Most folks who think about the colon worry about the polyps and cancers that may develop from epithelial cells. Like all tissues, the colon requires a supply of blood in part, it's provided by the many small penetrating arteries that pass through the colon's muscular wall to carry blood to its inner layer of epithelial cells. The wall of the colon contains two groups of muscles, a circular muscle that rings the colon and three long muscles that run the entire length of the tube. When healthy, the colon is a smooth cylinder lined by a layer of epithelial cells. The intestinal contents take about 18 to 36 hours to journey through the colon in the process, the few remaining nutrients are snatched into the bloodstream and much of the water is absorbed, resulting in solid fecal material. From there, digested material travels up the ascending colon, across the transverse colon, and down the descending colon to the final portion, the sigmoid colon, in the lower left part of the abdomen. Residual material enters the colon, or large intestine, in the cecum, which lies in the right lower portion of the abdomen (see Figure 1). The food you eat is mostly digested in the stomach and small intestine. The colon is a 4 1/2-foot-long tube that constitutes the final portion of the intestinal tract. It's a learning experience that's particularly unfortunate, since diverticular disease is largely preventable. Still, when complications develop, blissful ignorance about diverticulosis abruptly gives way to an unwelcome education about the pain of diverticulitis or the bleeding of diverticulosis. That's understandable, since the most prevalent form of the problem, diverticulosis, produces few if any symptoms. But few of these well-informed gents can tell you if they have diverticular disease of the colon, even though it's an extremely common condition. Many health-conscious peoplemen can recite their cholesterol counts and, blood pressure readings, and PSA levels without even glancing at their medical records. An acute abdominal series does not have the sensitivity to reliably diagnose serious urgent care conditions such as appendicitis, small bowel obstruction, or malignancyĪcknowledgment: Images and case presented by Experity Teleradiology (about diverticulitis and how diverticular disease is largely preventable CT is most helpful in assessing colon cancer vs focal/segmental diverticulitis.Pearls for Urgent Care Management and Considerations for Transfer Marked colonic thickening > 1.0 to 1.5 cm – pseudomembranous, tuberculous, cytomegalovirus colitis, colonic neoplasms, vasculitis.Mild thickening – plaque-like tumors, mild colonic inflammation.There is significant overlap in the degree of colonic wall thickening among different colonic pathologic processes.Multiple skip regions – Crohn’s disease.Rectum – early stages of ulcerative colitis, stercoral colitis.Isolated splenic flexure and proximal descending colon – watershed area for low-flow intestinal ischemia.Cecal region – amebiasis, typhlitis (neutropenic colitis), tuberculosis.However, some pathologic entities have a propensity to localize to certain areas: Almost any pathologic condition can affect any areas of the colon.Vasculitis (almost always involves the small bowel as well).Ulcerative colitis (typically begins in the rectum and spreads proximally).Differential Diagnosis of Colonic Thickening The information in Table 1 may be helpful in delineating the extent of disease in patients with this diagnosis. The 12 cm segment of persistent narrowing in the descending colon indicates this to be segmental disease. This patient was diagnosed with segmental colonic thickening, with possible colitis.
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