disorders of the colon

7/30/2019 Disorders of the Colon

1/47

By: Angelyn Sy / Paolo Valenzuela


2/47

Large intestine Lower part of the

alimentary tract

Smaller than the smallintestine

Divided into parts:

Cecum

Colon

Rectum

Anus


3/47

Cecum First part of the large

intestine It is made up of 2/3 of

the large intestine Colon

4 parts Ascending

Transverse

Descending Sigmoidal

Rectum

Anus


4/47

Cecum

large blind pouch forming the beginning of thelarge intestine in the lower right quadrant of the

abdominal cavity, and from which the appendixextends


5/47

Ascending colon Found on the right side of the abdomen, extending up to

the lower border of the liver

Transverse colon part of the large intestine which lies across the upper

part of the abdominal cavity Descending colon

part of the large intestine which descends from thetransverse colon to the sigmoid colon on the left side ofthe abdominal cavity

Sigmoidal colon S-shaped section of the large intestine between the

descending colon and the rectum on the lower left sideof the abdominal cavity


6/47

Rectum terminal portion of the large intestine, extending

from the sigmoid colon to the anal canal

Anus opening at the lower end of the large intestine

through which solid waste is eliminated from thebody by the process of defecation


7/47

Its function is for the reabsorption of much ofthe water used in the digestive process.


8/47

Constipation Infrequent or difficult evacuation

of feces

Minor episodes of constipationmay be due to:

Changes in diet like a decrease infiber intake

Alterations in daily routines like

decrease of physical activity


9/47

An increase in musclecontraction in the colon increase intraluminal pressure

retards towards themovement of the feces increase gthe contact time forreabsorption of water andhardening the stool

Increase in fiber dietincreases luminal diameter thusdecreasing intraluminalpressure and allowing moreforward flow of the feces.


10/47

Diarrhea Increased frequency or decreased consistency of

bowel movements

Small bowel diarrhea

Usually large volume, consisting of large rushes and isassociated with periumbilical cramping

Colonic diarrhea

Usually small volume, consisting of small spurts and isassociated with hypogastric cramping


11/47

Irritable Bowel Syndrome Diverticulosis

Diverticulitis

Ulcerative Colitis Crohns Disease (Granulomatous Colitis)

Polypoid Lesion of the Colon

Colon Cancer


12/47

Most chronic GI disorder

Characterized by: intermittent abdominal pain

bloating

complaints of excess gas

food intolerance

disordered bowel function either diarrhea,constipation or both


13/47

Pain occurs in the lowerabdomen or the left- orright-upper quadrant

Does not awakenpatients at night

Splenic flexure syndrome Pain occurs under the left coastal margin

Hepatic flexure syndrome Pain occurs under the right coastal margin


14/47

Stress

Anxiety

Depression

Fear

High calorie or high fat diet


15/47

Complete blood count

Over 30 years of age Sigmoidoscopy

Microscopic stool exam


16/47

Antispasmodic agents (Hyoscyamine,dicyclomine) relax smooth muscle in the gut and reduce

contractions

Antidiarrheal agents (Loperamide) slows intestinal transit, increases intestinal water

absorption, and increases resting sphincter tone

Antidepressants and anti-axnxiety shown to relieve pain with low doses may slow intestinal transit time and aid in the

treatment of diarrhea


17/47

Dietary modification Regular high-fiber diet

Fiber supplementation with bulk laxatives

Psychotherapy Cognitive behavior therapy

Hypnosis

Stress management / relaxation techniques


18/47

Initial treatment

includes education, reassurance, stressmanagement, and relaxation techniques.


19/47

Diverticula Acquired herniations of

the mucosa through themuscular layers of the

bowel May be the ultimate

expression of IBS Most common in the

sigmoid colon which hasthe highest intraluminalpressure

Usually asymptomaticalthough theyoccasionally bleed


20/47

Anatomic diagnosis that describes thepresence of one or more diverticula.

Uncomplicated, asymptomatic diverticulosistypically is diagnosed incidentally and doesnot require further work-up.


21/47

Barium edema

Computed tomography (CT)

CT colonography


22/47

High fiber diet used in the management of

irritable bowel syndrome

Avoiding ingestion of seeds, corn, popcorn,and nuts for fear that they might becomeentrapped in diverticula


23/47

Diverticulitis occurs when a small, hard piece of stool is trapped

in the opening of the diverticula.

Leads to inflammation and death of the segment of

colon containing the diverticula.


24/47

Manifests with acute, left lower-quadrantabdominal pain, fever and leukocytosis Other symptoms Nausea

Vomiting Constipation

Diarrhea

Caused by erosion of the luminal wall by increased

intraluminal pressure or thickened fecal material inthe neck of the diverticulum


25/47


CT with intravenous and oral contrast

Ultrasonography


26/47

Asymptomatic Diverticula in the absenceof clinical symptoms

High-fiber diet

Symptomatic Diverticula and abdominalpain, with or without

change in bowel habits; noinflammation

High-fiber diet


27/47

Diverticulitis:uncomplicated (in stable

patients)

Abdominal pain, fever,leukocytosis; able totolerate oral fluids

Oral antibiotics (to coveranaerobes and gram-

negative rods); clear liquiddiet; avoid morphine

(Duramorph) if possiblebecause of risk ofincreasing intracolonic

pressureDiverticulitis:

uncomplicated (in older or

ill patients)

Abdominal pain, fever,leukocytosis; able to

tolerate oral fluids, orpatient is older than 85years

IV antibiotics (to coveranaerobes and gram-

negative rods); IV fluids;bowel rest, nothing bymouth; meperidine

(Demerol)

Diverticulitis: complicated Abdominal pain, fever,

leukocytosis; with orwithout sepsis,

Stabilization with fluids

and antibiotics; surgicalconsultation; percutaneous


28/47

Asymptomatic diverticulosis Eat high-fiber diet to prevent symptomatic

diverticular disease

Symptomatic diverticular

disease

Should undergo colonoscopy to exclude

underlying neoplasm

Suspected diverticulitis Shloud undergo tomography with IV and oralcontrast

Acute diverticulitis asoutpatient

Should take metronidazole combined withquinolone or trimethoprim-sulfamethoxazole

Acute diverticulitis asinpatient

Should take metronidazole or clindamycincombined with aminoglycosides,amonobactam, or a third-generationcephalosporin.


29/47

Chronic disease of unknown etiology

Immune-mediated disease but it is notknown what triggers the immune response

Colitis with open sores or ulcers on the lining

of the colon


30/47

the mucosa of therectum and bowel is

edematous with anexudate


31/47

Characterized by Bloody diarrhea

Stool may also be purulent

Lower abdominal pain Hematochezia maroon v colored purple

Fever


32/47

Stool examination for ova and parasites

Stool culture


Sigmoidoscopy with mucosal biopsy

Abdominal X-ray


33/47

Perforation with peritonitis

Toxic megacolon resulting from a dilatedfunctionless bowel

Adenocarcinoma of the colon


34/47

Anti-inflammatory drugs

Corticosteriods

Azathioprine

Methotrexate


35/47

Total colectomy with ileo-anal pull through


36/47

Granulomatous inflammation that affectsboth the colon and small bowel

Colon Frequently indistinguishable from ulcerative colitis


37/47

Bowel biopsy

Which may show the characteristic ofgranulomatous inflammation


38/47

Perforation with peritonitis

Toxic megacolon resulting from a dilatedfunctionless bowel

Adenocarcinoma of the colon


39/47

Mild Salicylates (Sulfasalazine and Mesalamine)

Antibiotics (Metronidazole and Ciprofloxacin)

Severe Steroids (Corticosteroid)


40/47

Surgery is indicated only for complicationssuch as perforation and stricture


41/47

Colonic polyps are verycommon

Adenomatous polyps are

the targets of coloncancer screening

Characterized by Rectal bleeding

Abdominal pain Diarrhea


42/47

Removed through the colonoscope by snare

electrocautery

May recur thus follow-up examinations areimportant


43/47

Malignant lesions of the colon includeadenocarcinoma, lymphoma, sarcoma, carcinoidtumors and rarely, metastatic tumors

Characterized by Bloody stool Change in bowel habits Abdominal pain Weight loss

Diarrhea

Constipation

Feeling very tired. Vomiting


44/47

Environmental

Genetic

Low dietary fiber intake

High fat intake


45/47

Yearly rectal exam after age 40 Stool Hemoccult testing yearly after age 50

and every 3 to 5 years thereafter

Digital rectal exam

Barium enema

Sigmoidoscopy

Colonoscopy

Biopsy


46/47

The prognosis(chance of recovery) dependson the following: Stage of the cancer

Whether the cancer has blocked or created a hole in

the colon. The blood levels of carcinoembryonic antigen (CEA;

a substance in the blood that may be increasedwhen cancer is present) before treatment begins.


47/47

Treatment depends on the ff: The stage of the cancer

Whether the cancer has recurred

The patients general health.

disorders of the colon

Documents