Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1. Clin Med III > 2- Diverticular disease > Flashcards

2- Diverticular disease Flashcards

1
Q

What are defined as sac-like protrusions of the colonic wall?

A

Diverticulum/ diverticula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is defined as the presence of diverticula?

A

Diverticulosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is defined as inflammation of a diverticulum?

A

Diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does the prevalence of diverticulosis change with age?

A

Increases with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What portion of the colon is primarily affected by diverticulosis?

A

Sigmoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does diverticulosis generally present clinically?

A

Asx, discovered incidentally, normal PE

(occasionally abd cramping, constipation, diarrhea, bloating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the pathophysiology of diverticulosis?

A
  • Develop at weak points in colon wall
  • Increased intraluminal pressure predispose mucosa and submucosa to herniate
  • Low fiber diet → constipation → intraluminal pressure → herniation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the complications of diverticulosis?

A

Diverticulitis, bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

For pts who present with diverticulosis that clinically manifests as diverticulitis, are the majority simple or complicated?

A

Simple (85%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Are labs/ imaging typically required for diverticulosis?

A

No- most discovered incidentally on colonoscopy/ imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is asx diverticulosis managed?

A

High fiber diet (20-35 g/ day), adequate hydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is NOT recommended for management of asx diverticulosis?

A

Avoidance of seeds/ nuts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pathophysiology of acute diverticulitis? (4 steps)

A

Debris obstructs diverticulum neck/ increased luminal pressure results in erosion of diverticular wall → inflammation/ focal necrosis → perforation (micro or macro) → free air/ peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is defined as intra-abdominal spread of bacteria/ fecal matter?

A

Peritonitis (emergency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What defines acute diverticulitis as complicated? (4)

A

Abscess, fistula, obstruction, perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pt presents with progressive, steady aching pain in the LLQ, fever/ chills, (+/- N/V, change in bowel habits, irritative urinary sxs, peritoneal signs, and tenderness on rectal exam). What are you concerned for?

A

Acute diverticulitis

17
Q

What are the causes of irritative urinary sxs (if present) in acute diverticulitis?

A

Pneumaturia (air in urine) or fecaluria (fecal matter in urine) if colovesical fistula

18
Q

If pt presents with sxs consistent with acute diverticulitis, what is important to review as part of their hx?

A

Prior hx of diverticulitis episodes

19
Q

If concern for acute diverticulitis, what exam should be performed in women?

A

Pelvic

20
Q

What lab diagnostics should be ordered if concern for acute diverticulitis?

If of childbearing age?

If diarrhea?

If occult blood?

A

CBC (leukocytosis), BMP/ CMP, UA/ urine culture

If of childbearing age → urine HCG

If diarrhea → stool studies

If occult blood → stool

21
Q

What is the test of choice for diagnostic eval of acute diverticulitis?

A

CT scan of AP w/ contrast

(localized bowel wall thickening/ fat stranding, colonic diverticula)

22
Q

Aside from CT of A/P with contrast (test of choice), what other imaging might be ordered for diagnostic eval of acute diverticulitis?

A

Abd/ chest x-ray, US

23
Q

What diagnostic studies are contraindicated for eval of acute diverticulitis?

A

Flex sigmoidoscopy/ colonoscopy (risk of perf)

Barium enema (leakage through perf and exacerbation of peritonitis)

24
Q

What is the management for uncomplicated acute diverticulitis?

A

Discharge home (+/- abx), clear liquid/ low residue diet, close f/u within 2 days

25
Q

What is the management for complicated acute diverticulitis?

A

Admit, NPO, IV fluids, IV abx, consult GI, surgery

26
Q

What is typically recommended for abx in the tx of acute uncomplicated diverticulitis?

A

G-/ anaerobic coverage x 7-10 days

  • Metro + Cipro
  • Metro + Bactrim
  • Augmentin
  • Modifloxacin (if tolerant to metro and beta-lactams)
27
Q

What are guidelines regarding repeat imaging for acute uncomplicated diverticulitis?

A

Not necessary if clinical improvement

28
Q

The following are indicative of what for acute diverticulitis?

  • CT shows complicated diverticulitis
  • Significant leukocytosis
  • High fever ( > 102.5)
  • Severe/ increasing abd pain
  • Peritoneal signs
  • Comorbidites/ IMC
  • Inability to tolerate PO
  • Noncompliance/ unreliability/ lack of support
  • Eldely
A

Inpatient management

29
Q

What are guidelines regarding repeat imaging for acute diverticulitis with inpatient management?

A

Repeat imaging necessary if failure to improve within 2-3 days of IV abx therapy

30
Q

When treating acute diverticulitis with inpatient management, what is the protcol after IV abx therapy?

A

Transitioned to PO abx to complete a total of 10-14 day course

31
Q

When is surgical referral for management of acute diverticulitis indicated? (3)

A
  • Perf w/ peritonitis
  • Deterioration/ failure to improve w/i 72 hrs of therapy
  • Complicated
32
Q

What is included as part of long-term management of acute diverticulitis?

A

High fiber diet once acute episode resolves

Colonoscopy performed 6-8 weeks after resolution to eval extent of disease/ exclude colon CA/ IBD

33
Q

The decision to perform prophylactic colonic resection in patients with recurrent diverticulitis is based on what?

A

Individualized (if uncomplicated, may not be necessary)

34
Q

What is a common cause of overt lower GI bleeding in adults and usually resolves spontaneously?

A

Diverticular bleeding

35
Q

A penetrating artery draped over the dome of diverticulum leading to easy exposure to injury and susceptibility to bleeding is the pathophysiology for what?

A

Diverticular bleeding (R colon often source of bleed)

36
Q

Pt presents with painless hematochezia, TTP on abd exam, blood on rectal exam, +/- bloating/ cramping/ fecal urgency/ abn vital signs. What are you concerned for?

A

Diverticular bleeding

37
Q

What diagnostics should be ordered for initial eval of diverticular bleeding?

A

CBC, CMP, EGD/ NG lavage

(BUN/Cr not elevated if colonic diverticular bleeding)

38
Q

Once initial resuscitation for diverticular bleeding is complete, what is the next step?

A

Locate source of bleeding with flex sig/ colonoscopy

39
Q

What is included in the management of diverticular bleeding?

A

Usually self limited but if necessary:

Resuscitation/ hospitalization (maintain blood volume)

Treatment of bleeding site (endoscopic therapy, angiographic therapy, +/- surgery)

1. Clin Med III (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions