Colon

Question 1

what is the incidence of diverticulosis

Answer 1

60% by age 60, with only 10-20% getting sx

Question 2

most common site for diverticulosis

Answer 2

sigmoid colon

Question 3

risk factors for diverticulosis

Answer 3

low fiber diet, chronic constipation, family hx, increasing age

Question 4

complications of diverticulOSIS

Answer 4

major bleeding

diverticulitis

Question 5

diagnostic approach

Answer 5

Colonoscopy if no signs of inflamm, otherwise CT A/P

Question 6

When is it safe to get a Colonoscopy if there have been signs of inflammation

Answer 6

6 wks after inflammation resolved d/t risk of perforation, reason is to r/o Colon CA

Question 7

Pathophys of diverticulTIS

Answer 7

obstruction of diverticulum by fecalith leading to infamm and microperforation

Question 8

Signs of DiverticuliTIS

Answer 8

LLQ pain
diarrhea
chills, fever
anorexia
LLQ MASS
n/v, dysuria

Question 9

Signs of CT A/P of diverticuLITIS

Answer 9

swollen bowel wall,

very helpful in dx an abscess

Question 10

What to avoid in acute settings of diverticulitis

Answer 10

Barium enema

Colonoscopy

Question 11

Most common fistula in diverticulitis

Answer 11

COLOVESICAL

colon –> bladder

Question 12

Initial therapy of Diverticulitis

Answer 12

Fluids, NPO (in case of surgery), Abx with anaerobic coverage, NG suction (prn for emesis/ileus)

Question 13

What is the lifelong risk of recurrence of diverticulitis

Answer 13

after 1st episode: 33%

after 2nd episode: 50%

Question 14

what surgery is performed electively for recurrent bouts?

Answer 14

Resection of involved segment and primary anastomosis

Question 15

Massive lower GI bleeding is seen with which of the divert’s

Answer 15

OSIS

Question 16

Most common cause of massive lower GI bleed in adults

Answer 16

Diverticulosis (esp Right sided)

Question 17

What is Colonic Volvulus

Answer 17

twisting of the colon on itself

Question 18

volvulus can lead to

Answer 18

vascular compromise with necrosis, perforation, or both

Question 19

most common site of volvulus

Answer 19

SIGMOID

redundant/ floppy

Question 20

risk factors

Answer 20

bulky stools
elongated colon
chronic constip
laxative abuse
pregnancy
bedridden elderly or institutionalized
prior hx abd surgery

Question 21

signs of Sigmoid volvulus on abx x-ray

Answer 21

“bent inner tube”

“omega” sign with loop aiming toward the RUQ

Question 22

dx of sigmoid volvulus

Answer 22

CT scan
sigmoidoscopy
x ray exam with Gastrografin enema

Question 23

lime green dye

Answer 23

indocyanine green

Question 24

“bird’s beak” sign

Answer 24

sigmoid volvulus

Question 25

Hartmann’s procedure

Answer 25

non functional colonic stump stapled and left in stomach

stoma opening to the outside for the functional piece

Question 26

major diff b/w Cecal volvulus and Sigmoid volvulus

Answer 26

Cecal volvules requires SURGICAL reduction whereas sigmoid often get endoscopic reduction of twist first