SILS Colectomy
The colon, also known as the large intestine, is a crucial part of the digestive system. It connects the ileum (the last part of the small intestine) to the cecum (the first part of the colon) in the lower right abdomen. The colon is divided into four sections:
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The ascending colon travels up the right side of the abdomen.
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The transverse colon runs across the abdomen.
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The descending colon travels down the left abdomen.
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The sigmoid colon is a short curving of the colon, just before the rectum.
The primary functions of the colon are to remove water, salt, and some nutrients from the digestive waste, forming stool. Muscles in the colon's walls help move its contents along, facilitating digestion. The colon is also home to billions of bacteria that live in a symbiotic balance with the body, contributing to overall health.
What is the Colon?
What are the problems associated with the Colon?
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Abdominal Pain
Cramping
Diarrhea
Associated Symptoms Depend upon the cause of colitis and may include:
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Fever
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Chills
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Fatigue
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Dehydration
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Eye inflammation
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Joint swelling
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Canker sores
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Skin inflammation
Conduct a Medical History and Physical Exam
Use colonoscopy or sigmoidoscopy to examine your colon and rectum. These procedures involve a small, lighted scope to inspect your intestine. Colonoscopy is typically preferred as it provides a view of the entire colon and allows for biopsies. These biopsies help diagnose conditions like ulcerative colitis and detect cancer.
Other Exams and Tests may be used include:
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Abdominal X-ray. It provides an internal view of the abdomen
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Barium enema. It allows the doctor to examine the colon.
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Computed tomography (CT) scan or MRI which provides detailed images of the inside of the body.
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Stool analysis (including a test for blood in the stool). This test looks for blood, signs of bacterial infection, parasites, or white blood cells.
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Blood and urine tests to check for anaemia, inflammation, or malnutrition.
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An erythrocyte sedimentation rate (ESR, or sed rate) or a C-reactive protein (CRP) blood test may be done to look for infection or inflammation.
Things you need to know:
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Treatment for ulcerative colitis depends mainly on how bad the disease is. It usually includes medicines and changes in diet. A few people have symptoms that are long-lasting and severe, in some cases requiring more medicines or surgery.
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You may need to treat other problems, such as anaemia or infection.
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Treatment in children and teens may include taking nutritional supplements to restore normal growth and sexual development.
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If you don't have any symptoms or if your disease is not active (in remission), you may not need treatment. But your doctor may suggest that you take medicines to keep the disease in remission.
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If you do have symptoms, they usually can be managed with medicines to put the disease in remission. It often is easier to keep the disease in remission than to treat a flare-up.
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Moderate to severe symptoms usually require steroid medicines to control inflammation.
Severe Symptoms treatment:
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Severe symptoms also may be treated with:
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Immunomodulator medicines or cyclosporine. These strong medicines suppress the immune system to prevent inflammation.
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Biologics. They block the inflammatory response in your body and help reduce the inflammation in your colon.
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Surgery - Removal of the large intestine (colon) cures ulcerative colitis. Surgery also is done to treat problems such as bleeding or toxic megacolon.
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Treatment
Diagnosis
Signs & Symptoms
1. Colitis
Inflammation of the colon, inflammatory bowel disease or infections are the most common causes.
Alternating Diarrhea and Consipation
Painful cramps or tenderness in the lower abdoment
Chills or Fever
Signs & Symptoms
Diagnosis
One or more diagnostic tests may be ordered.
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X-rays
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CT scanning
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Ultrasound testing
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Sigmoidoscopy
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Colonoscopy
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Blood tests to look for signs of infection or the extent of bleeding.
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In people with rapid, heavy rectal bleeding, the doctor may perform a procedure called angiography to locate the source of the bleeding.
Uncomplicated Diverticulitis
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Antibiotics, to treat infection.
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This treatment is successful in 70 to 100 percent of people with uncomplicated diverticulitis.
Complicated Diverticulitis
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Intravenous antibiotics
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Insertion of a tube to drain an abscess, if one has formed
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Surgery (two main types):
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Primary bowel resection
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Bowel resection with colostomy
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Treatment
2. Diverticulosis
Inflammation of the colon, inflammatory bowel disease or infections are the most common causes.
Bright red blood coating the stool
Dark blood mixed with the stool
Black or tarry stool
Bright red blood in vomit
"Coffee-grounds" appearance of vomit
Fatigue, weakness, pale appearance
Anaemia - your blood is low on iron-rich hemogloblin
Signs & Symptoms
Diagnosis
Diagnostic Tests and Procedure
The doctor will also test your stool for blood. You'll also take a blood test to check to see if you're anemic. The results will give your doctor an idea of the extent of the bleeding and how chronic it may be.
If you have bleeding in your digestive tract, you'll likely get an endoscopy. This common procedure lets your doctor see exactly where the symptom is happening. In many cases, the doctor can use the endoscope to treat the cause of bleeding, too. It's a thin, flexible tool that is inserted through your mouth or rectum to see the areas of concern and take a tissue sample, or biopsy, if needed.
Several other methods may be used including:
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Angiography
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Radionuclide Scanning
Endoscopic Chemical Injection for Bleeding Control
You may get an endoscopy. For instance, if your upper digestive tract is bleeding, your doctor may be able to control it by injecting chemicals directly into the problem area, using an endoscope to guide the needle.
Endoscopic Heat Treatment and Vessel Clipping
A doctor can also use heat to treat (or “cauterize”) an area that’s bleeding and surrounding tissue through the endoscope, or place a clip on a bleeding blood vessel.
Surgery
Surgery
Treatment
3. Colon Bleeding
Multiple potential colon problems can cause bleeding. Rapid bleeding is visible in the stool, but very slow bleeding might not be.
Cramping
Irregular bowel habits, passage of mucus without blood or pus
Weight loss
Fever, Sweats
Malaise, Fatigue
Arthralgias
Growth retardation and delayed or failed sexual maturation in children
Extraintestinal manifestations (10-20%): Arthritis, uveitis, or liver disease
Grossly bloody stools, occasionally with tenesmus: Typical of UC, less common in CD
Perianal disease (eg, fistulas, abscesses)
Diarrhea: Possible presence of mucus/blood in stool; occurs at night; incontinence
Constipation in UC, including rectal involvement, may lead to obstipation or even bowel obstruction.
Cramps in CD: right lower, in UC: around navel or left lower.
Nausea and vomiting: More often in CD than in UC
Signs & Symptoms
Diagnosis
The following imaging studies may be used to assess patients with IBD:
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Upright chest and abdominal radiography
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Barium double-contrast enema radiographic studies
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Abdominal ultrasonography
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Abdominal/pelvic computed tomography scanning/magnetic resonance imaging
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Computed tomography enterography
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Colonoscopy, with biopsies of tissue/lesions
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Flexible sigmoidoscopy
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Upper gastrointestinal endoscopy
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Capsule enteroscopy/double balloon enteroscopy
Step 1
Aminosalicylates (oral, enema, suppository formulations): For treating flares and maintaining remission; more effective in UC than in CD
Step 1A
Antibiotics: Used sparingly in UC (limited efficacy, increased risk for antibiotic-associated pseudomembranous colitis); in CD, most commonly used for perianal disease, fistulas, intra-abdominal inflammatory masses
Step II
Corticosteroids (intravenous, oral, topical, rectal): For acute disease flares only
Step III
Immunomodulators: Effective for steroid-sparing action in refractory disease; primary treatment for fistulas and maintenance of remission in patients intolerant of or not responsive to aminosalicylates
Step IV
Clinical trial agents: Tend to be disease-specific (ie, an agent works for CD but not for UC, or vice versa)
Surgical Intervention
Procedures and techniques to treat or manage medical conditions through surgical means.
Treatment
4. Inflammatory Bowel Disease
A name for either Crohn's disease or ulcerative colitis. Both conditions can cause colon inflammation (colitis).
Symptoms of Colon Polyps: When to Be Concerned
Colon polyps usually do not cause symptoms unless they are larger than 1 cm (0.4 in.) or they are cancerous. The most common symptom is rectal bleeding. Sometimes the bleeding may not be obvious (occult) and may only be discovered after doing a screening test for blood in the stool called a fecal occult blood test (FOBT).
Uncommon Symptoms of Large Colon Polyps
Colon polyps usually do not cause pain or a change in bowel habits unless they are large and are blocking part of the colon. These symptoms are rare, because polyps usually are discovered and removed before they become large enough to cause problems.
Advanced Symptoms of Colorectal Cancer
After cancer develops, additional symptoms may occur, such as changes in bowel habits and significant weight loss.
Signs & Symptoms
Diagnosis
Colon Polyp Detection: Exploring Testing Options
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Unless colon polyps are large and cause bleeding or pain, the only way to know if you have polyps is to have one or more tests that explore the inside surface of your colon.
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Two of these exams, flexible sigmoidoscopy and colonoscopy, also can be used to collect tissue samples (called a biopsy) or to remove colon polyps.
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There are two basic types of tests - stool tests and tests that look inside your body.
Stool Test
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Fecal occult blood test (FOBT). An FOBT is a cost-effective method for detecting tiny amounts of blood in stool, aiding in colon polyp and cancer screening. While it has been proven to reduce colon cancer deaths in studies, a positive FOBT alone doesn't confirm these conditions. Conversely, a negative result doesn't rule them out. If an FOBT detects blood, a follow-up colonoscopy is essential to locate the source and potentially remove polyps if present.
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Fecal immunochemical test (FIT). This test, more specific than FOBT, checks for blood in stool with fewer dietary restrictions and less stool sampling. A positive result may still necessitate a follow-up colonoscopy.
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Stool DNA test (sDNA). This test checks for changes to the cells in the colon by looking at DNA in the stool. Certain kinds of changes in cell DNA happen when you have cancer. Like the other stool tests, if your test is positive, you may need to have a colonoscopy.
Tests that look inside your body
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Flexible sigmoidoscopy allows the doctor to look at the lower third of the colon. During a sigmoidoscopy exam, samples of any growths can be collected (biopsied). And precancerous and cancerous polyps can sometimes be removed.
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Colonoscopy. This screening method lets a doctor inspect the entire colon for polyps and cancer. During a colonoscopy, samples of any growths can be collected (biopsied). And precancerous and cancerous polyps usually can be removed.
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Computed tomographic colonography (CTC). This test is also called virtual colonoscopy. A computer and X-rays make a detailed picture of the colon to help the doctor look for polyps. If this test finds polyps, you may need to have a colonoscopy.
Antibiotics
Polyps are removed during screening if you have a flexible sigmoidoscopy or colonoscopy.
Initial Treatment
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If adenomatous polyps are found during an exam with flexible sigmoidoscopy, a colonoscopy will be done to look for and remove any polyps in the rest of the colon.
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The bigger a colon polyp is, especially if it is larger than 1 cm (0.4 in.), the more likely it is that the polyp will be adenomatous or contain cancer cells.
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If only hyperplastic polyps are found during your flexible sigmoidoscopy, you likely do not need to have a colonoscopy. These polyps do not become cancerous. In this case you can continue your regular screenings, unless you are at an increased risk for colon cancer because of a family history of colon cancer or an inherited polyp syndrome.
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A sessile polyp doesn't have a stalk. It is mostly a flat growth. Like other colon polyps, it grows on the inside wall of the colon. Sessile polyps can turn into cancer. Like other polyps, they are removed if found during sigmoidoscopy or colonoscopy.
Ongoing Treatment
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Regular screenings for colon polyps are the best way to prevent polyps from developing into colon cancer.
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Most colon polyps can be identified and removed during a colonoscopy.
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If you have had one or more adenomatous polyps removed, you probably need regular follow-up colonoscopy exams every 3 to 5 years.
Treatment if the condition gets worse
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Surgery is sometimes needed for large colon polyps that have a broad area of attachment (sessile polyps) to the colon wall. These large polyps sometimes cannot be removed safely during a colonoscopy and may be more likely to develop into cancer.
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If cancer is found when the colon polyps are examined, you will begin treatment for colorectal cancer.
Treatment
9. Colon Polyps
Polyps are small growths. Some of these develop into cancer, but it takes a long time. Removing them can prevent many colon cancers.
What to Watch Out For
Traveler's diarrhea usually lasts from 3 to 7 days and is rarely life threatening.
The Typical Symptoms of Traveler's Diarrhea include:
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Abrupt onset of diarrhea
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Nausea and vomiting
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Bloating
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Urgent need to have a bowel movement
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Malaise (weakness or discomfort)
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Explosive and painful gas
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Cramps
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Loss of appetite
Signs & Symptoms
8. Traveler's Diarrhea
Many different bacteria commonly contaminate water or food in developing countries. Loose stools, sometimes with nausea and fever, are symptoms.
Cramping
Abdominal Pain
Bloating
Nausea
Fever
Vomiting
Signs & Symptoms
Diagnosis
Physical Exam
Review of your medications.
Blood Test
Stool Test
Medicine
Over-the-counter medicine such as bismuth subsalicylate (Pepto-Bismol, Kaopectate) or loperamide (Imodium) which are available as liquids or tablets.
Natural Remedy
If you have itching, burning, soreness, or pain in your rectal area because you have a lot of bowel movements, try these tips to feel better:
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Take a warm bath.
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Use a hemorrhoid cream or try white petroleum jelly.
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Do your best to stay hydrated
Treatment
5. Diarrhea
Stools that are frequent, loose, or watery are commonly called diarrhea. Most diarrhea is due to self-limited, mild infections of the colon or small intestine.
Diarrhea, Fever and Abdominal Cramps
Symptoms of salmonellosis include diarrhea, fever, and abdominal cramps. They develop 12 to 72 hours after infection, and the illness usually lasts 4 to 7 days. Most people recover without treatment.
Diarrhea Recovery
If you only have diarrhea, you usually recover completely, although it may be several months before your bowel habits are entirely normal.
Signs & Symptoms
Diagnosis
Diagnosing Salmonellosis
Salmonellosis is diagnosed based on a medical history and a physical exam. Your doctor will ask you questions about your symptoms, foods you have recently eaten, and your work and home environments. A stool culture and blood tests may be done to confirm the diagnosis.
Managing and Treating Salmonellosis
You treat salmonellosis by managing any complications until it passes. Dehydration caused by diarrhea is the most common complication. Antibiotics are not usually needed unless the infection has spread.
Treatment
6. Salmonellosis
The bacteria Salmonella can contaminate food and infect the intestine. Salmonella causes diarrhea and stomach cramps, which usually resolve without treatment.
What to Watch Out For
The symptoms of shigellosis include diarrhea (often bloody), fever, and stomach cramps starting 1 or 2 days after you are exposed to the bacteria.
Duration and Severity of Shigellosis
Shigellosis usually lasts 5 to 7 days. In some people, especially young children and older adults, the diarrhea can be so severe that a hospital stay is needed. Some people who are infected may have no symptoms at all but may still spread shigellosis to others.
Signs & Symptoms
Diagnosis
Lab Tests for Accurate Shigellosis Diagnosis
Because many different diseases can cause a fever and bloody diarrhea, lab tests are the best way to diagnose shigellosis.
Confirming Shigellosis: Diagnostic Tests
A stool culture confirms the diagnosis. Blood tests may be done if your symptoms are severe or to rule out other causes.
Antibiotics
Shigellosis is usually treated with antibiotics.
Preventing Dehydration: Proper Hydration Methods
To prevent dehydration, take frequent sips of a rehydration drink (such as Pedialyte). Try to drink a cup of water or rehydration drink for each large, loose stool you have. Soda and fruit juices have too much sugar and not enough of the important electrolytes that are lost during diarrhea, and they should not be used to rehydrate.
Maintaining Your Diet for Recovery
Try to stay with your normal diet as much as possible. Eating your usual diet will help you to get enough nutrition. Doctors believe that eating a normal diet will also help you feel better faster. But try to avoid foods that are high in fat and sugar. Also avoid spicy foods, alcohol, and coffee for 2 days after all symptoms have disappeared.
Treatment
7. Shigellosis
The bacteria Shigella can contaminate food and invade the colon. Symptoms include fever, stomach cramps, and diarrhea, which may be bloody.
Recognizing Early Signs of Colorectal Cancer
In its early stage, colorectal cancer usually produces no symptoms. The most likely warning signs include:
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Changes in bowel movements, including persistent constipation or diarrhea, a feeling of not being able to empty the bowel completely, an urgency to move the bowels, rectal cramping, or rectal bleeding.
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Dark patches of blood in or on stool; or long, thin, "pencil stools".
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Abdominal discomfort or bloating.
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Unexplained fatigue, loss of appetite, and/or weight loss.
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Pelvic pain, which occurs at later stages of the disease.
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Call Your Doctor About Colorectal Cancer if:
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You notice a change in your bowel movements, experience bleeding from the rectum, or notice blood in or on your stool. Don't assume you have hemorrhoids; your doctor will most likely perform a rectal exam, possibly a sigmoidoscopy, or a colonoscopy -- an exam that involves a long flexible tube inserted in your rectum.
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You experience persistent abdominal pain, unusual weight loss, or fatigue. These symptoms may be due to other causes, but they could also be linked to cancer.
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You are diagnosed with anemia. In determining its cause, your doctor should check for bleeding from the digestive tract because of colorectal cancer.
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Signs & Symptoms
Diagnosis
Colon Cancer Screening Methods
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Stool Test for Colon Cancer
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Colonoscopy for Colon Cancer
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Flexible Sigmoidoscopy
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Barium Enema (2 types, single / air Contrast study)
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In a single-contrast study, the colon is filled with barium, which outlines the intestine and reveals large abnormalities.
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Other types of screening
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Proctoscopy
Treatment may include the following, alone, or in combination
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Surgery
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Chemotherapy
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Radiation
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Biological Therapy
Colorectal Cancer Treatment Team: Specialists Involve
As with many cancers, a team approach to treating colorectal cancer is often used. In addition to receiving care by nurses, social workers and counselors, and dieticians, you may also be treated by one or more of the following doctor specialists.
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Surgeon
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Gastroenterologist,
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Medical oncologist
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Radiation oncologist
Treatment
10. Colon Cancer
Cancer of the colon affects more than 100,000 Americans each year. Most colon cancer is preventable through regular screening.