Diverticular disease, polyposis & AVM Flashcards
what is the difference between diverticulosis and diverticulitis
diverticulosis - presence of diverticula w/o inflammation
What is the difference between true and false diverticula?
false - mucosa and musculoaris mucosa only, herniated through serosa
true - all layers, usually congenital
What is the most common site of diverticular disease?
sigmoid colon
What kind of diet decreases incidence of diverticulosis
high-fiber
What is a complication that can occur in diverticulosis?
infection from:
- perforation (macroscopic/microscopic)
- contamination, inflammation, infection
What is the clinical presentation of diverticulosis? (Sx, radiograph, CT) What is contraindicated in the case of perforation?
Left-sided abd pain
radiographs detecting free abdominal air
CT = pericolic inflammation (phlegmon, abscess)
Contrast enema contraindicated in perforation
What are the CT findings of Uncomplicated diverticulitis?
- pericolic soft tissue stranding
- colonic wall thickening
- Phlegmon
What is the advised treatment of uncomplicated diverticulitis in immunosuppressed pts?
colectomy after a signel episode of document diverticulitis
What are different types of Complicated Diverticulitis?
Diverticulitis w:
- abscess
- obstruction
- diffuse peritonitis (free perforation)
- fistulas (colovesical, colovaginal, coloenteric, colocutaneous[rare])
What is the staging system of Complicated Diverticulitis? What are the 4 stages?
Hinchey staging system:
Stage 1: inflammation w pericolic abscess
Stage 2: inflammation w a retroperitoneal/pelvic abscess
Stage 3: purulent peritonitis
Stage 4: fecal peritonitis
What is Tx for incomplete obstructive Sx of Diverticulosis?
- respond to fluid resuscitation
- nasogastric suction
- low volume water or Gastrografin enemas
what is the most significant lower GI bleed? what is Tx?
erosion of peridiverticular arteriole
Tx: epinephrine injection or cautery
What are characteristics of Right-Sided Diverticula?
- cecum + ascending colon infrequently involved
- contains all layers of bowel wall
3 congenital - more common in younger/asian pts
- asymptomatic
What do a majority of colorectal carcinomas evolve from?
adenomatous polyps
What are the four types of colorectal polyps?
- neoplastic (tubular, villous, tubulovillous, serrated)
- Hyperplastic
- Hamartomatous (juvenile, Peutz-Jeghers, Cronkite-Canada)
- Inflammatory (pseudo, benign lymphoid)
What are the most to least cancerous types of neoplastic polyp?
villous > tubulovillous > tubular
What are characteristics of hyperplastic polyps?
extremely common
shows histologic hyperplasia W/O dysplasia
What are general characteristics of Hamartomatous polyps?
- NOT premalignant
2. bleeding = common symptom
What are characteristics of juvenile polyposis? (inheritance, Sx, progression)
- autosomal dominant
- pts develop Hundreds of polyps
- Lesions may degenerate into adenomas - carcinoma
What is Peutz-Jeghers syndrome? Sx, progression
polyposis of small intestine, colon, rectum
Melanin spots on buccal mucosa and lips
not significant risk for malignant degeneration
What are Sx of Cronkite-Canada syndrome
- GI polyposis
- Alopecia
- cutaneous pigmentation
- atrophy of fingernails/toenails
- Primary Sx = Diarrhea
- vomiting, malabsorption, protein-losing enteropathy
What is Cowden’s syndrome (inheritance, Sx) and what are associated diseases?
- Autosomal dominant
- Hamartomas of all 3 embryonal cell layers
- facial trichilemmomas
- a/w breast cancer + thyroid disease
What context do inflammatory polyps usually present?
IBD,
amebic colitis,
ischemic colitis
schistosomal colitis
What is the microscopic appearance of inflammatory polyps?
islands of normal, regenerating mucosa surrounded by areas of mucosal loss
What are characteristics (inheritance, genetic mutation, Sx, progression) of Familial Adenomatous Polyposis (FAP)?
- Autosomal dominant condition
- Mutation of APC gene on Chromosome 5q
- Sx = hundred to thousands of adenomatous polyps after puberty
- risk of CRCancer approaches 100% by age 50
What other diseases is FAP associated with?
- congenital hypertrophy retinal pigmented epithelium
- Desmoid tumors
- Epidermoid cysts
- Gardner’s syndrome (Mandibular osteomas)
- Turcot’s syndrome (CNS tumors)
Where is the most common location of Angiodysplasia (aberrant blood vessels)
GI tract
Cecum - 37 percent of GI locations
