Granuloma - Aggregate of ACTIVATED (epithelioid) macrophages
- Causes:
Crohn's- Ileocecal area
- Rectal sparing
- Patchy distribution
- Aphthous ulcers
- Transmural inflammation
- Adhesions
- Fistulas
- Strictures
- GRANULOMAS
- Fissuring ulcers
- => Cobblestoning (areas of surviving mucosa between fissures)
- Dysplasia is less common
UC- Affects mucosa only
- Crypt abscesses
- In mucosa
- Full of neutrophils
- Extensive, diffuse inflammation
- Dysplasia is common
- Because it affects the mucosa
Bowel obstruction- Features
- Absolute constipation
- Colicky pain
- Vomiting
- Abdominal distension
- Small bowel
- Adhesions (=> kinking)
- Crohn's
- Volvulus
- Hernia
- Intususception
- Large bowel
- CRC
- 25% present with obstruction
- Diverticular strictures
- Sigmoid volvulus
Ileus- Clinical features
- Mimics obstruction
- BUT pain is from the underlying disorder, not from the bowel
- Bowel is paralysed => No colicky pain
- Causes
- Post-op
- Any cause of peritonitis
- Opioids
- Electrolyte imbalance
Notes- 4 signs of acute inflammation, plus LOF
- Neutrophils climb along fibrin scaffold
- IL-6 stimulated mediators
- CRP
- Opsonin
- Complement activation
- Fibrinogen
- Mannose binding lectin
- Granulation tissue is PINK
- Huge proliferation of capillaries
- Pseudomonas => Green tinge
- Old patient with rectal bleeding
- Angiodysplasia
- Ischaemic bowel disease
- Ca
- Anterior resection = Removal of all or part of the rectum, with primary anastamosis
- Obstruction: Pain progresses from colicky to peritonitic as bowel is paralysed and dies
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