Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3M - General Surgery > Diverticular Disease > Flashcards

Diverticular Disease Flashcards

1
Q

What is a diverticulum?

A

An outpouching of the bowel wall most commonly found in the sigmoid colon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

4 types of manifestations of diverticulum.

A

Diverticulosis = presence of diverticula (asymptomatic and found on imaging)

Diverticular disease (symptomatic)

Diverticulitis (symptomatic + inflammation)

Diverticular bleed (diverticulum erodes into a vessel and causes large volumes of painless bleeds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Epidemiology

A

Diverticulosis = 50% of >50y 70% of >80y

Only 25% of these cases become symptomatic

M>F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathophysiology

A

Aging bowel = becomes weakened

Movement of stool -> increase in luminal pressure

Leads to outpouching of the mucosa through the weaker areas of the bowel.

Bacteria can overgrow in the outpouchings, especially when there is an obstruction.

This can also leads to perforation and peritonitis sepsis in severe cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can happen in chronic cases of diverticular disease?

A

Fistulae can form

Colovesical or colovaginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the weaker areas of the bowel wall?

A

The junctions of the trinagular muscle sheets

Blood vessels penetrate to supply the bowel wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can diverticulitis be classified as?

A

Simple

Complicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain simple diverticulitis

A

Inflammation without abscess or free perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain complicated diverticulitis

A

Abscess or free perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors

A

Age

Low dietary fibre intake

Obesity

Smoking

FH

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical features of diverticular disease

A

Intermittent lower abdo pain that is typically colicky in nature

May be relieved by defecation

Altered bowel habits

Nausea

Flatulence

No systemic features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of acute diverticulitis

A

Acute abdominal pain that is usually sharp in nature and localised in the LIF

Worsened pain on movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examination findings of acute diverticulitis

A

Localised tenderness

Systemic upset

Decreased appetite

Pyrexia

Nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Presentation of perforated diverticulum.

A

Signs of localised peritonism or generalised peritonitis

They might be extremely unwell and it can be fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When might the symptoms of diverticulitis and diverticular disease be masked?

A

In patients that are taking corticosteroids or immunosuppressants.

In patients with a redundant sigmoid colon the pain may be found in the right lower quadrant or suprapubic area.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Explain diverticular abscess

A

Occurs as a consequence of complicated diverticulitis.

17
Q

Management of diverticular abscess.

A

Usually enough to treat conservatively with IV abx if they are < 5 cm.

If the abscess is bigger -> radiological drainage is first line.

Complicated multi-loculated abscesses will need surgical intervention with laparoscopic washout or Hartmann’s procedure.

18
Q

Dx

A

IBD

Bowel cancer

Mesenteric ischaemia

Gynae like ovarian cysts or ectopic pregnancy

Renal stones

19
Q

Laboratory blood tests.

A

FBC

CRP

U&Es

Faecal calprotectin if diagnosis is less clear

In suspected diverticulitis Group and Save as well as a VBG should be done too.

Urine dipstick to exclude urological causes

20
Q

Imaging of suspected diverticulitis

A

CT abdomen-pelvis scan

Colonoscopy should neber be performed in any presenting cases of suspected diverticulitis because of the risk of perforation.

In suspected uncomplicated diverticular disease a flexible sigmoidoscopy can be done.

21
Q

CT findings of diverticulitis

A

Thickening of the colonic wall

Pericolonic fat stranding

Abscesses

Localised air bubbles

Free air

22
Q

How is acute diverticulitis staged?

A

By Hinchey Classification that is based on CT findings

Higher stages = higher morbidity and mortality

23
Q

Explain Hinchey classification system

A

S1 = Phlegmon or diverticulitis with pericolic or mesenteric abscess

S2 = Diverticulitis with walled off pelvic abscess

S3 = Diverticulitis with generalised purulent peritonitis

S4 = Diverticulitis with generalised faecal peritonitis

24
Q

Management of diverticular disease

A

Uncomplicated disease can be managed as outpatient with simple analgesia and sufficient oral fluid intake

Outpatient colonoscopy/sigmoidoscopy can be arranged to exclude any malignancy

25
Q

Management of diverticular bleeds

A

Often conservatively managed.

Significant bleeding might warrant resuscitation and giving blood.

If they fail to respond -> embolisation or surgical resection.

26
Q

When is hospital admission warranted in uncomplicated diverticular disease?

A

Uncontrolled pain

Concerns of dehydration

Significant co-morbidities or immunocompromised

Significant PR bleed

Symptoms persisting for longer than 48 hours despite conservative management

27
Q

Management of acute diverticulitis

A

Conservative usually with abx, IV fluids and analgesia

Youn patients with uncomplicated diverticulitis can have ambulatory management.

Symptoms usually improve within 2-3 days.

Clinical deterioration warrants prompt repeat imaging to check for progression or complication.

28
Q

Indications of surgical management

A

Perforation with faecal peritonitis

Overwhelming sepsis

Diverticular abscess

29
Q

Explain surgical management

A

Hartmann’s procedure which is a sigmoid colectomy with formation of an end colostomy.

Reversal of colostomy may be possible at a later date.

30
Q

Other surgical interventions

A

Resection with primary anastomosis

Loop ileostomy

Laparoscopic peritoneal lavage

31
Q

Complications

A

Recurrence (10-35%)

Diverticular strictures

Fistula formation

32
Q

Explain diverticular strictures

A

Following repeated episodes of acute inflammation.

The bowel goes scarred and fibrotic leading to strictures.

This can lead to large bowel obstruction

33
Q

Explain fistula formation

A

Repeated inflammation can lead to this which warrants surgical intervention.

Colovesical fistula between bowel and bladder

Colovaginal fistula between bowel and vagina

Y3M - General Surgery (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions