The document summarizes key aspects of the large intestine. It describes the anatomy and features that distinguish the large intestine from the small intestine. It discusses diverticular disease of the colon, noting that diverticula form due to a lack of fiber leading to high intraluminal pressure, especially in the sigmoid colon. Complications of diverticulitis that are mentioned include abscess, bleeding, fistula, obstruction, and perforation. The document also provides overviews of ulcerative colitis, Crohn's disease, volvulus, Hirschsprung disease, and Ogilvie's syndrome.

1. LARGE INTESTINE
MohmmadRjab Seder
College of Medicine and Health Sciences
Palestine Polytechnic University
2023

2. Large intestine
◦ AKA: Colon
◦ Ilium end → anus …. (approx. 1.5 m)
◦ 6 cm in diameter.

6. Interior of the Colon

9. The large intestine can be distinguished from small intestine by:
1. Omental appendices (epiploic appendages)
2. Tineae coli
3. Haustra
4. A much greater caliber.

15. Diverticular Disease
of the Colon
◦ Mucosal out-pouching.
◦ Lack of fibers → chronic constipation → ↑ intraluminal colonic pressure.
◦ The sigmoid colon is the commonest site affected.
◦ The rectum is never affected.

18. Complications of Diverticulitis?
◦ Abscess
◦ Bleeding
◦ Fistula
◦ Obstruction
◦ Perforation

19. Clinical Features
◦ Uncommon before age of 40.
◦ Incidence increase with age.
Diverticulosis:
◦ Asymptomatic.
◦ Lower abdominal pain.
◦ Distention And flatulence.
Diverticulitis:
◦ Left iliac pain.
◦ Pyrexia.
◦ Tenderness.
Fresh bleeding per rectum
may be the first presentation
of diverticular disease.

20. Investigations
◦ Barium enema.
◦ Endoscopy.
◦ CT scan.

21. Lower GI showing Diverticula

22. Diverticulosis
CT: Arrowheads point to multiple diverticula arising from the recto sigmoid. The
contrast in diverticula is left over from previously administered GI contrast.

23. IBD
Is a group of autoimmune diseases that cause chronic inflammation
of the GIT.
◦ Ulcerative colitis (UC)
◦ Crohn’s disease (CD)
◦ Indeterminate Colitis

24. Ulcerative Colitis
◦ Colitis characterized by ulceration.
◦ Idiopathic.

25. Clinical Features
◦ Female > Male.
◦ 30th - 40th.
Presentation:
◦ Watery diarrhea mixed with blood, pus, and mucus.
◦ Pain, fever, weight loss, and dehydration.
◦ Remissions and relapses.

26. Investigations
◦ Labs:
◦ Anaemia and leukocytosis.
◦ Hypoproteinemia and hypokalemia.
◦ Serology: ANCA, ASCA, IgG, IgA (suggestive).
◦ Faecal calprotectin.
◦ Plain X-ray: toxic megacolon.
◦ Barium enema: mucosal irregularity, or loss of haustration.
◦ CT Abdomen: mural thickening and narrowing of the colon.
◦ Colonoscopy.
Barium enema and
colonoscopy are CI
in the presence of
toxic megacolon.

27. Colitis
1. Ulcerative colitis
2. Microscopic colitis
3. Pseudomembranous colitis
4. Ischemic colitis
5. Allergic colitis

28. Crohn’s Disease
An idiopathic, chronic, transmural, granulomatous, inflammatory
bowel disease, that can involve any segment in the GI tract from
mouth to anus.
◦ Skip lesions may present.
◦ 20th – 40th.
◦ Males > Females.
◦ Symptoms include diarrhea, abdominal pain, weakness, weight
loss, and anorectal disease.

29. Investigations
◦ Barium meal.
◦ CT, MRI.
◦ Colonoscopy and biopsy.

30. Volvulus
◦ Twisting of a bowel loop around its mesenteric (vascular) axis.
◦ Volvulus → obstruction + strangulation.
◦ Commonest in sigmoid colon.

33. Hirschsprung Disease
◦ Also called congenital aganglionic megacolon.
◦ Occurs when some of your baby's ganglion cells don't develop
properly, delaying the progression of stool through the intestines.

34. Ogilvie’s Syndrome
◦ Acute Colonic Pseudo-Obstruction (ACPO).
◦ A condition characterized by massive colonic distension in the
absence of mechanical obstruction.
◦ Causes include neuroleptic medications, anticholinergics,
amphetamines, steroids and narcotics.

35. Any Question?