Colon Flashcards
what is the incidence of diverticulosis
60% by age 60, with only 10-20% getting sx
most common site for diverticulosis
sigmoid colon
risk factors for diverticulosis
low fiber diet, chronic constipation, family hx, increasing age
complications of diverticulOSIS
major bleeding
diverticulitis
diagnostic approach
Colonoscopy if no signs of inflamm, otherwise CT A/P
When is it safe to get a Colonoscopy if there have been signs of inflammation
6 wks after inflammation resolved d/t risk of perforation, reason is to r/o Colon CA
Pathophys of diverticulTIS
obstruction of diverticulum by fecalith leading to infamm and microperforation
Signs of DiverticuliTIS
LLQ pain diarrhea chills, fever anorexia LLQ MASS n/v, dysuria
Signs of CT A/P of diverticuLITIS
swollen bowel wall,
very helpful in dx an abscess
What to avoid in acute settings of diverticulitis
Barium enema
Colonoscopy
Most common fistula in diverticulitis
COLOVESICAL
colon –> bladder
Initial therapy of Diverticulitis
Fluids, NPO (in case of surgery), Abx with anaerobic coverage, NG suction (prn for emesis/ileus)
What is the lifelong risk of recurrence of diverticulitis
after 1st episode: 33%
after 2nd episode: 50%
what surgery is performed electively for recurrent bouts?
Resection of involved segment and primary anastomosis
Massive lower GI bleeding is seen with which of the divert’s
OSIS
Most common cause of massive lower GI bleed in adults
Diverticulosis (esp Right sided)
What is Colonic Volvulus
twisting of the colon on itself
volvulus can lead to
vascular compromise with necrosis, perforation, or both
most common site of volvulus
SIGMOID
redundant/ floppy
risk factors
bulky stools elongated colon chronic constip laxative abuse pregnancy bedridden elderly or institutionalized prior hx abd surgery
signs of Sigmoid volvulus on abx x-ray
“bent inner tube”
“omega” sign with loop aiming toward the RUQ
dx of sigmoid volvulus
CT scan
sigmoidoscopy
x ray exam with Gastrografin enema
lime green dye
indocyanine green
“bird’s beak” sign
sigmoid volvulus
