Diverticular Disease

Question 1

Where do most Extraluminal Duodenal Diverticula present?

Answer 1

Juxtapapillary (within 2cm of Ampulla of Vater)

Question 2

What problem normally arises with Extraluminal diverticula?

Answer 2

Blocked ampulla of vater leading to bile obstruction

Question 3

Condition associated with small bowel diverticula.

Answer 3

Scleroderma: autoimmune attack of connective tissue leading to weakening in luminal wall

Question 4

What is the presentation in a patient with Meckel Diverticulosis?

Answer 4

Abdominal pain of unknown origin, usually very young patients (under 2 yrs.)

Question 5

Name the two types of ectopic tissue that can be found in Meckel Diverticulosis.

Answer 5

Gastric and Pancreatic

Question 6

What is intussusception?

Answer 6

Complication of Meckel’s where intestines can collapse into itself possibly leading to necrosis.

Question 7

What is a Littre’s Hernia?

Answer 7

Diverticulum ending up in an indirect inguinal hernia.

Question 8

What is the major cause and treatment of Gastric or duodenal volvulus?

Answer 8

Cause: laxity in supportive ligaments
Treatment: surgical intervention

Question 9

How does G or D volvulus present?

Answer 9

Chest pain and/or vomiting

Question 10

Common radiograph sign with barium enema that indicates colonic volvulus.

Answer 10

Coffee Bean sign

Question 11

Treatment of colonic volvulus.

Answer 11

1st try non-surgical with endoscopic or barium enema mechanical manipulation.

2nd try surgical

Question 12

Theory of cause of colonic diverticula.

Answer 12

Diminished Fiber

Question 13

Where are colonic diverticula actually pseudodiverticula?

Answer 13

Diverticula have to be congenital and involve the entire GI wall.

Question 14

What are the 3 clinical manifestations of colonic diverticular disease?

Answer 14

1. Painful Diverticular Disease (diagnosis if the other two are ruled out)
2. Diverticulitis
3. Hemorrhage from Diverticular Disease

Question 15

What are the tests and symptoms that diagnose diverticulitis?

Answer 15

• Usually left-sided lower quadrant pain
• nausea
• anorexia
• Fever w/ elevated WBC

Question 16

In patients with diverticulitis, what does a palpable mass in the left lower quadrant mean?

Answer 16

Abscess caused by diverticular formation

Question 17

When would you NOT do a colonoscopy to check diverticulitis?

Answer 17

With an acute attack.

Question 18

How is uncomplicated diverticulitis treated?

Answer 18

• antibiotics
• bowel rest (IV food)
• hydration

Question 19

What is phlegmon?

Answer 19

Non-inflammatory material that accumulates as a complication of diverticulosis.

Question 20

How is complicated diverticulitis treated?

Answer 20

• antibiotics
• bowel rest (IV food)
• hydration
• surgery

Question 21

Which group of people should have surgery after only one episode of diverticulitis?

Answer 21

Immunocompromised

Question 22

What complication of diverticular disease merits an emergent surgical intervention?

Answer 22

Diffuse peritonitis with free air on radiograph

Question 23

What is a problem in diagnosing diverticular hemorrhage?

Answer 23

It is painless and patients may not notice the dark stools.

Question 24

Most common site of ischemic colitis.

Answer 24

Splenic Flexure (watershed area where SMA and IMA form an anastomosis in blood supply)

Question 25

Modality of choice to locate and diagnose ischemic colitis.

Answer 25

Colonoscopy

Question 26

What characteristic on radiograph indicates ischemic colitis?

Answer 26

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

Question 27

Treatment for ischemic colitis.

Answer 27

IV fluids
Bowel rest
Broad spectrum antibiotics

Question 28

What is Stercoral Colitis?

Answer 28

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.

Question 29

What is the mechanism of Stercoral Colitis?

Answer 29

1. A fecalith impacts a narrow area (usually in sigmoid)
2. Impaction leads to colitis and pressure necrosis
3. Increased pressure in colon cuts off blood supply leading to further necrosis and eventual perforation

Question 30

How does Stercoral Colitis present on CT?

Answer 30

As a diverticulum in the rectum. (But the rectum does not get diverticula)

Question 31

Best treatment for Stercoral Colitis

Answer 31

Endoscopic removal

don’t use oral laxatives, manual removal is just for rectum