Recommended after approximately 6 weeks to rule out

•
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

Normal
Inflamed