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Differentiating Features of Ulcerative Colitis and Crohn Disease

A classification of inflammatory bowel disease (IBD) based on scientific data has not gained acceptance. An early attempt was made to classify IBD according to two categories: (1) ulcerative colitis (UC) and Crohn disease; and (2) collagenous colitis, eosinophilic enteritis, Behçet disease, transient colitis, microscopic colitis, prestomal ileitis, pouchitis, and solitary rectal ulcer. None of these entities had a definitive etiology, resulting in overlap and confusion.…

Ileal Pouch Anal Anastomosis and Pouchitis

The surgical treatment of choice for patients requiring colectomy for ulcerative colitis or familial adenomatous polyposis (FAP) is restorative proctocolectomy with ileal pouch anal anastomosis (IPAA). The “pouch” is an ileal reservoir that acts as a neorectum to store fecal material and to avoid constant output from the ileostomy. Anastomosis of the ileal-to-rectal mucosa is controversial, but most surgeons prefer mucosectomy, bringing the ileal mucosa to…

Ileostomy and Colostomy

Colostomies are performed for numerous reasons, including obstructive lesions caused by cancer, severe diverticulitis, severe intractable constipation, and trauma. Ileostomies are performed for the same reasons, but permanent ileostomy is reserved almost exclusively for patients with ulcerative colitis and diffuse polyposis of the colon. Although ileal pouch anal anastomosis (IPAA) is now the preferred procedure (see Chapter 93 ), some patients may not be surgical candidates…

Ulcerative Colitis

Ulcerative colitis (UC) is a disease of unknown etiology characterized by diffuse mucosal inflammation of the large bowel ( Fig. 91.1 ). The disease is variable in extent, severity, and clinical course, and knowledge of many aspects remains incomplete. The incidence and prevalence of UC vary with geography and race. Most studies have been performed in North America and England; incidence varies from 0 to 10…

Diverticulosis

Diverticular Disease of the Colon Diverticulosis of the colon is an acquired condition that results from herniation of the mucosa through defects in the muscle coats ( Fig. 90.1 ). Defects are usually located where the blood vessels pierce the muscular wall to gain access to the submucosal plane. These vessels enter at a constant position, just on the mesenteric side of the two lateral taeniae…

Diseases of the Appendix: Inflammation, Mucocele, and Tumors

Inflammatory changes of the vermiform appendix are the most frequent cause of laparotomy in western countries, where the incidence of appendicitis is approximately 10 times that in eastern countries. The appendix is part of the cecum, and its abdominal marking usually lies in the transition of the outer to the middle third of an imaginary line drawn from the anterosuperior iliac spine to the umbilicus (the…

Megacolon and Hirschsprung Disease

Megacolon is divided into the congenital and acquired types. The congenital form is Hirschsprung disease and includes classic, short-segment, and ultrashort-segment types as well as total colonic aganglionosis ( Fig. 87.1 ). Open full size image Fig. 87.1 Megacolon (Hirschsprung Disease). Acquired megacolon includes many disorders. However, idiopathic acquired megacolon has no cause and is often associated with an acute form of Ogilvie syndrome (see Chapter…

Effects of Drugs on the Colon

Folklore and society have maintained the philosophy that regular bowel movements are essential to health. Consequently people have attempted to maintain bowel regularity and to experience a “good” bowel movement by using laxatives and drugs that affect the gastrointestinal (GI) tract, particularly the colon ( Fig. 86.1 and Box 86.1 ). Open full size image Fig. 86.1 Effects of Drugs on the Large Intestine. Box 86.1…

Constipation

Constipation can generally be defined as fewer than three bowel movements per week. However, if it is included as a “functional disorder” in accordance with the Rome II criteria, the definition would state that the diagnosis of constipation requires at least 12 weeks of symptoms during the preceding 12 months and that two of the following criteria should be present: straining, lumpy or hard stool, sensation…

Intestinal Bleeding

Gastrointestinal (GI) bleeding is acute or chronic loss of blood from the upper or lower part GI tract ( Fig. 82.1 ). Acute bleeding may be life threatening, whereas chronic bleeding may be slow or even occult. The GI tract can lose as much as 50 mL of blood daily; it is replaced without anemia but indicates a GI lesion. This chapter discusses lower GI bleeding; Chapter…

Stool Examination

Examination of the stool directly and through microscopy and chemical tests can provide much useful information, although patients, physicians, and laboratories tend to avoid stool evaluation ( Fig. 81.1 ). Open full size image Fig. 81.1 Examination of the Stool. Gross and Microscopic Inspection An acholic stool suggests biliary obstruction; a tarry stool indicates gastrointestinal (GI) bleeding; and a red stool signifies bleeding from the lower…

Anoscopy, Sigmoidoscopy, and Colonoscopy

Clinicians can now examine the anal canal, rectum, and colon with ease and with little discomfort to the patient. The indications for each procedure depend on the clinical presentation. For example, red blood on toilet paper or blood dripping into the toilet bowl frequently requires anoscopy and sigmoidoscopy but not colonoscopy. Chronic diarrhea or abdominal pain and signs of intermittent obstruction necessitate colonoscopy ( Fig. 79.1…

Anatomy of the Colon, Rectum, and Anus

The Structure and Histology of the Colon and Sigmoid Colon The large intestine varies in caliber depending on its functional state. Haustra form sacculations that are separated by constricting furrows, so that the lumen bulges and contracts alternately. The caliber is greatest at the commencement of the large intestine (cecum) and narrows toward the rectum. Viewed as a whole, the various parts of the large intestine…

Ileostomy, Colostomy, and Gastroenteric Stomas

This chapter discusses ileostomies and colostomies. Gastroenteric anastomoses also are discussed in Chapter 41, Chapter 42, Chapter 43 and in Chapter 191 . Ileal pouch anal anastomoses are discussed in Chapter 93 . Total or partial colectomy with resultant ileostomy or colostomy is performed primarily to treat inflammatory bowel disease (IBD), familial adenomatous polyposis (FAP), cancer involving pelvic organs, and abdominal trauma. Various types of ileostomies…