Colon - Diverticulitis

Question 0

Diverticulum?

Answer 0

Herniation of the mucosa and submucosa through a weakness of the muscle

Question 1

Plan for patient with diverticulitis?

Answer 1

IV antibiotics, CT scan to exclude paracolic abscess or fistula

Question 2

Diverticulosis versus diverticulitis?

Answer 2

Un-Inflamed diverticula versus inflamed particular

Question 3

Symptoms of diverticulosis?

Answer 3

Usually asymptomatic but may resemble IBS or may have a cute symptoms

Question 4

Complications of diverticulosis?

Answer 4

Acute diverticulitis
Hemorrhage
Obstruction

Question 5

Diverticular hemorrhage presents as?

Answer 5

Painless bright red blood

Question 6

Treatment of diverticulosis?

Answer 6

Dietary measures
Increase fiber
In some patients colonic segment resection

Question 7

Stages of diverticulitis?

Answer 7

Stage 1: small, confined paracolic abscess
Stage 2: distant abscess (retroperitoneal or pelvic)
Stage 3: peritonitis from rupture of abscess (Noncommunicating with Bowl lumen)
Stage 4. Peritonitis caused by free communicating perforation

Question 8

Mechanism of acute diverticulitis?

Answer 8

Fecaliths obstruct diverticula neck, leading to inflammation, diminished venous outflow, bacterial overgrowth

Question 9

Pathognomonic finding for colovesicular fistula?

Answer 9

Pneumaturia or fecaluria

Question 10

Differential for diverticulitis?

Answer 10

GI: Painful diverticular disease without diverticulitis, appendicitis, Crohn’s disease, colon carcinoma, ischemic colitis, IBS

Gyn: ruptured ovarian cyst, endometriosis, ectopic pregnancy, PID

Question 11

If suspect acute diverticulitis, use this test? avoid these tests?

Answer 11

CT scan with contrast

1. Contrast enema (fear of perforation and spillage of contrast into Abdominal cavity)
2. Endoscopy (wait for six weeks after resolution of the attack

Question 12

When to admit patients for diverticulitis?

Answer 12

Need for narcotics to control pain, comorbid illnesses, inability to tolerate oral liquids, abscess or peritonitis

Question 13

Indications for emergent surgical intervention?

Answer 13

1. Generalized peritonitis
2. Uncontrolled sepsis
3. Perforation

Question 14

Treatment for diverticulitis as outpatients?

Answer 14

Broad-spectrum antibiotics:

1. Bactrim/Cipro/Levo + flagyl
2. Augmentin

Question 15

Treatment in hospitalized patients?

Answer 15

IV antibiotics:

1. Zosyn
2. Timentin

Question 16

Suspect Abscess when? Treatment?

Answer 16

Tender mass, persistent fever, leukocytosis, despite adequate therapy

Nothing (if small) or CT guided percutaneous drainage

Question 17

Treatment of fistula?

Answer 17

Surgery for Fistula closure and primary anastomoses