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Key Clinical Questions

  • image When should you suspect and how do you evaluate ischemic colitis?

  • image What medications should be avoided, if possible, in patients with suspected ischemic colitis, and in suspected colonic pseudo-obstruction?

  • image How does the presentation of acute appendicitis in the older adult differ from that of younger individuals?

  • image How do you evaluate and treat diverticulitis, colonic obstruction, and colonic pseudo-obstruction?

Large bowel disorders (LBD) impose a substantial burden on Americans, accounting for more than 1% of all inpatient admissions, contributing as comorbidities to other hospitalizations, and resulting in expenditures of more than 30 billion dollars annually, which is likely to increase as the population ages. This chapter describes disorders of ischemic colitis, diverticulitis, acute appendicitis, colonic obstruction, and colonic pseudo-obstruction. Other disorders, including lower gastrointestinal bleeding, inflammatory bowel diseases, tumors and cancer of the colon, and diarrhea are described in chapters dedicated to those disorders. Table 163-1 describes key diagnostic tests and therapeutic options for important large bowel disorders, while Table 163-2 describes the colonoscopic findings.

TABLE 163-1Key Diagnostic Tests and Therapies for Important Large Bowel Diseases in Hospitalized Patients

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