14. Diverticular Disease Flashcards
Outpouchings of the colon
Diverticulosis
Etiology of diverticulosis.
Abnormal intermittent high pressure in the colon.
Weakest point of the colon.
Vasi recti
*common location for diverticula
Where do diverticula occur?
At the point where the artery penetrates the muscle wall, resulting in a break in the integrity of the colonic wall.
- Think “hernia”-but not actually
What is the difference between false diverticulum and true diverticulum?
False: only a protrusion of the mucosa and submucosa through the muscle wall.
True: Saclike herniatior of the ENTIRE bowel wall
What is the primary function of the colon?
- Reabsorb WATER + SODIUM
- Secrete POTASSIUM + BICARBONATE
- Store FECAL MATERIAL
Which part of the colon is retroperitoneal?
ASCENDING and DESCENDING
Which part of the colon is intraperitoneal?
TRANSVERSE and SIGMOID COLON
The SMA supplies blood to the:
CECUM, ASCENDING, and TRANSVERSE colon
The IMA supplies blood to:
LEFT COLIC, SIGMOID, and SUPERIOR HEMORRHOIDAL ARTERIES
What is causing diverticulosis around the world?
Poor diet.
*NEED TO EAT MORE FIBER
When is diverticulosis diagnosed?
Routine colonoscopy screening.
*No Sx
1st step after diagnosing diverticulosis.
HIGH-FIBER DIET!
What is the most common cause of lower GI bleeding in the colon?
Diverticulosis
What is the standard protocol for diverticulosis?
Monitor
* Most are self limiting
Inflammatory condition caused by perforation of one of the sacs.
Diverticulitis
Complications of diverticulitis.
- Abscess
- Perforation
- Stricture
- Fistula
- Rectal bleeding or hemorrhage
A patient presents with ACUTE ONSET OF LLQ ABDOMINAL PAIN. Think:
Diverticulitis
A patient presents with generalized peritonitis and abdominal distension, this is and indication of:
Perforation
*SEVERE PAIN!
An abnormal connection between two epitheliazed surfaces.
Fistula
This type of fistula may present with pneumaturia, fecaluria, pyuria, or UTI symptoms.
Colovesical fistula: common
This type of fistula may present with stool passing through the vagina.
Colovaginal fistula.
This type of fistula may present with malabsorption/diarrhea.
Coloenteric
These usually result from recurrent inflammation resulting in lumen narrowing. May present as large bowel obstruction.
Stricture
Diagnostic image of choice for diverticulitis diagnosis.
CT scan of abdomen/pelvis
What might you see on a CT scan of diverticulitis?
Pericolic fat infiltration, thickened colon wall, fat stranding.
What might you see on a complicated diverticulitis CT scan?
Abscess
Stricture
Fistula
Free air if perforated
What is another exam of choice after diverticulitis attack?
Colonoscopy
- Exclude colon cancer or confirm diagnosis of complicated diverticulitis
- 6 weeks after attack
Tx for uncomplicated diverticulitis
Empiric antimicrobial therapy
*Cipro & Metronidazole
Diverticulitis tx for inpatient
IV antibiotics and IV analgesics
Options for preventing recurrence of diverticulitis
Dysbiosis (microbial imbalance in the body)> Probiotics
A perforated diverticulitis with a confined parabolic abscess. Stage?
Stage 1
Perforated diverticulitis that has closed spontaneously with distant/larger abscess formation. Stage?
Stage II
Perforated diverticulitis with purulent peritonitis. Stage?
Stage III
Perforation and free communication with the peritoneum, resulting in fecal peritonitis. Stage?
Stage IV
Stage I and II management.
Managed with antibiotics + percutaneous drainage of abscess.
*Resection 6+ wks later. Abscess >3cm can be drained
Hinchey II & IV management
Directly to surgery
Surgical management goals for diverticulitis.
1) Control SEPSIS
2) Eliminate complications
3) Remove diseased segment
4) Restore continuity
