TeacherOfMedicine: gastrointestinal disease

Showing posts with label gastrointestinal disease. Show all posts

Saturday, 21 March 2020

Proctocolitis

Disease class: Colitis

Disease class: Sigmoid diseases

Proctocolitis refers to inflammation spanning from the anus and rectum (proctitis) up a segment of colon (colitis).

Causes

Inflammatory bowel disease

Particularly ulcerative colitis

Sexually transmitted infections

Related concepts

Rectosigmoiditis: inflammation of the rectum, and sigmoid colon
Proctosigmoiditis: inflammation of the anus, rectum, and sigmoid colon
Distal colitis: inflammation of the entire distal colon up to the splenic flexure (the junction between descending colon and transverse colon)
Hemicolitis: inflammation of the entire distal colon including half of the transverse colon
Extensive colitis: inflammation of the entire distal colon up to the hepatic flexure (the junction between transverse colon and ascending colon)
Pancolitis: inflammation of the entire colon

Management

Treat underlying causes (see above)
See colitis

Saturday, 14 March 2020

Shigellosis

Disease class: Bacterial infection

This is a notifiable disease. This means that all diagnosed cases must be reported to the national Public Health services.

Pathogens

Shigella species

Saturday, 8 February 2020

Campylobacteriosis

Disease class: Bacterial infection
Disease class: Foodbourne diseases

Pathogens

Campylobacter jejuni

Friday, 25 October 2019

Toxic megacolon

Disease class: Megacolon

Definition

Causes

Inflammatory bowel disease

Ulcerative colitis

Clostridium difficile colitis

Complications

Colonic rupture
Bacteraemia
Sepsis
Septic shock

Investigations

Abdominal radiograph (AXR)
CT scan of abdomen and pelvis with bowel contrast (if possible)

Diagnostic tips

Faecal loading can cause small areas of dilatation.
It is normal for some segments of bowel to have a relatively large diameter. The "369 rule" refers to the approximate normal diameters of small bowel (up to 3cm), large bowel (up to 6cm), caecum + sigmoid colon (up to 9cm).
If the clinical history and physical examination support a diagnosis of toxic megacolon and the AXR may show abnormal dilation, it is worth discussing the AXR with a specialist colleague.
If there is a strong suspicion of toxic megacolon, inform senior colleagues, request an arterial blood gas analysis, request an urgent abdominal radiograph (if not done already) and seek specialist advice immediately.

Treatment

Depends on severity and underlying cause

Conservative

Watchful waiting

Medical

Antibiotic therapy

Clostridium difficile eradication therapy (e.g. oral vancomycin)

Surgical

Pancolectomy

Megacolon

Disease class: Colonic diseases

Types

A megacolon is a colon with a significantly increased diameter, usually throughout a large continuous segment of bowel.

Investigations

Abdominal radiograph (AXR)
CT scan of abdomen and pelvis with bowel contrast (if possible)

Diagnostic tips

Faecal loading can cause small areas of dilatation.
It is normal for some segments of bowel to have a relatively large diameter. The "369 rule" refers to the approximate normal diameters of small bowel (up to 3cm), large bowel (up to 6cm), caecum + sigmoid colon (up to 9cm).