• Recommended after approximately 6 weeks , to rule out the presence of other diseases, such as cancer and inflammatory bowel disease
Recurrent Diverticulitis • 25 % will have more than one attack of acute diverticulitis • Recurrence was more virulent and lead to recommendation for elective resection: – after the second episode in >50year old – after first episode in younger patients. • However, more recent data fails to show worse prognosis in recurrent attacks. • American Society of Colon and Rectal Surgeons: – Decision for elective resection is on a case by case basis
Diverticular Hemorrhage • Rupture of the vasa recta at the dome of a diverticulum • Source proximal to the splenic flexure in 60% • Mean age 66 year old • Most common cause of life threatening lower GI bleed (3-5% of those with diverticulosis)
• Hemorrhoids arises from a plexus of dilated veins arising from the: • Superior and inferior hemorrhoidal veins. • Submucosal layer in the lower rectum • External or internal: below or above the dentate line. Classifications • Grade I: May bulge into the lumen but do not extend below the dentate line. • Grade II : Prolapse out of the anal canal with defecation or with straining but reduce spontaneously. • Grade III: Prolapse out of the anal canal with defecation or straining, and require the patient to reduce them into their normal position. • Grade IV: Irreducible and may strangulate
• Hemorrhoids are common and can cause • bleeding, • itching, of perianal skin pain • thrombosis, occur in both internal and external hemorrhoids • Mild cases can be treated with fiber supplements and topical medications. • Minimally invasive (endoscopic) techniques are available. • Surgery is reserved for severe cases or thrombosis
Pathogenesis of Diseases of the Oesophagus
Gastro-Oesophageal Reflux Disease (GORD) • Abnormal retrograde movement of stomach contents to oesophagus • Hydrochloric acid, pepsin • Very common • ~ 1 in 12 people heartburn daily • ~ 1 in 6 heartburn weekly • Oesophagitis in ~5% • Reflux more likely to occur when: – Decreased tone of sphincter – Sliding hiatal hernia – Decreased oesophageal clearance – Decreased saliva production – When lying down
• Hydrochloric acid and pepsin • -> H+ ions diffuse into cells • -> acidification of mucosa • -> inflammation, necrosis • Clinical : symptoms of heartburn • Endoscopic : red/congested mucosa • Manometric : decreased sphincter pressure • pH: number, duration of dips: pH<4 • Pathological: microscopic evidence of oesophagitis
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- Fall '19