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Summer FDTN Exam 5 > Diverticular disease > Flashcards

Diverticular disease Flashcards

1
Q

What are diverticula

A

multiple sac like protrusions of the colon wall

Diverticulum is single

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2
Q

-osis vs -itis is

A

Diverticulosis: presence of diverticula
Diverticulitis: inflammation of a diverticulum

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3
Q

Where is diverticulosis and where/how does it present

A

MC in sigmoid colon (decreased diameter, increased pressure)
Prevalence increases with age
Usually discovered incidentally bc pts are ASx

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4
Q

What is the pathophys of diverticulosis

A

Develop at weak points in colon wall where vasa recta penetrate
Increased pressure predisposes mucosa to herniation
Low fiber diet= constipation= increased intraluminal pressure= herniation

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5
Q

What are clinical manifestations of diverticulosis

A

ASx
Occasional abdominal cramping, constipation, diarrhea, and bloating
but PE is totally normal

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6
Q

What are complications of diverticulosis

A

Diverticulitis (simple MC, or complicated) and bleeding

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7
Q

How do you diagnose diverticulosis

A

No labs or imaging needed!

MC discovered incidentally on colonoscopy or imaging

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8
Q

How do you manage ASx diverticulosis

A

**High Fiber Diet! 20-35g/d to increase stool bulk and reduce work of colon for a BM
Adequate hydration
(no longer have to avoid seed or nuts)

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9
Q

What is acute diverticulitis

A

Acute symptomatic episode corresponding to inflammation of diverticulum

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10
Q

What is the pathophys of acute diverticulitis

A

thick debris obstructs neck of diverticulum OR high pressure causes erosion of diverticular wall= inflammation and focal necrosis= perforation

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11
Q

What are the types of perforation

A

Micro and Macro

Macroperforation is a medical emergency 2/2 free are or peritonitis

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12
Q

What are the types of acute diverticulitis

A

Uncomplicated (*MC)

Complicated: abscess, fistula, obstruction, or perforation

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13
Q

What are clinical manifestations of acute diverticulitis

A

Progressive steady aching in LLQ (+/- mass)
Fever (low grade)
Rectal mass or ttp (get a guaiac)
+/- N/V, bowel habit changes, irritative urinary Sx, peritoneal signs (rebound, guarding)
Do a pelvic on women

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14
Q

A colovesical fistula can lead to

A

pneumaturia (gas in urine) or fecaluria

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15
Q

What is rigidity

A

involuntary hardening in response to an infection

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16
Q

What diagnostics should you get if you suspect acute diverticulitis

A 
CBC: leukocytosis (absent in old ppl) 
BMP/CMP, Amylase Lipase 
UA/Urine culture 
Urine HCG in women 
Stool studies if it's diarrhea 
Stool for occult blood (DRE w/ guaiac test) 
**CT A/P WITH contrast** 
Can get abd/chest XR to assess for obstruction/perforation, but it is nonspecific 
US
17
Q

What will a CT w/ show in acute diverticulitis

A

Local bowel wall thickening/fat stranding
Presence of colonic divertcula
(hard to tell this from carcinoma)

18
Q

What diagnostics are contraindicated with suspected acute diverticulitis

A

Flex Sig, Colonoscopy: risk of perforation

Barium enema: barium can leak through perforation and exacerbate peritonitis

19
Q

How do you treat Uncomplicated acute diverticulitis

A

Send home w/ oral antibiotics
Close follow up, 2 days
Low residue diet (advance to high fiber diet as tolerated)
Do not need repeat imaging if patient is improving

20
Q

How do you manage complicated diverticulitis (or any inpt management)

A

Admit
NPO, IV fluids
IV antibiotics (transition to PO for 10-14d total)
Analgesics
Consult GI and surgery
Repeat imaging if no improvement in 2-3 days of IV Abx

21
Q

What Abx are Rx to uncomplicated acute diverticulitis

A

Gram negative/Anaerobic coverage x 7-10 days

*Metronidazole 500mg PO TID + Ciprofloxacin 500mg PO BID

22
Q

What would warrant inpt Tx of acute diverticulitis

A 
Complicated 
Significant leukocytosis 
Fever >102.5 
Severe/increasing pain 
Peritoneal signs 
Immunocompromised 
Can't tolerate PO 
Noncompliant 
Failed outpt Tx 
Elderly
23
Q

Empiric Tx for high risk intra-abdominal infections are

A

Ertapenem or Zosyn (piper-Tazo) –or–

Cefazolin+Metronidazole

24
Q

When does acute diverticulitis warrant surgical referral

A

Perforation with peritonitis
Condition deteriorates w/in 72 hours
Complicated (abscess, fistula, obstruction, perforation)

25
Q

Criteria for acute diverticulitis discharge are

A

Vitals normal
Severe abdominal pain and leukocytosis resolve
Tolerate PO

26
Q

Long term management of acute diverticulitis is

A

Once acute episodes resolve, high fiber diet*
Colonoscopy s/p 6-8 weeks resolution to eval extent of dz and exclude colon cancer/IBD (if they haven’t had one in a long time)
+/- prophylactic colonic resection (individualize)

27
Q

What is a common cause of OVERT lower GI bleeding

A

Diverticular bleeding!
overt means you can see it.
Usually resolves spontaneously

28
Q

What is the pathophys of diverticular bleeding

A

Penetrating artery overlies dome of diverticulum= susceptible to bleeding
Right colon is MC source of bleed 2/2 wider diverticulum w/ more vasa recta exposure

29
Q

What are manifestations of diverticular bleeding

A

**Painless hematochezia
Abd exam usually normal (except ttp)
Blood on rectal exam
+/- bloating, cramping, fecal urgency, abn vitals

30
Q

What diagnostics should you get in diverticular bleeding

A

CBC (trend H&H)
BMP (BUN/Cr not elevated)
END/NG lavage
Flex sig to locate bleeding AFTER initial resuscitation

31
Q

How can you tell upper from lower GI bleed on a BMP

A

BUN:Cr is elevated in an upper GI bleed, and notmal in a lower GI bleed

32
Q

How do you manage diverticular bleeding

A

Resuscitation, hospitalization (maintain blood volume, transfuse prn)
Tx bleeding site w/ Endoscopic therapy, Angiographic therapy, or surgical intervention (if needed)

Summer FDTN Exam 5 (12 decks)

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