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Gastroenterology > 321 Diverticular > Flashcards

321 Diverticular Flashcards

Chapter 321. Diverticular disease and common anorectal disorder

1
Q

Saclike herniation of the entire bowel wall

A

True diverticulum

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2
Q

Protrusion of the mucosa and submucosa through the muscularis propria of the colon

A

Pseudodiverticulum

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3
Q

Part usually spared by diverticular disease

A

Rectum

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4
Q

Commonly affected sites of diverticular diseases

A

Left colon and sigmoid

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5
Q

In Asian populations, where are 79% of diverticula seen?

A

Right colon and cecum

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6
Q

Most common cause of hematochezia in patients more than 60 years old

A

Hemorrhage from colonic diverticulum

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7
Q

How many of patient with diverticular disease develop GI bleeding

A

20%

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8
Q

Characteristic of patient at increased risk for bleeding

A

Hypertensive
Atherosclerosis
Aspirin use
NSAID use

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9
Q

True or false. Most diverticular bleeds are self limited and stop spontenously with bowel rest

A

True

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10
Q

When will a patient with diverticular disease need surgery

A

6 units bleed in 24 hours and unstable vital signs

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11
Q

Surgery if bleeding has been defined

A

Segmental resection

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12
Q

Surgery if site of bleeding has not been definitely identified

A

Subtotal colectomy

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13
Q

Surgery if patient had no severe comorbidities

A

Surgical resection with primary anastomosis

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14
Q

When is higher anastomotic leak reported

A

In patients who receive more than 10 units of blood

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15
Q

What is the CT scan finding diagnostic of diverticular disease

A

Sigmoid diverticula, thickened colonic wall more than 4 mm and inflammation within the periodic fat with or without collection of contrast material or fluid

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16
Q

What defines complicated diverticular disease?

A

Diverticular disease associated with abscess or perforation

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17
Q

Hinchey classification of diverticular disease. Stage I

A

Stage I: perforated diverticulitis with confined paracolic abscess

18
Q

Hinchey classification of diverticular disease. Stage II

A

Stage II: perforated diverticulitis that has closed spontaneously with distant abscess formation

19
Q

Hinchey classification of diverticular disease. Stage III

A

Stage III: noncommunicating perforated diverticulitis with focal peritonitis

20
Q

Hinchey classification of diverticular disease. Stage IV

A

Stage IV: perforation and free communication with peritoneum, resulting in fecal peritonitis

21
Q

Common fistula formation in diverticular disease

A

Cutaneous, vaginal, vesicle fistulas

22
Q

Fistula common in women who has undergone hysterectomy

A

Colo vaginal fistula

23
Q

Recommended fiber per day in diverticular disease

A

30 grams fiber per day

24
Q

Recommend antibacterial coverage for diverticular disease

A

TMP SMX
Metronidazole
Ciprofloxacin
–cover aerobic gram Negative rods and anaerobic bacteria

25
Q

Alternative single agent therapy

A

3rd generation penicillin: IV Piperacillin or oral penicillin/clavulanic acid

26
Q

Probiotics found to be beneficial in diverticular disease

A

Lactobacillus acidophilus

Bifidobacterium

27
Q

When is CT guided percutaneous drainage of diverticular abscess done

A

Abscess greatet than 3 cm and have well defined wall

28
Q

What is the treatment of abscess less than 3 cm

A

Antibiotic therapy

29
Q

How is Hinchey Stage III managed

A

Hartmanns procedure

30
Q

True or false. Rectal prolapse is 6x more common in men than in women

A

False. Women > men

31
Q

Test done if child has rectal prolapse

A

Sweat Chloride test

32
Q

Comorbidity in 20% of children with rectal prolapse

A

Cystic fibrosis

33
Q

Circumferential full thickness protrusion of the rectal wall through the anal orifice

A

Rectal prolapse (procidentia)

34
Q

Conditions associated with rectal prolapse

A

Redundant sigmoid colon
Pelvic laxity
Deep rectovaginal septum

35
Q

Pathophysiology of rectal prolapse

A

Damage to pudendal nerve from repeated stretching with straining to defecate

36
Q

True or false. Unilateral pudendal nerve injury is more significantly associated with prolapse and incontinence than bilateral nerve injury

A

False. Bilateral > unilateral

37
Q

Result of attempting to defecate against a closed pelvic floor

A

Animus

38
Q

Mainstay treatment of rectal prolapse

A

Surgical correction

39
Q

Involuntary passage of fecal material at least 1 month in an individual with a development age of at least 4 years

A

Fecal incontinence

40
Q

Major cause of fecal incontinence

A

Obstetric injury to the pelvic floor

Gastroenterology (13 decks)

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