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X Clin Med III Exam 2 > Diverticular Disease > Flashcards

Diverticular Disease Flashcards

1
Q

When do you see more diverticulosis?

A

Increases with age (over 60 see more)

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2
Q

Predominant sight of diverticulosis

A

Sigmoid colon (smallest diameter and largest intraluminal pressure)

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3
Q

Most common presentation of diverticulosis

A

Asymptomatic and discovered incidentally

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4
Q

Why does diverticulosis occur?

A

Develops at weak point in the colonic wall where vasa recta penetrate
Increased pressure predisposes mucosa and submucosa to herniate
Also a low fiber diet–constipation–intraluminal pressure–herniation (progression maybe)

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5
Q

Other sxs of diverticulosis

A

Occasional abdominal cramping, constipation, diarrhea, bloating
Normal exam

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6
Q

Diagnostics for diverticulosis

A

No labs or imaging needed b/c usually found incidentally

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7
Q

Tx for asymptomatic diverticulosis

A

High fiber diet (20-35 g/day)-increase stool bulk
Adequate hydration
Don’t recommend avoidance of seeds/nuts

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8
Q

Why does diverticulitis occur?

A

Inspissated debris obstructs neck of diverticulum or increased luminal pressure result sin erosion of diverticular wall leading to inflammation and necrosis and then a perf (free air and peritonitis)

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9
Q

Most common type of diverticulitis

A

Uncomplicated

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10
Q

Types of complicated diverticulitis

A

Abscess, fistula, obstruction or perforation

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11
Q

Presentation of acute diverticulitis

A

Progressive, steady aching pain usually LLQ
Fever/chills
Maybe n/v, change in bowel habits, irritative urinary sxs
Low fever, maybe peritoneal signs

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12
Q

What can be seen with a colovesical fistula with diverticulitis?

A

Pneumaturia or fecaluria

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13
Q

Exam for diverticulitis

A

LLQ abd tenderness
Rectal exam may have mass or tenderness (stool guaiac)
Pelvic exam for women

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14
Q

Labs for diverticulitis

A

CBC-moderate leukocytosis (maybe not in elderly)
BMP/CMP (maybe amylase or lipase)
UA/culture and urine HCG
Stool studies if diarrhea

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15
Q

Test of choice for acute diverticulitis

A

CT scan of A/P with contrast (see localized bowel wall thickening and fat stranding, presence of colonic diverticula)

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16
Q

Other options for imaging for acute diverticulitis

A

Abd/CXR (for obstruction or perf)

U/s

17
Q

Diagnostics contraindicated in diverticulitis

A 
Flex sig/colonoscopy (risk of perf)
Barium enema (can leak through perf and exacerbate peritonitis)
18
Q

General tx for uncomplicated diverticulitis

A

Usually give oral abx
Clear liquid/low residue diet
Close f/u in 2 days

19
Q

General tx for complicated diverticulitis

A

Admit

NPO, IVF, IV abx

20
Q

Outpatient tx of uncomplicated diverticulitis

A

Gram negative/anaerobic coverage x 7-10 days
CL/low residue diet and advance as tolerated to high fiber diet (resolve acute episode)
Maybe repeat imaging
F/u in 2 days!!!

21
Q

When is inpatient management done for diverticulitis?

A 
Complicated on CT
Significant leuokcytosis
>102.5 F
Severe of increasing abd pain
Peritoneal signs
Comorbidities/immunocompromised
Can't tolerate PO
Noncompliance/unreliability/lack of support
Failed outpt tx
Elderly
22
Q

Inpatient tx of diverticulitis

A

NPO or CL depending on severity
IVF, analgesic
IV abx (transition to oral for a 10-14 day course)

23
Q

When is repeat imaging done with an inpatient diverticulitis?

A

Failure to improve within 2-3 days of IV abx therapy

24
Q

When to refer to surgery with acute diverticulitis?

A

Perforation with peritonitis
Condition deteriorates/fails to improve within 72 hrs of medical therapy
Complicated

25
Q

Long term management of diverticulitis

A

High fiber diet when acute episode resolves
Colonoscopy 6-8 wks after resolution for some ppl (evaluate extent of disease or exclude concomitant colon cancer of IBD)

26
Q

Common cause of overt lower GI bleeding in adults

A

Diverticular bleeding

27
Q

Tx for diverticular bleeding?

A

Usually resolves spontaneously

28
Q

Why does diverticular bleeding occur?

A

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

29
Q

Where is diverticular bleeding seen the most?

A

Right colon (b/c diverticulum are wider and have more exposure of vasa recta)

30
Q

Presentation of diverticular bleeding

A

Painless hematochezia
Maybe bloating, cramping, fecal urgency, abd vital signs pending severity
Usually normal exam but maybe TTP

31
Q

Diagnostics for diverticular bleed

A

CBC (trend H/H)

BMP (BUN/Cr should not be elevated in pts with colonic diverticular bleed but upper GI will be)

32
Q

How to locate source of bleeding for diverticular bleed

A

Flex sig/colonoscopy and maybe tagged RBC scan/angiography (after initial resuscitation)

33
Q

Management of diverticular bleeding

A

Resuscitation/hospitilization and maintain BV (transfuse)

Tx of bleeding site: endoscopic therapy, angiographic therapy and maybe surgical intervention

X Clin Med III Exam 2 (9 decks)

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