Large Intestine Disease

Diverticulitis are small, bulging pouches developing from the weak places in the colon.

Symptoms

• Lower abdominal pain
• Abdominal tenderness
• Nausea and vomiting
• Fever
• Constipation or diarrhoea.

Diagnosis

• CT Scan

Treatment

• Antibiotics
• Analgesics
• Surgery in case of perforation, abscess, fistula or bowel obstruction

Complications

• Abscess formation
• Intestinal Obstruction
• Peritonitis
• Fistula formation

A volvulusis a twisting or axial rotation of a portion of bowel about its mesentery, which can lead to intestinal obstruction.

Causes

• Redundant intestinal tissues
• Constipation

Signs and symptoms

• Abdominal pain with distention
• Nausea, vomiting
• Constipation

Diagnosis

• X Ray Abdomen
• Gastrografin
• CT Scan
• Sigmoidoscopy

Treatment

• Correction of fluid and electrolyte imbalance
• Surgery

Complications

• Perforation
• Strangulation
• Faecal peritonitis
• Gangrene
• Recurrence

Form of inflammatory bowel disease (IBD) that causes inflammation and ulcers in the colon.

Causes

• The exact cause is not known.
• It is autoimmune disease.

Symptoms

• Diarrhoea mixed with blood or mucus
• Abdominal pain and cramping
• Rectal pain
• Rectal bleeding on PR examination
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever

Diagnosis

• CBC
• Stool R/M
• Colonoscopy with biopsy
• CECT Abdomen

Treatment

Medical Management

• Azathioprine
• Cyclosporine

Surgical Management

RPC IPAA (Restorative ProctocolectomyIleal Pouch Anal Anastomosis)

• In this surgery, entire colon and rectum are removed and a pouch is created from small intestine and attached directly to anus, allowing you to expel waste normally.
• In some cases a pouch is not possible. Instead, surgeons create a permanent opening on abdomen (ileal stoma) through which stool is passed for collection in an attached bag.

Complications

• Severe bleeding
• Colon perforation
• Severe dehydration
• Osteoporosis
• Inflammation of skin, joints, eyes, and sores in oral cavity
• Risk of colon cancer

Intestinal Gangrene is caused by inadequate blood flow through the mesenteric vessels, resulting in ischaemia and eventual gangrene of the bowel wall.

Causes

• Acute mesenteric arterial thrombosis
• Acute mesenteric arterial embolism
• Non occlusive mesenteric ischemia
• Mesenteric venous thrombosis

Signs and Symptoms

• Moderate to severe, diffuse, non localized, constant, and sometimes colicky abdominal pain.
• Abdominal distention
• Nausea, vomiting
• Anorexia
• Constipation
• Diarrhoea
• Tachycardia
• Tachypnoea
• Fever
• Hypotension
• Tender mass on palpation
• Bowel sounds – hyperactive to absent
• Voluntary and involuntary guarding appears.

Diagnosis

• CBC
• PT, APTT
• X-Ray Abdomen erect
• USG Abdomen
• CT Scan
• CT Angiography
• MRI
• MR Angiography

Treatment

• Medicines
• Vasodilators
• Anticoagulants
• Thrombolytics
• Analgesics
• Antibiotics
• Surgery

Complications

• Sepsis and septic shock
• Bowel necrosis necessitating bowel resection
• Multiple organ dysfunction syndrome (MODS)
• Death

Cancer of Colon :

Ca colon means development of cancer in the colon.

Stages of Colon Cancer

• Stage I – Cancer limited to the superficial lining (mucosa) of the colon or rectum but hasnt spread beyond the colon wall or rectum.
• Stage II – Cancer grown into or through the wall of the colon or rectum but hasn’t spread to nearby lymph nodes.
• Stage III – Cancer has spread to nearby lymph nodes but not affectingthe other parts of body.
• Stage IV – Cancer has spread to other organs such as liver or lungs.

Risk factors

Older age- Age above 50.

Race – African-Americans have a greater risk of colon cancer.

Family history of colorectal cancer or polyp.

Inflammatory intestinal conditions – Ulcerative colitis or Crohn’s Disease.

GeneticDisorders – Familial adenomatous polyposis (FAP) and Hereditary
non polyposis colorectal cancer (HNPCC), which is also known as Lynch syndrome.

Diet– Diet which is low in fibre and high in fat and red, processed meat.

Sedentary lifestyle

Diabetes

Obesity

Smoking

Alcohol

Radiation therapy directed at abdomen for treating previous cancers.

Symptoms

• Diarrhoea or constipation or a change in the consistency of stool.
• Blood in stool.
• Abdominal cramps or pain.
• Feeling of inomplete evacuation
• Weakness or fatigue
• Weight loss

Diagnosis

• Colonoscopy with Biopsy
• CECT Abdomen + Pelvis
• Colon Cancer Staging – To know how much the tumour has spread whether the lymph nodes are involved or not and the extent of metastasis.

Treatment

If cancer is in a very early stage or localised in a polyp, it can be removed during colonoscopy.

Polyps that can not be removed during colonoscopy may be removed using laparoscopic surgery. In this procedure, surgeon performs the operation through key hole incisions inabdominal wall, by inserting instruments with attached cameras that display the colon on a video monitor.

Stage II Cancer-Partial colectomy – the part ofcolon that contains the cancer, along with a margin of normal tissue on either side of the cancer, is removed. Nearby lymph nodes are also removed and tested for cancer.

If the cancer is at the outlet ofrectum, a permanent or temporary colostomy is done. In this surgery, an opening is created in the wall of abdomen, from the remaining portion of bowel, for the elimination of body waste into a special
bag, which is known as colostomy bag, which if healed, is removed after 1 month. In some cases, the colostomy may be permanent.