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home - Colon - Miscellaneous - Structural Problems Written by Dr Sebastian Zeki
Methods GMP
Knows the physiology of intestinal absorption, secretion and motility SCE 1
Understands the biochemical processes occurring within the gut
lumen and at mucosal level

Has awareness of the factors controlling these processes – in
particular the neuro-endocrine influences

Understands the range of mechanisms by which diarrhoea can result
from disturbances in each of these processes

Knows the causes of both acute and chronic diarrhoea
Knows the range of investigations appropriate to determining the
cause of the patient’s diarrhoea and is aware of the range of
therapeutic possibilities

Makes a detailed clinical assessment of patients that present with
either acute or chronic diarrhoea

Recognises the potential need for urgent fluid replacement CbD,
Makes appropriate use of microbiology and other relevant laboratories in reaching a diagnosis

Shows ability to interpret results, reach a diagnosis and formulate a
treatment plan

Reacts appropriately to the urgency of the clinical presentation
Always shows sympathy and understanding especially when the
patient is distressed

Structural Problems

Volvulus of the colon Caecal Volvulus Epidemiology The Caecum is involved in 52 %.The Sigmoid is involved in 43 %.The Transverse colon is involved in 3 %.The Splenic flexure is involved in 2 %.Av.age of presentation: 53. 50% volvuli are caecal Risk factors for Sig-moid Volvulus:Age- Average age is 72- 40 % lived in nursing homes or institutions.Hirschsprung’s- due to aganglionic segment below sigmoid. Usually full axial rotation with mesenteric vessel torsionIn 10% is cephalad causing gangrene Risk Factors for Caecal volvulus:Increased caecal mobility as a result of anomalous fixation of the right colon.Acquired anatomic abnormalities, such as surgical adhesions, can also contribute.Pregnancy.Congenital malformations.Colonoscopy.Hirschsprung's disease.Mobile caecum syndrome. Clinical Manifestations And Diagnosis:-As per small bowel obstruction.-Diagnsosi: barium or water-soluble contrast enema or CT scan.-AXR: Kidney shaped caecum extending in to the left upper quadrant often with dilated small bowel loops. Treatment of caecal volvulus:Cecopexy.Cecostomy.Caecal resection.Colonoscopy- but is unlikely to reduce the volvulus, and risks colonic perforation. Associations:Narrow mesenteric attachment.Crohn's disease.Pregnancy.Chagas' disease.Colonic hypertrophy associated with a high fibre diet. Sigmoid Volvulus DiagnosisAn AXR is diagnostic in 60 % of patients.On x-ray the distended sigmoid colon looks like ‘bent inner tube’ from pelvis to RUQ. - can get large bowel distended above it.A barium enema using water-soluble contrast may be helpful in uncertain cases.CT can show a whirl pattern of dilated sigmoid colon around mesocolon and vessels.CT can also show a bird-beak appearance of the afferent and efferent colonic segments. RecurrenceOccurs in 60%.Can be dealt with endoscopically: PEC.Surgical options include a mesosigmoi-dopexy and resection with primary anasto-mosis (most successful) or a Hartmann's procedure. Flexi sig-Dont do if any suggestion of gangrene.Usually see twisting within 25cm of anal verge and dilated area above.Consider leaving a rectal tube in to reduce acute recurrence. Treatment: Written by Dr Sebastian Zeki