By: Angelyn Sy / Paolo Valenzuela

Large intestine
Lower part of the alimentary tract Smaller than the small intestine Divided into parts:
Cecum Colon Rectum Anus

Cecum

Colon

First part of the large intestine It is made up of 2/3 of the large intestine 4 parts
Ascending Transverse Descending Sigmoidal

Rectum Anus

Cecum
large blind pouch forming the beginning of the large intestine in the lower right quadrant of the abdominal cavity, and from which the appendix extends

Ascending colon

Transverse colon

Found on the right side of the abdomen, extending up to the lower border of the liver part of the large intestine which lies across the upper part of the abdominal cavity part of the large intestine which descends from the transverse colon to the sigmoid colon on the left side of the abdominal cavity S-shaped section of the large intestine between the descending colon and the rectum on the lower left side of the abdominal cavity

Descending colon Sigmoidal colon

Rectum
terminal portion of the large intestine, extending from the sigmoid colon to the anal canal

Anus
opening at the lower end of the large intestine through which solid waste is eliminated from the body by the process of defecation

Its function is for the reabsorption of much of the water used in the digestive process.

Constipation
Infrequent or difficult evacuation of feces Minor episodes of constipation may be due to:
Changes in diet like a decrease in fiber intake Alterations in daily routines like decrease of physical activity

How does fiber intake affects bowel movement? An increase in muscle contraction in the colon increase intraluminal pressure retards towards the movement of the feces increase gthe contact time for reabsorption of water and hardening the stool Increase in fiber diet increases luminal diameter thus decreasing intraluminal pressure and allowing more forward flow of the feces.

Diarrhea
Increased frequency or decreased consistency of bowel movements Small bowel diarrhea
Usually large volume, consisting of large rushes and is associated with periumbilical cramping

Colonic diarrhea
Usually small volume, consisting of small spurts and is associated with hypogastric cramping

Irritable Bowel Syndrome Diverticulosis Diverticulitis Ulcerative Colitis Crohns Disease (Granulomatous Colitis) Polypoid Lesion of the Colon Colon Cancer

Most chronic GI disorder Characterized by:

intermittent abdominal pain bloating complaints of excess gas food intolerance disordered bowel function either diarrhea, constipation or both

Pain occurs in the lower abdomen or the left- or right-upper quadrant Does not awaken patients at night

Splenic flexure syndrome Hepatic flexure syndrome

Pain occurs under the left coastal margin
Pain occurs under the right coastal margin

Stress Anxiety

Depression
Fear High calorie or high fat diet

Complete blood count

Over 30 years of age
Sigmoidoscopy Microscopic stool exam

Antispasmodic agents (Hyoscyamine, dicyclomine)

relax smooth muscle in the gut and reduce contractions

Antidiarrheal agents (Loperamide)

slows intestinal transit, increases intestinal water absorption, and increases resting sphincter tone shown to relieve pain with low doses may slow intestinal transit time and aid in the treatment of diarrhea

Antidepressants and anti-axnxiety

Dietary modification
Regular high-fiber diet Fiber supplementation with bulk laxatives

Psychotherapy
Cognitive behavior therapy Hypnosis Stress management / relaxation techniques

Initial treatment
includes education, reassurance, stress management, and relaxation techniques.

Diverticula

Acquired herniations of the mucosa through the muscular layers of the bowel May be the ultimate expression of IBS Most common in the sigmoid colon which has the highest intraluminal pressure Usually asymptomatic although they occasionally bleed

Anatomic diagnosis that describes the presence of one or more diverticula. Uncomplicated, asymptomatic diverticulosis typically is diagnosed incidentally and does not require further work-up.

Barium edema Computed tomography (CT)

CT colonography

High fiber diet used in the management of irritable bowel syndrome

Avoiding ingestion of seeds, corn, popcorn, and nuts for fear that they might become entrapped in diverticula

Diverticulitis
occurs when a small, hard piece of stool is trapped in the opening of the diverticula. Leads to inflammation and death of the segment of colon containing the diverticula.

Manifests with acute, left lower-quadrant abdominal pain, fever and leukocytosis
Other symptoms
Nausea Vomiting Constipation Diarrhea

Caused by

erosion of the luminal wall by increased intraluminal pressure or thickened fecal material in the neck of the diverticulum

Complete blood count CT with intravenous and oral contrast

Ultrasonography

Disease
Asymptomatic

Features
Diverticula in the absence of clinical symptoms Diverticula and abdominal pain, with or without change in bowel habits; no inflammation

Treatment
High-fiber diet

Symptomatic

High-fiber diet

Disease Diverticulitis: uncomplicated (in stable patients)

Features Abdominal pain, fever, leukocytosis; able to tolerate oral fluids

Treatment Oral antibiotics (to cover anaerobes and gramnegative rods); clear liquid diet; avoid morphine (Duramorph) if possible because of risk of increasing intracolonic pressure IV antibiotics (to cover anaerobes and gramnegative rods); IV fluids; bowel rest, nothing by mouth; meperidine (Demerol) Stabilization with fluids and antibiotics; surgical consultation; percutaneous

Diverticulitis: uncomplicated (in older or ill patients)

Abdominal pain, fever, leukocytosis; able to tolerate oral fluids, or patient is older than 85 years Abdominal pain, fever, leukocytosis; with or without sepsis,

Diverticulitis: complicated

Patients with Asymptomatic diverticulosis Symptomatic diverticular disease Suspected diverticulitis Acute diverticulitis as outpatient Acute diverticulitis as inpatient

Comments Eat high-fiber diet to prevent symptomatic diverticular disease Should undergo colonoscopy to exclude underlying neoplasm Shloud undergo tomography with IV and oral contrast Should take metronidazole combined with quinolone or trimethoprimsulfamethoxazole Should take metronidazole or clindamycin combined with aminoglycosides,a monobactam, or a third-generation cephalosporin.

Chronic disease of unknown etiology

Immune-mediated disease but it is not known what triggers the immune response Colitis with open sores or ulcers on the lining of the colon

the mucosa of the rectum and bowel is edematous with an exudate

Characterized by
Bloody diarrhea Stool may also be purulent Lower abdominal pain Hematochezia maroon v colored purple Fever

Stool examination for ova and parasites Stool culture

Complete blood count

Sigmoidoscopy with mucosal biopsy Abdominal X-ray

Perforation with peritonitis Toxic megacolon resulting from a dilated functionless bowel Adenocarcinoma of the colon

Anti-inflammatory drugs
Corticosteriods Azathioprine Methotrexate

Total colectomy with ileo-anal pull through

Granulomatous inflammation that affects both the colon and small bowel Colon
Frequently indistinguishable from ulcerative colitis

Bowel biopsy
Which may show the characteristic of granulomatous inflammation

Perforation with peritonitis Toxic megacolon resulting from a dilated functionless bowel Adenocarcinoma of the colon

Mild
Salicylates (Sulfasalazine and Mesalamine) Antibiotics (Metronidazole and Ciprofloxacin)

Severe
Steroids (Corticosteroid)

Surgery is indicated only for complications such as perforation and stricture

Colonic polyps are very common Adenomatous polyps are the targets of colon cancer screening Characterized by
Rectal bleeding Abdominal pain Diarrhea

Removed through the colonoscope by snare electrocautery

May recur thus follow-up examinations are important

Malignant lesions of the colon include adenocarcinoma, lymphoma, sarcoma, carcinoid tumors and rarely, metastatic tumors Characterized by
Bloody stool Change in bowel habits Abdominal pain Weight loss Diarrhea Constipation Feeling very tired. Vomiting

Environmental Genetic

Low dietary fiber intake

High fat intake

Yearly rectal exam after age 40 Stool Hemoccult testing yearly after age 50 and every 3 to 5 years thereafter Digital rectal exam Barium enema Sigmoidoscopy Colonoscopy Biopsy

The prognosis(chance of recovery) depends on the following:

Stage of the cancer Whether the cancer has blocked or created a hole in the colon. The blood levels of carcinoembryonic antigen (CEA; a substance in the blood that may be increased when cancer is present) before treatment begins.

Treatment depends on the ff:

The stage of the cancer Whether the cancer has recurred The patients general health.