Chapter 82: Diverticulitis Flashcards
What is Diverticula?
Small herniations at sites where the vasculature, called vasa recta, penetrates the circular muscle layer of the colon
Most acquired diverticula are considered ____, involving only the mucosal and submucosal layers
Most acquired diverticula are considered false diverticula, involving only the mucosal and submucosal layers
Dominant bacteria in diverticulitis
Bacteroides fragilis and E. coli
Where is the diverticulitis seen in asian?
Right sided
Where is most common location of diverticulitis?
Left sided (descending and sigmoid colon)
The preferred imaging modality for diverticulitis because of its ability to evaluate the severity of disease and the presence of complications
CT scan
True or False
CT of abdomen and pelvis with IV contrast only for patients with a body mass index >20 kg/m2 and addition of PO contrast for patients with a body mass index <20 kg/m2 is appropriate
True
CT of abdomen and pelvis with IV contrast only for patients with a body mass index >20 kg/m2 and addition of PO contrast for patients with a body mass index <20 kg/m2 is appropriate
Isolated to inflammation of the diverticula with or without phlegmon or small abscess confined to the bowel wall
Uncomplicated diverticulitis
Cornerstone of treatment for uncomplicated diverticulitis
Antibiotic
True or False
With increased understanding of the inflammatory rather than infectious etiology of uncomplicated diverticulitis, recent studies have reported no benefit to routine antibiotic use
True
With increased understanding of the inflammatory rather than infectious etiology of uncomplicated diverticulitis, recent studies have reported no benefit to routine antibiotic use
Suggested as a tool to guide the use of antibiotics in diverticulitis,
Procalcitonin
CT Imaging Risk Factors for Progression to Complicated Diverticulitis
- Fluid collections (frequently anterior to rectum)
- Greater length of inflamed colon (85 mm vs. 65 mm)
- Inflamed diverticulum greater than 2 cm
Antibiotic for diverticulitis is how long?
Shorter duration of 4-5 days
Complicated diverticulitis is classified by
Hinchey classification scheme
Hinchey classification scheme
- Stage 1 is small, confined pericolic or mesenteric abscesses
- Stage 2 is larger abscesses, extending to the pelvis
- Stage 3 is perforated diverticulitis and purulent peritonitis
- Stage 4 refers to free perforation with fecal contamination of the peritoneal cavity
