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Block 11 module 5 > colonic diverticular disease > Flashcards

colonic diverticular disease Flashcards

1
Q

colonic diverticular disease is ____ sided in western countries

A

left

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2
Q

outward herniation of the mucosa and submucosa which occurs in areas where nutrient/penetrating arteries (vasa recta) are located

A

diverticula

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3
Q

pseudodiverticula only involves what layers

A

mucosa through the musculairs propria

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4
Q

diverticula are clogged by feces that erodes into the diverticulum that causes inflammatory changes because the colonic glands are not drained

A

diverticulitis

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5
Q

Left or RIght:
Diverticulitis -
Diverticular bleeding

A

diverticulitis - left

diverticular bleeding - right

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6
Q

Diverticula ruptures/perforates because of

A

blockage by a fecalith or hardened stool

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7
Q

why does the rectum not develop diverticula

A

it has no points of weakness

no taenia coli

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8
Q

LLQ pain is a presenting symptom if this disease

A

SUDD

simple uncomplicated diverticular disease

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9
Q

dual purpose of detecting pneumoperitoneum and assessing cardiopulmonary status in a generally elderly population with common comorbid illness

A

erect chest film

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10
Q

plain ab x-ray does not confirm diverticulitis, but it’s useful in

A

ruiling out other conditions

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11
Q

why barium enema is not used

A

it can leak to the peritoneum and cause peritonitis

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12
Q

why air contrast is not used

A

it can increase intraluminal pressure of the colon. It can induce rupture.

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13
Q

Procedure of choice for confirmation

A

CT

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14
Q

what can be seen in UTS

A

active inflammation

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15
Q

diverticula findings in UTS

A

Bowel wall thickening
─ Presence of diverticula abscess
─ Hyperechogenicity of the bowel wall

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16
Q

MRI is not good with

A

intestines and diverticula diagnosis

17
Q

SUDD with confirmation of inflammation and infection within the colon should be treated initially with

A

antibiotics and bowel rest

18
Q

For long-term medical management of uncomplicated diverticular disease

A

rifaximin

19
Q

why rifaximin is used for IBS

A

it eradicates concimitant small bowel bacterial overgrowth

20
Q

goals of surgery in in diverticular diseases

A

controlling sepsis
Eliminating complications such as fistula or obstruction
─ Removing the diseased colonic segment
restoring intestinal continuity

21
Q

when is elective resection recommended

A

after 2 attacks of uncomplicated diverticulitis

22
Q

procedure of choice for diverticulitis in the elective setting

A

sigmoid colectomy with primary anastomosis

23
Q

clinical signs of abscess

A

tender mass of abdomen
persistent fever
leukocytosis

24
Q

management if < 5cm

A

antibiotics

─ small pericolic abscesses (stage I) can be treated conservatively with broad-spectrum antibiotics and bowel rest only

25
Q

management if .5cm

A

percutaneous drainage with definitive surgery after 1.5 months
─ 1 stage resection in 3-6 weeks

26
Q

indications for urgent surgery

A

inaccessible (can not be punctured)
• multiloculated
• no improvement after 7-10 days of antibiotics

27
Q

presence of small pericolic or mesenteric abscesses

A

• Stage I (Confined Pericolic Abscess)

28
Q

presence of larger abscesses, often at the pelvis

abscesses may be retroperitoneal or pelvic

A

Stage II (Distant Abscess)

29
Q

due to the rupture of a peridiverticular abscess

A

Stage III (Generalized Purulent Peritonitis)

30
Q

peritonitis due to the rupture of an uninflamed and unobstructed diverticulum into the free peritoneal cavity with fecal contamination (a “free rupture”)

A

Stage IV (Fecal Peritonitis)

31
Q

considered surgical emergencies that require urgent operative intervention

A

Free Perforation (Stages III & IV)

32
Q

EVIDENCES SUGGESTIVE OF DIVERTICULAR HEMORRHAGE

A

bright red or marron blood per rectum
• diverticulosis on colonoscopy or contrast studies
• exclusion of UGIB

Block 11 module 5 (2 decks)

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