenosis are the most common. Intestinal malrotation with midgut volvulus, meconium ileus, Hirschsprung’s disease, imperforate anus, n...

Acute intussusception This occurs when one portion of the gut invaginates into an immediately adjacent segment; almost invariably , it is the proximal into the distal. The condition is encountered most commonly in children, with a peak incidence between 5 and...

Bolus obstruction Bolus obstruction in the small bowel may be caused by gall stones, food, trichobezoar, phytobezoar, stercoliths and worms. Gallstones This type of obstruction tends to occur in the elderly secondary to erosion of a large gallstone directly ...

CHRONIC LARGE BOWEL OBSTRUCTION The symptoms of chronic intestinal obstruction may arise from two sources: the cause and the subsequent obstruction. /uni25CF intraluminal (rare) – faecal impaction; /uni25CF intrinsic intramural – strictures (Crohn’s disease, ...

CLASSIFICATION Intestinal obstruction may be classified into two types: /uni25CF Dynamic , in which peristalsis is working against a mechanical obstruction. It may occur in an acute or a chronic form ( Figure 78.1 ). /uni25CF Adynamic , in which there is no mec...