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#Phase 2.1: Peri Op > Diverticular Disease > Flashcards

Diverticular Disease Flashcards

1
Q

What is a diverticulum?

A

Outpouching of gut wall

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2
Q

What is Diverticulosis?

A

Presence of diverticula (asymptomatic)

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3
Q

What is diverticular disease?

A

Symptoms arising from diverticula

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4
Q

What is Diverticulitis?

A

Inflamm. of diverticulum

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5
Q

What is the pathophysiology of a diverticulum? (3 steps)

A
  1. Naturally weakened bowel over time
  2. Movement of stool –> increases luminal pressure
  3. Outpouching of mucosa @ weaker areas
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6
Q

What is the pathophysiology of diverticulitis?

A

Bacteria grows in diverticula –> inflam

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7
Q

How are diverticulitis classified?

A

Simple vs Complicated

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8
Q

What makes a diverticulitis a Complicated diverticulitis? (2 things)

A
  1. Abscess
  2. Perforation
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9
Q

What are the risk factors for developing a diverticulum? (6 things)

A
  1. Age
  2. FHx
  3. Obesity
  4. Smoking
  5. NSAIDs
  6. Low fibre intake
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10
Q

What are the clinical features of Diverticular disease? (4 things)

A
  1. Nausea
  2. LIF pain (colicky, relieved by defecation)
  3. Alt bowel habits
  4. Flatulence (farting)
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11
Q

What are the clinical features of Diverticulitis ? (8 things)

A
  1. Fever
  2. Nausea
  3. LOA
  4. Tachycardia
  5. LIF pain (SHARP, worse on movement)
  6. Localised tenderness
  7. Guarding + rigidity (suggests complicated: absc + perf)
  8. Reduced bowel sounds
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12
Q

How will a perforated diverticulum present?

A

Localised peritonism / generalised peritonitis

Very unwell, maybe fatal

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13
Q

What can mask the symptoms of diverticulitis, even if its perforated?

A

If patient taking corticosteroids / immunosuppressants

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14
Q

What are other differentials of suspected diverticular diseases? (5 things)

A

Lower abdominal pain + bowel symptoms

  1. Inflamm bowel disease
  2. Bowel cancer

Abdominal pain

  1. Mesenteric ischaemia
  2. Gynae causes
  3. Renal stones
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15
Q

What lab tests should be done for suspected diverticular diseases? (4 things)

A
  1. FBC (raised WCC)
  2. CRP (raised)
  3. U&Es
  4. Faecal calprotectin (if diagnosis not clear)
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16
Q

In addition to routine blood tests, what other lab tests should be done especially for suspected diverticulitis? (2 things)

A
  1. Group & Save
  2. Urine dipstick (exclude urological causes)
17
Q

What is the best scan for suspected diverticulitis?

A

CT abdomen-pelvis

18
Q

What may a CT abdomen-pelvis of suspected diverticulitis show? (4 things)

A
  1. Thickened colon wall
  2. Pericolonic fat stranding (fasc inf of mesentry in pic)
  3. Abscesses
  4. Localised air bubbles / free air
19
Q

Why should a colonoscopy NOT be done for suspected diverticulitis?

A

Risk of perforation

20
Q

What scans should be done for suspected diverticulitis? (3 things)

A
  1. CT: best for abscesses
  2. Erect CXR: pneumoperitoneum in perforation
  3. AXR: dilated bowel loops / obstruction / abscesses
21
Q

What is the staging system for acute diverticulitis?

A

Hinchey Classification

22
Q

What are the stages of Hinchey Classification for acute diverticulitis? (4 stages)

A

Stage 1a: Phlegmon (inflamm w no liquid / pus)
Stage 1b: Pericolic / Mesenteric abscess
Stage 2: Walled off pelvic abscess
Stage 3: Generalised purulent (pus) peritonitis
Stage 4: Generalised faecal peritonitis

23
Q

What is a phlegmon?

A

Inflamm of soft tissue w NO liquid / pus

24
Q

How do you manage a patient with uncomplicated diverticular disease? (4 things)

A
  1. As outpatient
  2. Simple analgesia
  3. Encourage oral fluid intake
  4. Outpatient colonoscopy (to exclude any masked malignancies)
25
Q

How do you manage a patient with diverticular bleeds? (3 things)

A
  1. Conservatively, most will be self-limiting
  2. Significant bleeding –> resuscitation with blood products + stabilisation
  3. Failed conservative –> embolisation / surgical resection
26
Q

When should you admit a patient with (uncomplicated) diverticular disease into hospital? (5 things)

A
  1. Uncontrolled pain
  2. Dehydration concerns
  3. Significant co-morbidities / immunocompromised
  4. Significant PR bleeding
  5. Symptoms 48 hours + despite conserv. management
27
Q

How do you manage a patient with acute diverticulitis? (3 things)

A

Conservatively

  1. Abx
  2. IV fluids
  3. Analgesia
28
Q

When is surgical intervention indicated for acute diverticulitis? (2 things)

A

Perforation with:

  1. Faecal peritonitis (Hinchey Classification Stage 4)
  2. Sepsis
29
Q

What is the surgical procedure for acute diverticulitis?

A

Hartmanns Procedure

(Sigmoid colectomy w. formation of end colostomy)

30
Q

What are the complications of diverticulitis?

A
  1. Perforation –> peritonitis / sepsis / death
  2. Diverticular stricture
  3. Fistula (colovesical (bowel n bladder) / colovaginal (bowel n vagina))
  4. Haemorrhage
  5. Abscess
31
Q

How do you manage a haemorrhage of acute diverticulitis? (2 things)

A
  1. Colonoscopic haemostasis
  2. Embolization / colonic resection (if haemostasis not successful)
32
Q

How do you manage a fistula of acute diverticulitis?

A
  1. Colonic resection (surgery)
33
Q

What are the features of an abscess of acute diverticulitis? (3 things)

A
  1. Swinging fever
  2. Leucocytosis
  3. Rectal mass
34
Q

How do you manage an abscess of acute diverticulitis? (2 things)

A
  1. Abx
  2. US / CT guided drainage

#Phase 2.1: Peri Op (24 decks)

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