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year 5 - GIT surgery > diverticular disease > Flashcards

diverticular disease Flashcards

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1
Q

what is the difference between a true diverticulum and a pseudodiverticulum ?

A

true diverticulum : composed of all layers of the intestines
pseudodiverticulum : lacks a muscularis ( mucosa and submucosa only)

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2
Q

what are the different sites associated with diverticular disease?

A

predominant right sided in south-asians
predominant on the left side in western populations

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3
Q

which part of the colon is affected by diverticular disease ?

A

the sigmoid colon ( smallest diameter )
followed by the descending colon

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4
Q

what is the presentation of pain in diverticular disease ?

A

intermittent left iliac fossa pain ( if complicated ) but mainly asymptomatic

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5
Q

what are the different causes of symptoms in diverticular disease ?

A

physiologic changes in colonic motility

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6
Q

where does the diverticulum appear in relation to the taenia of the colon ?

A

between the middle diverticula and the lateral diverticula

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7
Q

where do diverticula not form ?

A

they do not form on the antimesenteric side of the colon

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8
Q

what is the management for uncomplicated diverticular disease ?

A

high fibre diet
muscle relaxants may be used

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9
Q

muscular thickening characteristic to which part of the colon ?

A

the sigmoid

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10
Q

what type of diet is more associated with diverticular disease ?

A

western diet

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11
Q

what are the two presentations associated with symptomatic diverticular disease ?

A

diverticulitis
or
bleeding

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12
Q

perforation of diverticulitis is better called ?

A

peridiverticulitis

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13
Q

what are the different types of diverticulitis ?

A

non-inflammatory
acute
chronic
complex

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14
Q

when can non-inflammatory diverticulitis be diagnosed ?

A

postoperative diagnosis probably due to a microabscess that healed

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15
Q

what is the presentation of acute diverticulitis ?

A

pain in the lower abdomen especially in the left iliac fossa
( tenderness and guarding in LIF )
fever altered bowel habits

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16
Q

what makes simplee acute diverticulitis different from complicated diverticulitis ?

A

simple - limited to the colonic wall with systemic signs of fever and leukocytosis
complicated - with perforation, added signs of tachycardia and hypotension

17
Q

what classification is used for perforations due to acute diverticulitis ?

A

hinchey classification

18
Q

what might mild diverticulosis mimic ?

A

IBS
as a result of increased intra-luminal pressure

19
Q

what are the complications associated with diverticular disease ?

A

diverticulitis
perforation
abscess
peritonitis
intestinal obstruction
fistula formation

20
Q

which presentation of diverticulitis that shows no signs of fever or leucocytosis ?

A

chronic atypical

21
Q

which presentation of diverticulitis presents with tachycardia and hypotension ?

A

acute complicated

22
Q

what is the main investigation for acute diverticulitis ?

A

CT

23
Q

what is the main investigation for chronic diverticulitis ?

A

colonoscopy and contrast studies
then CT for differential diagnosis

24
Q

what are the differential diagnosis for acute diverticulitis ?

A

pelvic inflammatory disease
appendicitis
crohn’s colitis
ischaemic colitis
perforated colonic carcinoma
pyelonephritis

25
Q

what are the different grades for hinchey classification ?

A

grade 1 - pericolic or mesenteric abscess
grade 2- pelvic or retroperitoneal abscess
grade 3 - generalized purulent peritonitis
grade 4 - faecal peritonitis

26
Q

mngmnt for hinchey grade 1 and 2 hinchey ?

A

IV ab and radiological ( CT or US percutaneous drainage ) drainage of abscess

27
Q

what is the management for grade 2 and 3 hinchey ?

A

resuscitation
then surgical exploration

28
Q

what is the surgical procedure for type 3 and 4 hinchey ?

A

hartmann or mikulicz

29
Q

what is the safest surgery for emergency situations ?

A

hartmann’s procedure

30
Q

when is laparoscopic washout used ?

A

for perforated diverticular disease to avoid performing hartmann

31
Q

when should the patient follow up after resolution of diverticular disease ?

A

6 weeks

year 5 - GIT surgery (8 decks)

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