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Year 3 Lower GI Surgery > Diverticular disease > Flashcards

Diverticular disease Flashcards

1
Q

Meckel’s Diverticulum

A

Ileal remnant of vitellointestinal duct - joins yoke sac to midgut lumen

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2
Q

Rule of 2s Meckel’s diverticulum

A
  • 2 inches long
  • 2 ft from ileocaecal valve
  • 2% of population
  • 2% symptomatic
  • Contain ectopic gastric or pancreatic tissue
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3
Q

Presentation of symptomatic Meckel’s

A
  • Rectal bleeding: from gastric mucosa
  • Diverticulitis mimicking appendicitis
  • Intussusception
  • Volvulus
  • Malignant change: adenocarcinoma
  • Raspberry tumour: mucosa protruding at umbilicus
  • Littre’s Hernia: herniation of Meckel’s
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4
Q

Diagnosis and tx of Meckel’s

A

Diagnosis: Tc pertechnecate scan ( +ve in 70%)

Tx
• Surgical resection

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5
Q

Intussusception

A

Portion of intestine invaginates into own lumen

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6
Q

Mesenteric Adenitis

A

• Viral infection / URTI → enlargement of mesenteric
lymph nodes
• pain, tenderness and fever

  • Post URTI
  • Headache + photophobia
  • Higher temperature
  • Tenderness is more generalised
  • Lymphocytosis
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7
Q

Diverticulum

A

Out-pouching of tubular structure

True = composed of complete wall (e.g. Meckel’s)

False = composed of mucosa only (pharyngeal,
colonic)

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8
Q

Diverticular disease

A

Symptomatic diverticulosis

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9
Q

Diverticulitis

A

Inflammation of diverticula

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10
Q

Pathophysiology of diverticular disease

A

Associated with:

  • ↑ intraluminal pressure
  • Low fibre diet: no osmotic effect to keep stool wet

• Mucosa herniates through muscularis propria at points
of weakness where perforating arteries enter.

• Most commonly located in sigmoid colon

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11
Q

Symptoms of diverticular disease

A
  • Altered bowel habit
  • Nausea
  • Flatulence
  • intermittent lower abdominal pain, typically colicky - Relieved by defecation
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12
Q

Treatment of uncomplicated diverticular disease

A
  • High fibre diet
  • simple analgesia
  • oral fluid intake
  • mebeverine (anti-spasmodic) may help
  • Elective resection for chronic pain

Failure to respond:
- embolisation or surgical resection

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13
Q

Presentation of

acute diverticulitis

A 
Abdominal pain and tenderness
- Typically LIF
- Localised peritonitis
- Sharp
- Worse with movement 
• Pyrexia
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14
Q

Investigations for diverticulitis

A

• Bloods

  • FBC: ↑WCC
  • ↑CRP/ESR
  • Amylase
  • G+S

• VBG - lactate

• Imaging
- Erect CXR: look for perforation

  • AXR: fluid level / air in bowel wall
  • First line - Contrast CT Abdo pelvis

• Endoscopy

  • Flexi Sig - uncomplicated diverticular disease
  • Colonoscopy: not in acute attack
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15
Q

Mx of mild attacks of acute diverticulitis

A

At home with bowel res - fluids only

Co-amoxiclav and metronidazole

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16
Q

When to admit diverticulitis

A
  • Unwell
  • Fluids can’t be tolerated
  • Pain can’t be controlled
17
Q

Mx of moderate to severe diverticulitis

A

• Medical

  • NBM
  • IV fluids
  • Analgesia
  • Antibiotics: cefuroxime + metronidazole

• Surgical:

  • Hartmann’s to resect diseased bowel
  • May consider lap washout for Hinchey 3
18
Q

Indications for surgery

A
  • Perforation
  • Large haemorrhage
  • Stricture → obstruction
19
Q

Complications of diverticulitis

A
  • Perforation
  • Haemorrhage
  • Abscess
  • Fistulae - UTIs
  • Strictures
20
Q

Perforation presentation and management

A
  • Sudden onset pain (± preceding diverticulitis)
  • Generalised peritonitis and shock
  • CXR: free air under diaphragm

Tx: Hartmann’s

21
Q

Presentation, investigations and Tx of haemorrhage

A

Presentation:
- Sudden, painless bright red PR bleed

Ix:
Mesenteric angiography or colonoscopy

Tx

  • Usually stops spontaneously
  • May need transfusion
  • Colonoscopy ± diathermy / adrenaline
  • Embolisation
  • Resection
22
Q

Presentation and management of abscess

A

Walled-off perforation

Presentation:
• Swinging fever
• Localising signs: e.g. boggy rectal mass
• Leukocytosis

Tx:
<5cm - Abx

> 5cm - Abx+ CT/US-guided drainage

23
Q

Tx of stricture

A

Resection

Stenting

24
Q

Risk factors

A 
Age
Low dietary fibre intake
Obesity
Smoking
FHx
NSAIDs
Ehlos Danlos
25
Q

Findings on CT scan of acute diverticulitis

A

Thickening of the colonic wall

Pericolonic fat stranding

Abscesses

Localised air bubble

Free air

26
Q

Colonoscopy

A

Colonoscopy should never be performed in any presenting cases of suspected diverticulitis, due to the increased risk of perforation

27
Q

Acute diverticulitis staging

A

Hinchey Classification

28
Q

Diverticular Stricture

A

Due to repeated episodes of acute inflammation

Bowel becomes scarred and fibrotic

Can cause large bowel obstruction

29
Q

Fistula Formation

A

Colovesical fistula - between the bowel and the bladder

  • recurrent UTIs
  • pneumoturia (gas bubbles in the urine)
  • passing faecal matter in the urine

Colovaginal fistula - between the bowel and the vagina
- copious vaginal discharge or recurrent vaginal infections

Year 3 Lower GI Surgery (10 decks)

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