Diverticular disease Flashcards
What is diverticulosis?
1 - abnormal small bowel walls
2 - abnormal gastric walls
3 - out-pouching of a hollow tube
4 - out-pouching of intestines through abdominal wall
3 - out-pouching of a hollow tube
- essentially a protrusion of the mucosa through the muscles of the bowel
Re-arrange the order of how diverticulum are formed?
1 - mucosa herniates through weakness in wall, normally where taeniae coli are located
2 - hypersegmentation occurs where peristalsis from 2 opposing segments of colon contract at the same time
3 - increased intraluminal pressure
4 - colonic circular muscle is thickened due to increased elastic tissue between muscle fibres
5 - 2 segments contracting send peristalsis waves towards each other
1 - colonic circular muscle is thickened due to increased elastic tissue between muscle fibres
2 - hypersegmentation occurs where peristalsis from 2 opposing segments of colon contract at the same time
3 - 2 segments contracting send peristalsis waves towards each other
4 - increased intraluminal pressure
5 - mucosa herniates through weakness in wall, normally where taeniae coli are located
In diverticulosis, which layers of the bowel are included in a true diverticulosis?
1 - serosa
2 - mucosa
3 - submucosa
4 - muscle
5 - all of the above
5 - all of the above
In diverticulosis, which layers of the bowel are included in a false (pseudo) diverticulosis?
1 - serosa
2 - mucosa
3 - submucosa
4 - muscle
5 - all of the above
2 - mucosa
3 - submucosa
- these are the most common type of diverticulosis in colon
What determines diverticulosis from diverticular disease?
1 - inflammation
2 - blood in stool
3 - symptoms associated with diverticula
4 - weight loss
3 - symptoms associated with diverticulosis
What common gastrointestinal symptom is often associated with diverticular disease?
1 - diarrhoea
2 - constipation
3 - blood in stool
4 - weight loss
2 - constipation
- associated with low dietary fibre
- diverticular disease is the most significant risk factor for constipation
Is diverticular disease more common in the developed western world or the rest of the world?
- western world, due to low dietary fibre and processed foods
What is the the most common location in the bowel for diverticular disease?
1 - ileum
2 - ascending colon
3 - sigmoid colon
4 - descending colon
3 - sigmoid colon
- has highest intra-luminal pressure
What age does 50% of diverticular disease occur in?
1 - >20 y/o
2 - >50 y/o
3 - >70 y/o
4 - >90 y/o
2 - >50 y/o
- can be reported as >60 y/o
Diverticular disease is an out-pouching of the mucosal pouches beyond the musculature wall of the bowel with symptoms associated. What % of patients with diverticular disease DO present with symptoms?
1 - 100%
2 - 90%
3 - 50%
4 - 10%
4 - 10%
Diverticular disease is an out-pouching of the mucosal pouches beyond the musculature wall of the bowel with symptoms associated. What is diverticulitis?
1 - inflammation of the diverticula
2 - infection of the diverticula
3 - pus forming diverticula
4 - blocked diverticula
1 - inflammation of the diverticulosis
Diverticular disease is an out-pouching of the mucosal pouches beyond the musculature wall of the bowel with symptoms associated. What is diverticular colitis?
1 - inflammation of the diverticula
2 - infection of the diverticula
3 - cresenteric inflammation on folds of an area of diverticulosis
4 - blocked diverticula
3 - cresenteric inflammation on folds of an area of diverticulosis
What is the most common cause of diverticulitis?
1 - TB
2 - stool blocking the diverticula
3 - E.coli infection
4 - fistula formation
2 - stool blocking the diverticula
How is diverticular disease most commonly identified?
1 - following CT scans
2 - incidental finding
3 - during colonoscopy
4 - X-ray
2 - incidental finding
- especially as only 10% of patients present with symptoms
If a patient presents with an acute abdomen that is due to acute diverticulitis, where is the most common location for pain?
1 - LIF
2 - RIF
3 - parasternal border
4 - left paracolic gutter
1 - LIF
- but can be anywhere, but most common is LIF as most common in sigmoid colon
- patient is systematically unwell
If a patient presents with an acute abdomen due to a perforated diverticular. Which of the following is NOT a common presentation of this?
1 - nausea and vomiting.
2 - fever.
3 - abdominal tenderness
4 - rebound tenderness
5 - constipation
6 - mass in LIF
6 - mass in LIF
- diverticular can lead to a mass, but most unlikley
In a patient with diverticular disease, is a diverticular bleed dangerous?
- no
- usually self limiting
Stool blocking the diverticula is the most common cause of diverticulitis. Which of the following does this NOT tend to lead to?
1 - fistula to adjacent organs
2 - bowel necrosis and perforation
3 - bowel obstruction
4 - abscess formation
5 - haemorrhage
5 - haemorrhage
- obstructions caused by stricture are very difficult to distinguish from malignancy
Which of the following is NOT a common presentation of acute diverticulitis?
1 - nausea and vomiting
2 - blood in urine
3 - odd bowel habits
4 - sign of infection or sepsis
5 - urinary habits change/dysuria
6 - peritonitis
2 - blood in urine
What is the conservative medical management of a patient presenting with uncomplicated symptomatic disease due to diverticulitis?
1 - antibiotics
2 - fluids
3 - soluble/insoluble diet
4 - analgesia and antibiotics
3 - soluble/insoluble diet
Which of the following is NOT a common differential of diverticulitis?
1 - IBS
2 - colorectal cancer
3 - acute appendicitis
4 - gastritis
5 - infectious/ischaemic colitis
6 - ovarian/uterus issues
7 - cystitis (bladder inflammation)
8 - nephrolithiasis (kidney stones)
4 - gastritis
What 2 blood markers are commonly used that can help identify if a patient has diverticulitis?
1 - WBC and CRP
2 - WBC and RBC
3 - CRP and RBC
4 - CRP and eosinophils
1 - WBC and CRP
Although preferentially used for patients who are older, what is commonly the first imaging modality used to try and diagnose diverticulitis?
1 - ultrasound
2 - MRI
3 - CT scan
4 - X-ray
3 - CT scan
- CT colongraphy is best
There are 4 stages of diverticulitis, called the Hinchey classification used to describe perforations of the colon due to diverticulitis. Of the 4 stages which can be treated medically with just antibiotics alone?
1 - stage 1
2 - stage 2
3 - stage 3
4 - stage 4
1 - stage 1
What is an abscess?
1 - sac filled with fluid or other material lined by epithelial cells
2 - fluid filled area lined by granulation tissue
3 - pus filled collection that can be lined by various cell types
4 - blind ended tract
3 - pus filled collection that can be lined by various cell types
There are 4 stages of diverticulitis, called the Hinchey classification used to describe perforations of the colon due to diverticulitis. What is the common cause for stage 1 diverticulitis to present?
1 - stricture forms
2 - pericolic or mesenteric abscess forms
3 - fistula forms
4 - spasm of large bowels
2 - pericolic or mesenteric abscess forms
- pericolic refers to surrounding of the colon
- <4cm in size
- mortality is <5%
There are 4 stages of diverticulitis, called the Hinchey classification used to describe perforations of the colon due to diverticulitis. What is the common cause for stage 2 diverticulitis to present?
1 - stricture forms
2 - small pericolic or mesenteric abscess forms
3 - fistula forms
4 - large pelvic abscess
4 - large pelvic abscess
- mortality is <5%
There are 4 stages of diverticulitis, called the Hinchey classification used to describe perforations of the colon due to diverticulitis. Of the 4 stages which can be treated medically with antibiotics and percutaneously drainage of the abscess?
1 - stage 1
2 - stage 2
3 - stage 3
4 - stage 4
2 - stage 2
- drainage may require laparoscopy
In a patient with stage 1 or 2 diverticulitis, which is associated , called the Hinchey classification, what is the best way to diagnose the patient?
1 - colonoscopy
2 - X-ray
3 - sigmoidoscopy
4 - CT with contrast
4 - CT with contrast
- generally barium enema
In a patient who is being treated medically with a conservative approach for a stage 1 or 2 acute presentation of diverticulitis, which 2 antibiotics are generally prescribed?
1 - Doxycycline
2 - Clarithromycin
3 - Ciprofloxacin
4 - Metronidazole
3 - Ciprofloxacin
4 - Metronidazole
Patients with signs of systemic upset (fevers, tachycardia), significant abdominal pain or co-morbidity require bowel rest, intravenous fluids and intravenous antibiotic therapy. Why does the bowel require rest?
1 - allows recovery
2 - antibiotics are most affective during rest
3 - immunity is better at rest
4 - inflammation can be worse with rest
1 - allows recovery
- antibiotics and fluid will relieve workload on colon allowing some recovery and even clearing of symptoms. Food can prolong and exacerbate symptoms
There are 4 stages of diverticulitis, called the Hinchey classification used to describe perforations of the colon due to diverticulitis. What is the common cause for stage 3 diverticulitis to present?
1 - rupture with faecal peritonitis
2 - small pericolic or mesenteric abscess forms
3 - small perforation causing gaseous and purulent peritonitis
4 - large pelvic abscess
3 - small perforation causing gaseous and purulent peritonitis
- mortality is 13%
There are 4 stages of diverticulitis, called the Hinchey classification used to describe perforations of the colon due to diverticulitis. The diverticulum can perforate from a pin hole size to >1cm. This can lead to gaseous and faecal contents causing peritonitis.Which 2 imaging modalities can detect this?
1 - ultrasound
2 - CT scan
3 - X-ray
4 - MRI
2 - CT scan
3 - X-ray
- scan must be erect
- we can see pneumoperitoneum
How can stage 3 small perforations be managed?
1 - bowel rest
2 - antibiotics
3 - percutaneous drain
4 - all of the above
4 - all of the above
- large stage 4 perforations need urgent surgery though
There are 4 stages of diverticulitis, called the Hinchey classification used to describe perforations of the colon due to diverticulitis. What is the common cause for stage 4 diverticulitis to present?
1 - rupture with faecal peritonitis
2 - small pericolic or mesenteric abscess forms
3 - small perforation causing gaseous and purulent peritonitis
4 - large pelvic abscess
1 - rupture with faecal peritonitis
- mortality is 43%
There are 4 stages of diverticulitis, called the Hinchey classification used to describe perforations of the colon due to diverticulitis. Of the 4 stages which needs to be treated surgically?
1 - stage 1
2 - stage 2
3 - stage 3
4 - stage 4
3 - stage 3
4 - stage 4
The Hartmann’s procedure is often used in a patient with acute diverticulitis at stage 3 or 4. What is this procedure?
1 - removal of whole colon and colostomy
2 - removal of whole sigmoid colon and colostomy
3 - removal of part of colon affected and colostomy
4 - removal of rectum and colostomy
3 - removal of part of colon affected and colostomy
- can be reversed at a later stage and turned into an anastomosis
Why are sigmoidoscopy and colonoscopy not performed during acute diverticulitis presentation?
1 - can be painful
2 - can cause infection
3 - increased risk of perforation
4 - cannot see anything
3 - increased risk of perforation
In patients who are discharged following surgical treatment, what % are likely to have a reoccurrence?
1 - 1%
2 - 15%
3 - 25%
4 - 33%
4 - 33%
- of this 33% will have 1 further occurrence
Which of the following is NOT a differential for diverticulitis?
1 - IBS
2 - Colorectal cancer
3 - Toxic mega colon
4 - Acute appendicitis
5 - Infection/Ischaemic colitis
6 - Ovarian abscess/cyst
7 - Cystitis
8 - Nephrolithiasis
3 - Toxic mega colon
Chronic diverticular occurs in patients with diverticular disease who have multiple acute presentations of their diverticular. How common is this?
1 - 0.1-0.2%
2 - 1-2%
3 - 10-20%
4 - 20-40%
2 - 1-2%
What are the 2 main problems that patients with chronic diverticular (patients with diverticular disease who have multiple acute presentations of their diverticular)?
1 - colorectal cancer
2 - diverticular fistulae
3 - meta-toxic colon
4 - chronic strictures
2 - diverticular fistulae
4 - chronic strictures
- both can lead to a larger bowel obstruction
The 2 main problems that patients with chronic diverticular (patients with diverticular disease who have multiple acute presentations of their diverticular) have are diverticular fistulae and chronic strictures. Which of the following are the most likely form of fistula to form?
1 - colo-vesicle
2 - colo-colonic
3 - colo-uterine
4 - colo-vaginal
1 - colo-vesicle
- cause UTIs, pneumaturia (air in urine) and stool in urine
4 - colo-vaginal
- common in women who have had hysterectomy
- UTI and faecal discharge in vagina
In a patient who has developed a diverticular fistula due to their chronic diverticular, which of the following is NOT a common part of patients management?
1 - conservative (antibiotics and fluids)
2 - Hartman’s procedure
3 - defunctioning stoma
4 - complete colectomy
4 - complete colectomy
In a patient who has developed chronic diverticular and decides to have elective surgery, what % will have recurrent persistent symptoms after?
1 - 0.25%
2 - 2.5%
3 - 25%
4 - 50%
3 - 25%
- stomas are high in elderly or complex surgeries
In a patient who has developed chronic diverticular, following treatment, what condition are the following symptoms most commonly associated with?
1 - colorectal cancer
2 - IBS
3 - IBD
4 - appendicitis
2 - IBS
