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FUN MED SPRING 2018 > 14. Diverticular Disease > Flashcards

14. Diverticular Disease Flashcards

1
Q

Outpouchings of the colon

A

Diverticulosis

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2
Q

Etiology of diverticulosis.

A

Abnormal intermittent high pressure in the colon.

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3
Q

Weakest point of the colon.

A

Vasi recti

*common location for diverticula

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4
Q

Where do diverticula occur?

A

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
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5
Q

What is the difference between false diverticulum and true diverticulum?

A

False: only a protrusion of the mucosa and submucosa through the muscle wall.

True: Saclike herniatior of the ENTIRE bowel wall

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6
Q

What is the primary function of the colon?

A
  • Reabsorb WATER + SODIUM
  • Secrete POTASSIUM + BICARBONATE
  • Store FECAL MATERIAL
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7
Q

Which part of the colon is retroperitoneal?

A

ASCENDING and DESCENDING

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8
Q

Which part of the colon is intraperitoneal?

A

TRANSVERSE and SIGMOID COLON

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9
Q

The SMA supplies blood to the:

A

CECUM, ASCENDING, and TRANSVERSE colon

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10
Q

The IMA supplies blood to:

A

LEFT COLIC, SIGMOID, and SUPERIOR HEMORRHOIDAL ARTERIES

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11
Q

What is causing diverticulosis around the world?

A

Poor diet.

*NEED TO EAT MORE FIBER

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12
Q

When is diverticulosis diagnosed?

A

Routine colonoscopy screening.

*No Sx

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13
Q

1st step after diagnosing diverticulosis.

A

HIGH-FIBER DIET!

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14
Q

What is the most common cause of lower GI bleeding in the colon?

A

Diverticulosis

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15
Q

What is the standard protocol for diverticulosis?

A

Monitor

* Most are self limiting

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16
Q

Inflammatory condition caused by perforation of one of the sacs.

A

Diverticulitis

17
Q

Complications of diverticulitis.

A
  • Abscess
  • Perforation
  • Stricture
  • Fistula
  • Rectal bleeding or hemorrhage
18
Q

A patient presents with ACUTE ONSET OF LLQ ABDOMINAL PAIN. Think:

A

Diverticulitis

19
Q

A patient presents with generalized peritonitis and abdominal distension, this is and indication of:

A

Perforation

*SEVERE PAIN!

20
Q

An abnormal connection between two epitheliazed surfaces.

A

Fistula

21
Q

This type of fistula may present with pneumaturia, fecaluria, pyuria, or UTI symptoms.

A

Colovesical fistula: common

22
Q

This type of fistula may present with stool passing through the vagina.

A

Colovaginal fistula.

23
Q

This type of fistula may present with malabsorption/diarrhea.

A

Coloenteric

24
Q

These usually result from recurrent inflammation resulting in lumen narrowing. May present as large bowel obstruction.

A

Stricture

25
Q

Diagnostic image of choice for diverticulitis diagnosis.

A

CT scan of abdomen/pelvis

26
Q

What might you see on a CT scan of diverticulitis?

A

Pericolic fat infiltration, thickened colon wall, fat stranding.

27
Q

What might you see on a complicated diverticulitis CT scan?

A

Abscess
Stricture
Fistula
Free air if perforated

28
Q

What is another exam of choice after diverticulitis attack?

A

Colonoscopy

  • Exclude colon cancer or confirm diagnosis of complicated diverticulitis
  • 6 weeks after attack
29
Q

Tx for uncomplicated diverticulitis

A

Empiric antimicrobial therapy

*Cipro & Metronidazole

30
Q

Diverticulitis tx for inpatient

A

IV antibiotics and IV analgesics

31
Q

Options for preventing recurrence of diverticulitis

A

Dysbiosis (microbial imbalance in the body)> Probiotics

32
Q

A perforated diverticulitis with a confined parabolic abscess. Stage?

A

Stage 1

33
Q

Perforated diverticulitis that has closed spontaneously with distant/larger abscess formation. Stage?

A

Stage II

34
Q

Perforated diverticulitis with purulent peritonitis. Stage?

A

Stage III

35
Q

Perforation and free communication with the peritoneum, resulting in fecal peritonitis. Stage?

A

Stage IV

36
Q

Stage I and II management.

A

Managed with antibiotics + percutaneous drainage of abscess.

*Resection 6+ wks later. Abscess >3cm can be drained

37
Q

Hinchey II & IV management

A

Directly to surgery

38
Q

Surgical management goals for diverticulitis.

A

1) Control SEPSIS
2) Eliminate complications
3) Remove diseased segment
4) Restore continuity

FUN MED SPRING 2018 (14 decks)

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