Diverticular disease and LGIB

Question 1

4 types of Diverticular disease

Answer 1

I) asymptomatic diverticulosis (most common)

2) painful diverticulosis (contraction of hypertrophied colonic muscle)
3) diverticular bleeding
4) diverticulitis

Question 2

Painfull diverticulosis

Answer 2

luminal narrowing, pencil-thin stools, and pain before defecation
Treat with bulking agents such as psyllium

Question 3

Diverticular bleeding usually originates in the

Answer 3

sigmoid

Question 4

the most common cause of colonic bleeding in the elderly

Answer 4

Diverticular bleeding

angiodysplasia is next on the list and often results in more severe bleeds.

Question 5

Treatment of Diverticular bleeding

Answer 5

Stabilize patient if needed, rule out UGI bleed with NG aspirate or endoscopy

Question 6

BUN/Cr>30:1 suggests what?

Answer 6

UGI bleed

Question 7

Diagnose diverticular bleeding with

Answer 7

colonoscopy or technetium-tagged RBC scan. Angiography works if bleeding is severe or continuous.

Question 8

Diverticulitis signs and symptoms

Answer 8

1) LLQ pain
2) fever
3) high WBC
4) LLQ tenderness-may be localized, rebound tenderness

Question 9

Diagnosis of diverticulitis

Answer 9

CT is most useful in assessing diverticulitis: It may show areas of thickened sigmoid colon or pericolic fluid accumulation.
Avoid GI colonoscopy on any patient with diverticulitis.

Question 10

Treat mild diverticulitis in a patient able to drink and without peritoneal signs

Answer 10

outpatient metronidazole (Gram-neg anaerobic) plus either ciprofloxacin or TMP/SMX (Gram neg aerobic) and close follow-up.

Question 11

Mod to severe diverticulitis

Answer 11

Inpatient parenteral treatment
1)dual-drug therapy such as (best!):
aminoglycoside or ciprofloxacin + clindamycin or metronidazole
2)single-drug therapy such as:
• ticarcillin/clavulanic acid
• imipenem/cilastatin
• cefotetan

Question 12

follow up after treatment of diverticulitis

Answer 12

Perforation from sigmoid colon cancer can present similarly to diverticulitis, so follow up in patients > 50 with a flexsig/colonoscopy after the acute condition resolves.

Question 13

the most frequent congenital GI anomaly

Answer 13

Meckel diverticulum

Question 14

when does meckel diverticulum ulcerate and bleed?

Answer 14

Although < 1/2 of these diverticula have gastric mucosa, only these ulcerate and bleed

Question 15

LGIB in children

Answer 15

Meckel diverticulum in 50%

Question 16

Dx of Meckel diverticulum

Answer 16

They may be seen with the technetium scan (“Meckel’ s scan”). Technetium is taken up by gastric mucosa

Question 17

(Osler-Rendu-Weber)

Answer 17

is the hereditary condition in which there arc multiple AVMs affecting all the organs, including brain. lung, skin, and mucous membranes and the GI tract-especially in the upper GI tract.