Diverticular Disease Flashcards
Where do most Extraluminal Duodenal Diverticula present?
Juxtapapillary (within 2cm of Ampulla of Vater)
What problem normally arises with Extraluminal diverticula?
Blocked ampulla of vater leading to bile obstruction
Condition associated with small bowel diverticula.
Scleroderma: autoimmune attack of connective tissue leading to weakening in luminal wall
What is the presentation in a patient with Meckel Diverticulosis?
Abdominal pain of unknown origin, usually very young patients (under 2 yrs.)
Name the two types of ectopic tissue that can be found in Meckel Diverticulosis.
Gastric and Pancreatic
What is intussusception?
Complication of Meckel’s where intestines can collapse into itself possibly leading to necrosis.
What is a Littre’s Hernia?
Diverticulum ending up in an indirect inguinal hernia.
What is the major cause and treatment of Gastric or duodenal volvulus?
Cause: laxity in supportive ligaments
Treatment: surgical intervention
How does G or D volvulus present?
Chest pain and/or vomiting
Common radiograph sign with barium enema that indicates colonic volvulus.
Coffee Bean sign
Treatment of colonic volvulus.
1st try non-surgical with endoscopic or barium enema mechanical manipulation.
2nd try surgical
Theory of cause of colonic diverticula.
Diminished Fiber
Where are colonic diverticula actually pseudodiverticula?
Diverticula have to be congenital and involve the entire GI wall.
What are the 3 clinical manifestations of colonic diverticular disease?
- Painful Diverticular Disease (diagnosis if the other two are ruled out)
- Diverticulitis
- Hemorrhage from Diverticular Disease
What are the tests and symptoms that diagnose diverticulitis?
- Usually left-sided lower quadrant pain
- nausea
- anorexia
- Fever w/ elevated WBC
In patients with diverticulitis, what does a palpable mass in the left lower quadrant mean?
Abscess caused by diverticular formation
When would you NOT do a colonoscopy to check diverticulitis?
With an acute attack.
How is uncomplicated diverticulitis treated?
- antibiotics
- bowel rest (IV food)
- hydration
What is phlegmon?
Non-inflammatory material that accumulates as a complication of diverticulosis.
How is complicated diverticulitis treated?
- antibiotics
- bowel rest (IV food)
- hydration
- surgery
Which group of people should have surgery after only one episode of diverticulitis?
Immunocompromised
What complication of diverticular disease merits an emergent surgical intervention?
Diffuse peritonitis with free air on radiograph
What is a problem in diagnosing diverticular hemorrhage?
It is painless and patients may not notice the dark stools.
Most common site of ischemic colitis.
Splenic Flexure (watershed area where SMA and IMA form an anastomosis in blood supply)
Modality of choice to locate and diagnose ischemic colitis.
Colonoscopy
What characteristic on radiograph indicates ischemic colitis?
Thumb printing on barium enema usually in the region of the splenic flexure.
Occurs with negative stool culture, absent C. diff toxin, negative splanchnic angiogram
Treatment for ischemic colitis.
IV fluids
Bowel rest
Broad spectrum antibiotics
What is Stercoral Colitis?
Patients present with abdominal pain resulting from colonic obstruction. Radiograph reveals inflamed colon and endoscopy reveals ulceration. Progression leads to necrosis and perforation of the colon.
What is the mechanism of Stercoral Colitis?
- A fecalith impacts a narrow area (usually in sigmoid)
- Impaction leads to colitis and pressure necrosis
- Increased pressure in colon cuts off blood supply leading to further necrosis and eventual perforation
How does Stercoral Colitis present on CT?
As a diverticulum in the rectum. (But the rectum does not get diverticula)
Best treatment for Stercoral Colitis
Endoscopic removal
don’t use oral laxatives, manual removal is just for rectum
