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Clin Med III Exam 2 > Diverticular Disease > Flashcards

Diverticular Disease Flashcards

1
Q

Diverticulosis

A

presence of diverticula

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2
Q

Diverticulitis

A

inflammation of diverticulum

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3
Q

Epidemiology of diverticulosis

A

increases w/ age

asymptomatic/incidental finding

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4
Q

diverticulosis primarily involves

A

sigmoid colon

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5
Q

Pathophys of diverticulosis

A

develop at weak points in colonic wall where vasa recta penetrate; increase intraluminal pressure predisposes mucosa and submucosa to herniate

low fiber diet —> constipation – intraluminal pressure –> herniation

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6
Q

Presentation of diverticulosis

A

asymptomatic - incidental finding
complications: diverticulitis and bleeding
occasional abdominal cramping, constipation, diarrhea, bloating
normal PE

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7
Q

Dx of diverticulosis

A

none

most found incidentally on colonoscopy/imaging

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8
Q

Management of diverticulosis

A

High fiber diet (20-35 g/day)

Hydration

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9
Q

Role of fiber in diverticulosis

A

increases stool bulk reducing work of colon for BM

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10
Q

What is acute diverticulitis?

A

symptomatic episode corresponding to inflammation of a diverticulum

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11
Q

Pathophys of diverticulitis

A

inspissated debris obstructs the neck of the diverticulum or increased luminal pressure results in erosion of diverticular wall –> inflammation and focal necrosis –> perforation

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12
Q

Macroperforation can cause

A

free air

peritonitis

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13
Q

Types of diverticulitis

A

uncomplicated (most common)

complicated: abscess, fistula, obstruction, perforation

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14
Q

Signs of complicated diverticulitis

A

abscess
fistula
obstruction
perforation

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15
Q

Sx of acute diverticulitis

A

Progressive, steady aching pain (typically LLQ) *
Fever and/or chills
+/- Nausea/vomiting
+/- Change in bowel habits
+/- Irritative urinary symptoms
Pneumaturia or fecaluria if colovesical fistula*
+/- peritoneal signs
LLQ abdominal tenderness (maybe mass)
normal or abnormal BS
rectal exam may reveal mass/tenderness (obtain stool guaiac)
pelvic exam in women

Important to review prior hx of diverticulitis episodes*

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16
Q

Labs for acute diverticulitis

A 
CBC - mid/mod leukocytosis (absent in elderly)
BMP/CMP
\+/- Amylase/Lipase
UA/Urine culture
HCG in women of childbearing age
stool studies if diarrha
Stool for occult blood
17
Q

Dx of acute diverticulitis

A

CT scan of A/P w/ contrast (TEST OF CHOICE)***

  • bowel wall thickening/fat stranding
  • presence of diverticula
  • assess for complications
  • findings may be similar to carcinoma

Abdominal/Chest x-ray (nonspecific) - obstruction/perforation

US

18
Q

Contraindicated in acute diverticulitis

A

Flex Sig/Colonoscopy - risk of perforation

Barium enema- barium could leak through perforation and exacerbate peritonitis

19
Q

Tx for uncomplicated diverticulitis

A

home w/ oral abx
- gram negative/anaerobic coverage x 7-10 days
CL/low residue diet - advance as tolerated to high fiber
close f/u within 2 days!
no repeat imaging needed in those who continue to improve

20
Q

F/u for uncomplicated diverticulitis

A

within 2 days

21
Q

Tx for complicated diverticulitis

A

Admit
NPO, IVF
Analgesics
IV abx- transition to PO to complete a total of 10-14 day coarse
Consult GI, Surgery
Repeat imaging if failure to improve w/i 2-3 days of IV abx

22
Q

Tx coarse for uncomplicated diverticulitis

A

gram negative/anaerobic coverage x 7-10 days

23
Q

Criteria for inpatient management

A
  • CT shows complicated diverticulitis
  • Significant leukocytosis
  • High fever > 102.5°F
  • Severe or increasing abdominal pain
  • Peritoneal signs
  • Significant comorbidities / Immunocompromised
  • Inability to tolerate PO
  • Noncompliance/unreliability/lack of support system
  • Failed outpatient treatment
  • Elderly
24
Q

Surgery criteria for diverticulitis

A
  • perforation w/ peritonitis (absolute indication)
  • condition deteriorates/fails to improve w/i 72 hours of medical therapy
  • complicated
25
Q

Long-term management of diverticulitis

A

high fiber diet once acute episode resolves
colonoscopy 6-8 weeks post diverticulitis (extent of disease & r/o concomitant colon CA or IBD)
elective prophylactic colonic resection in those w/ recurrent diverticulitis??? (discuss)

26
Q

Goal of f/u colonoscopy

A

evaluate extent of diverticular disease

r/o concomitant colon CA or IBD

27
Q

Common cause of OVERT lower GI bleed in adults

A

diverticular bleeding (usually resolves spontaneously)

28
Q

Pathophys of diverticular bleeding

A

penetrating artery draped over the dome of diverticulum is easily exposed to injury and susceptible to bleeding

29
Q

Most common source of diverticular bleed

A

right colon (wider and more exposure of vasa recta)

30
Q

Presentation of diverticular bleeding

A 
PAINLESS HEMATOCHEZIA
\+/- bloat, cramping, fecal urgency
\+/- abnormal VS
abdominal exam usually normal (some are TTP)
blood on rectal exam
31
Q

Dx of diverticular bleed

A

CBC (trend H/H)
BMP - BUN/Cr normal (UGI elevates BUN)
EGD/NG lavage (r/o UGI source)

Once initial resuscitation complete, locate source of bleed – FLEX SIG/COLONOSCOPY, +/- tagged RBC scan/angiography

32
Q

Distinguish between massive UGI and LGI bleed

A

UGI: elevated BUN/Cr
LGI: normal BUN/Cr

33
Q

Tx of diverticular bleed

A

resuscitation/hospitilization - maintain blood volume (transfuse prn)

Tx of bleeding site:

  • endoscopic therapy
  • angiographic therapy
  • +/- surgical intervention
34
Q

Diagnostic test of choice for diverticulitis

A

CT scan of A/P

35
Q

Diverticuliits commonly present w/ pain in what quadrant

A

LLQ

36
Q

Dx test of choice for diverticulitis

A

CT w/ contrast

37
Q

Complicated diverticulitis

A

abscess
obstruction
perforation
fistula

38
Q

Signs of fistula

A

pneumaturia (“bubbles in urine”)

fecaluria

Clin Med III Exam 2 (8 decks)

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