DISEASES OF SMALL AND

LARGE INTESTINE
OLATUNJI OLUWAGBEMISOKE ESTHER
GROUP 20
ULCERATIVE COLITIS
is an idiopathic chronic inflammatory disorder limited to the colon,
primarily affecting the colonic mucosa, the extent and severity of
colon involvement are variable. Ulcerative colitis is a lifelong illness
that has a profound emotional and social impact on patients who are
affected. 6
ETHIOLOGY AND PATHOGENESIS;
Etiologic factors potentially contributing to ulcerative colitis
include: genetic factors, immune system reactions, environmental
factors, nonsteroidal anti-inflammatory drug (NSAID) use, low
levels of antioxidants, psychological stress factors, a smoking
history, and consumption of milk products.
CLINICAL VIEW OF ULCERATIVE COLITIS
DIAGNOSTICS OF ULCERATIVE COLITIS

CT SHOWS AXIAL HYPERENHANCEMENT XRAY IMAGING; BARIUM ENEMA, IRREGULAR MUCOSA WITH
LOSS OF NORMAL HAUSTRAL MARKINGS.INFLAMMATION
AND SUBMUCOSAL EDEMA CREATES A GRANULAR APPEARANCE
 SURGICAL TREATMENTS OF ULCERATIVE
COLITIS

• RESTORATIVE PROCTOLECTOMY
WITH ILEO-ANAL POUCH
• CONTRAINDICATIONS INCLUDE;
preoperative fecal incontinence,
possibility of crohn’s disease, previous
significant small-bowel resection and
distal rectal cancer.
CROHNS DISEASE
The exact cause of crohn’s disease remains unknown. Genetic,
microbial, immunologic, environmental, dietary, vascular, and
psychosocial factors, including smoking, oral contraceptives,
and nonsteroidal anti-inflammatory agents (nsaids) use play a
role.

Macroscopically, the initial abnormality is hyperemia and

edema of the involved mucosa. Ulcers located
transversely and longitudinally over an inflamed mucosa,
giving the mucosa a cobblestone appearance. The lesions
are often segmental.
CLINICAL IMAGES OF CROHNS DISEASE
XRAY DIAGNOSTICS
 There is marked narrowing of a loop of ileum in the right
lower quadrant
(red arrow). The loop sits away from the other small bowel
loops ("proud loop") mostly because of surrounding
fat (white arrow). There is a sinus tract also visualized (green
arrow), another manifestation of crohn disease.
Radiographic features include:,Thickened folds (edema),String sign
(tubular narrowing due to spasm or stricture depending on chronicity),
Mucosal ulcers (aphthous ulcers or deeper transmural ulcers), Sinus
tracts and fistulae, Inflammation of surrounding mesentery (creeping
fat) with possible abscess formation, Partial obstruction
MRI DIAGNOSTICS

• The coronal and sagittal T2-

weighted images (a) and (b) show
circumferential thickening of a loop
of small bowel (arrows) with some
high signal oedema around them.
Magnified view from a transverse
image (c) showed a fistula (arrow)
between two loops of small bowel.
The features are those of active
Crohn disease
COMPLICATIONS AND PATTERNS IN CROHNS
DISEASE.
SURGICAL TREATMENT
DIVERTICULITIS.
Diverticula are small mucosal herniations protruding
through the intestinal layers and the smooth muscle along
the natural openings created by the vasa recta or nutrient
vessels in the wall of the colon. These herniations create
small pouches lined solely by mucosa.

Diverticulitis is defined as an inflammation of one or more

diverticula. Fecal material or undigested food particles may
collect in a diverticulum, causing obstruction. This
obstruction may result in distension of the diverticula
secondary to mucous secretion and overgrowth of normal
colonic bacteria.
IMAGES OF DIVERTICULITIS.
 IMAGING

Barium present in multiple diverticula

There are multiple colonic diverticula, one of them
projecting over the pelvis, likely associated arising from the anterior aspect of the caecum which
with the sigmoid colon shows prominent mural thickening and surrounding fat
stranding as well as multiple enlarged lymph nodes . 
SURGERY

• A 2-stage surgical approach is the most common

surgical procedure performed today for the
emergency treatment of acute diverticulitis. o A
traditional Hartmann procedure is commonly
performed, which involves resection of the
diseased segment of bowel, an end-colostomy, and
closure of the rectal stump. Typically, 3 months
later, a second procedure can be performed to
close the rectal stump. This is the preferred
approach in patients with fecal peritonitis and in
most cases of purulent peritonitis.
LAPAROSCOPIC HARTMANN PROCEDURE
POLYPS
It is a morphologic term given to tissue that project into the
lumen of the gastrointestinal tract and therefore is a broad
term encompassing many entities, both benign and
malignant. This can result from abnormal growth of the
mucosa or from a submucosal process that causes the
mucosa to protrude into the lumen.
COLONIC POLYPS.
IMAGING
TREATMENT

• the consensus guidelines recommend complete

excision of the adenoma plus more frequent
colonoscopic surveillance. Colonoscopy is repeated
at 5-10 years for 1-2 low risk adenomas, at 3 years if
3-10 low-risk or any high-risk adenomas, and less
than 3 years if greater than 10 adenomas.
• Complications of polypectomy include perforation
and bleeding. A small perforation (microperforation)
in a fully prepared, stable patient may be managed
with bowel rest, broad-spectrum antibiotics, and
close observation