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Major disorders of the Small Intestine
and Colon
1. Tumours
Here we distinguish between benign and malignant tumours.
The following are benign tumours:
- Polyps
- Adenomas
- Hamartomas
The following are malignant tumours:
- the colonic carcinoma
- the rectal carcinoma
2. Haemorrhoids (piles)
3. Irritable bowel syndrome
4. Chronic inflammatory bowel diseases
Disorder 1: Polyps
/ Adenomas and Carcinomas of the Colon
1. Definition:
A polyp is any protrusion into the intestinal cavity. An adenoma
is a tissue growth in the mucous membrane of the colon. A
carcinoma is a malignant tumour, which commonly develops from
adenomas Over 50% of colonic polyps or colonic carcinomas
are located in the end part of the colon. Around 20% of patients
over 60 years of age have colonic polyps. Carcinomas also
predominate in elderly persons.
2. Symptoms and Signs
- 60% of patients display no symptoms (commonly the condition
is detected by chance).
- Diarrhoea and secretion of mucus
- Pain due to constipation
- Spontaneous passing of blood or blood in bowel movements
3. Complications and Risks:
- Mutation of adenomas (development of malignant tumours)
- Haemorrhage
- Perforation of the intestine
- Spreading and formation of secondary growths
4. Diagnosis / Preliminary investigation
- Precautionary investigations for possible cancers should
begin from the age of 45.
- Examination of the rectum using a finger
- Intestinal endoscopy with, where required, the removal of
a sample of tissue or the removal of any polyps or adenomas
- Examination of the colon using a contrast medium (if intestinal
endoscopy is not possible)
- Ultrasound examination (a special device which is used to
see into the intestine).
- Major preliminary examinations: coloscopy with tissue biopsy.
On suspicion of a malignant tumour, the possibility of secondary
tumours must be investigated using ultrasound or computerised
tomography.
5. Therapy / Treatment
In the case of polyps and adenomas: complete
removal using the Endoscope.
In cases where there are indicators of malignant tumours
or these are suspected - but without a large number of secondary
tumours - surgery is a must. Either part of the colon or the
entire colon is removed.
Procedure:
1. Single operation
2. Double operation with the temporary attachment of an artificial
rectum, the rectum being remodelled in a second operation.
3. In the case of tumours which are situated very close to
the anus (rectal carcinoma), a permanent
3. Within the framework of interdisciplinary treatment, many
patients with advanced carcinomas are treated with chemotherapy
or radiation therapy before and after surgery.
6. After-care
- Regular check-ups using intestinal endoscopy
- In the case of carcinoma further checks such as determining
master tumor in the blood, ultrasound examination of the abdomen
or computerised tomography (x-ray technology) to exclude possible
secondary tumours is required.
Disorder 2: Haemorrhoids
1. Definition (What are Haemorrhoids?)
Haemorrhoids are enlarged veins in the anal region.
2. Symptoms and Signs (What are the
signs of haemorrhoids?)
Blood in bowel movements is commonly caused by haemorrhoids
(among other causes), and other symptoms are itching and occasional
pain.
3. Complications and Risks
Occasionally, serious bleeding can occur.
4. Diagnosis / Preliminary Investigation
(How are haemorrhoids diagnosed?)
Normally haemorrhoids are easy to diagnose. The examination
is carried out using proctoscopy, rectoscopy or coloscopy.
5. Therapy / Treatment (How are haemorrhoids
treated?)
At the Inselspital, the diagnosis and treatment of haemorrhoids
are carried out in the gastroenterologists' proctological
consulting rooms. There haemorrhoids can be tied off and destroyed
(sclerosed) during a rectoscopy. In addition, surgeons have
developed new operating procedures for the treatment of very
large haemorrhoids.
6. After care
After care is required in the event that the symptoms reoccur.
Disorder 3: Irritable
Bowel Syndrome
1. Definition: (What is irritable
bowel syndrome?)
Irritable bowel syndrome often causes serious abdominal pain,
most probably as a result of uncoordinated peristaltic movements
2. Symptoms and Signs (What symptoms
do patients with irritable bowel syndrome have?)
Patients with irritable bowel syndrome commonly experience
abdominal pain, which is often relieved following a bowel
movement.
3. Complications and Risks
None
4. Diagnosis (How is irritable bowel
syndrome diagnosed?)
Before irritable bowel syndrome can be diagnosed, all other
colonic disorders must be excluded. Normally, an endoscopy
is required to do this.
5. Therapy / Treatment (How is irritable
bowel syndrome treated?)
The symptoms experienced by most patients can be relieved
by taking medication.
6. After care
Regular check-ups are advisable to optimise the treatment
with medication.
Disorder 4: Chronic Inflammatory
Bowel Diseases
1. Definition (What is chronic inflammatory
bowel disease?)
Chronic inflammatory bowel diseases include Crohn's disease
and ulcerative colitis . These involve inflammation confined
exclusively to the colon (= ulcerative colitis) or a possible
attack affecting intestinal segments of quite variable size
in which the entire gastrointestinal tract can in principal
be affected (Crohn's disease). The cause of these diseases
has not yet been fully clarified, although hereditary and
environmental factors and disorders of the immune system are
important. At the Inselspital there are several working groups
which are engaged in scientific research into the origins
and treatment of chronic inflammatory bowel diseases. As a
result, patients at the Inselspital can benefit from the latest
information and treatments on offer in this field.
2. Symptoms and Signs
Patients suffer from a wide variety of symptoms, such as abdominal
pain, blood in bowel movements, diarrhoea, weight loss and
fever. Occasionally, pain in the joints can also occur.
3. Complications and Risks
Chronic inflammatory bowel disease can lead to infections,
which makes treatment with antibiotics or surgery necessary.
Often there is bleeding, without this necessarily being dangerous.
Serious haemorrhages or perforations of the intestinal wall
are rare. In the case of Crohn's disease, intestinal obstruction
is an additional complication.
4. Diagnosis
Normally a coloscopy has to be carried out. In addition, in
the case of Crohn's disease, the small intestine must be examined
using a special x-ray procedure. At the Inselspital, a diagnosis
can also be made on the basis of blood tests in the majority
of cases.
5. Therapy/Treatment
Most forms of treatment involve the influencing of the immune
system through the use of medication. The aim of the treatment
of patients with a chronic inflammatory bowel disease is always
to bring the patient out of a particular phase of the disease
quickly using the medication. Normally, consistent medicinal
treatment can keep all the symptoms of the disease well under
control.
The Inselspital is the only hospital in Switzerland so far
to conduct interdisciplinary consultations, involving gastroenterologists
and surgeons, to ensure the best possible treatment for these
diseases (Telephone 031/632 8560). In the case of ulcerative
colitis, the removal of the colon leads to the disease being
cured. The artificial rectum (ileostomy) which has to be attached
following removal of the colon is no longer required if a
pouch operation is performed. In this operation, the small
intestine is formed into a reservoir and joined to the natural
rectum. In the case of Crohn's disease, surgery is only carried
out in the event of complications (abscess, cicatricial atrophy).
6. After-care
As both Crohn's disease and ulcerative colitis are chronic
diseases, regular check-ups are absolutely essential, as the
inflammation must be kept at the lowest possible level at
all times.
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