321 Diverticular Flashcards
Chapter 321. Diverticular disease and common anorectal disorder
Saclike herniation of the entire bowel wall
True diverticulum
Protrusion of the mucosa and submucosa through the muscularis propria of the colon
Pseudodiverticulum
Part usually spared by diverticular disease
Rectum
Commonly affected sites of diverticular diseases
Left colon and sigmoid
In Asian populations, where are 79% of diverticula seen?
Right colon and cecum
Most common cause of hematochezia in patients more than 60 years old
Hemorrhage from colonic diverticulum
How many of patient with diverticular disease develop GI bleeding
20%
Characteristic of patient at increased risk for bleeding
Hypertensive
Atherosclerosis
Aspirin use
NSAID use
True or false. Most diverticular bleeds are self limited and stop spontenously with bowel rest
True
When will a patient with diverticular disease need surgery
6 units bleed in 24 hours and unstable vital signs
Surgery if bleeding has been defined
Segmental resection
Surgery if site of bleeding has not been definitely identified
Subtotal colectomy
Surgery if patient had no severe comorbidities
Surgical resection with primary anastomosis
When is higher anastomotic leak reported
In patients who receive more than 10 units of blood
What is the CT scan finding diagnostic of diverticular disease
Sigmoid diverticula, thickened colonic wall more than 4 mm and inflammation within the periodic fat with or without collection of contrast material or fluid
What defines complicated diverticular disease?
Diverticular disease associated with abscess or perforation
Hinchey classification of diverticular disease. Stage I
Stage I: perforated diverticulitis with confined paracolic abscess
Hinchey classification of diverticular disease. Stage II
Stage II: perforated diverticulitis that has closed spontaneously with distant abscess formation
Hinchey classification of diverticular disease. Stage III
Stage III: noncommunicating perforated diverticulitis with focal peritonitis
Hinchey classification of diverticular disease. Stage IV
Stage IV: perforation and free communication with peritoneum, resulting in fecal peritonitis
Common fistula formation in diverticular disease
Cutaneous, vaginal, vesicle fistulas
Fistula common in women who has undergone hysterectomy
Colo vaginal fistula
Recommended fiber per day in diverticular disease
30 grams fiber per day
Recommend antibacterial coverage for diverticular disease
TMP SMX
Metronidazole
Ciprofloxacin
–cover aerobic gram Negative rods and anaerobic bacteria
Alternative single agent therapy
3rd generation penicillin: IV Piperacillin or oral penicillin/clavulanic acid
Probiotics found to be beneficial in diverticular disease
Lactobacillus acidophilus
Bifidobacterium
When is CT guided percutaneous drainage of diverticular abscess done
Abscess greatet than 3 cm and have well defined wall
What is the treatment of abscess less than 3 cm
Antibiotic therapy
How is Hinchey Stage III managed
Hartmanns procedure
True or false. Rectal prolapse is 6x more common in men than in women
False. Women > men
Test done if child has rectal prolapse
Sweat Chloride test
Comorbidity in 20% of children with rectal prolapse
Cystic fibrosis
Circumferential full thickness protrusion of the rectal wall through the anal orifice
Rectal prolapse (procidentia)
Conditions associated with rectal prolapse
Redundant sigmoid colon
Pelvic laxity
Deep rectovaginal septum
Pathophysiology of rectal prolapse
Damage to pudendal nerve from repeated stretching with straining to defecate
True or false. Unilateral pudendal nerve injury is more significantly associated with prolapse and incontinence than bilateral nerve injury
False. Bilateral > unilateral
Result of attempting to defecate against a closed pelvic floor
Animus
Mainstay treatment of rectal prolapse
Surgical correction
Involuntary passage of fecal material at least 1 month in an individual with a development age of at least 4 years
Fecal incontinence
Major cause of fecal incontinence
Obstetric injury to the pelvic floor
