Diverticuli

Question 1

What is a diverticulum?


Answer 1

A blind pouch leading off of the alimentary tract that communicates with the lumen of the tract


Question 2

What is the difference between a true diverticulum and a false diverticulum?


Answer 2

True diverticulum contains three layers (mucosa, submucosa, serosa), whereas false diverticulum contains only two layers (mucosa, submucosa)


Question 3

A 62-year-old man with known diverticulosis has a screening colonoscopy. Where would you most expect to observe a diverticulum?


Answer 3

The sigmoid colon


Question 4

What is the etiology of diverticulosis?


Answer 4

Increased intraluminal pressure combined with focal weakness of the colonic wall


Question 5

A patient is concerned about her likelihood of developing diverticulosis. What dietary change do you suggest?


Answer 5

Increase the amount of dietary fiber


Question 6

A 57-year-old woman presents with vague abdominal discomfort and painless rectal bleeding. What is the most likely diagnosis?


Answer 6

Diverticulosis


Question 7

Diverticulitis classically causes pain in what region of the abdomen?


Answer 7

The left lower quadrant (most commonly occurs in the sigmoid colon)


Question 8

A man with fevers and rectal bleeding is found to have diverticulitis. What are the four most common potential complications?


Answer 8

Perforation, peritonitis, abscess formation, and bowel stenosis


Question 9

A 73-y/o man admitted for LLQ pain and rectal bleeding develops pneumaturia on day 4 of hospitalization. What complication has occurred?


Answer 9

Colovesical fistula (one of the more common complications of diverticulitis)


Question 10

After being diagnosed with diverticulitis, your patient asks about the mainstay of treatment. What do you respond?


Answer 10

Antibiotics, although surgery may be required


Question 11

A patient’s vasa recta perforate the muscularis externa. What is the diagnosis?


Answer 11

Pseudodiverticulum or false diverticulum


Question 12

An 80-year-old woman has vague GI discomfort and hematochezia, along with many people her age. She will most likely have what diagnosis?


Answer 12

Diverticulosis


Question 13

A patient has symptoms similar to appendicitis but instead has the pain on the left side. What is highest on your differential?


Answer 13

Diverticulitis (left-sided appendicitis)


Question 14

What is a Zenker diverticulum?


Answer 14

Herniation of mucosal tissue at Killian triangle, between the thyropharyngeal/cricopharyngeal parts of the inferior pharyngeal constrictor


Question 15

Is Zenker diverticulum a true or false diverticulum?


Answer 15

False diverticulum (it contains only the mucosa and submucosa—a true diverticulum involves all three layers)


Question 16

A patient presents with halitosis and decreased oral intake due to discomfort on swallowing. What is the most likely diagnosis?


Answer 16

Zenker diverticulum


Question 17

In what age and gender group is Zenker diverticulum most common?


Answer 17

Elderly men

Question 18

What is the most common congenital anomaly of the gastrointestinal tract?


Answer 18

Meckel diverticulum


Question 19

A 19-month-old boy has a congenital anomaly causing melena and RLQ pain. What are some potential complications?


Answer 19

Intussusception, volvulus, colonic obstruction (this is a Meckel diverticulum)


Question 20

Approximately what size is a typical Meckel diverticulum?


Answer 20

2 inches (the five 2’s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)


Question 21

How far are Meckel diverticula typically located from the ileocecal valve?


Answer 21

2 feet (the five 2’s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)


Question 22

In approximately what percentage of the population can Meckel diverticula be found?


Answer 22

2% (the five 2s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)


Question 23

When in life do Meckel diverticula typically present?


Answer 23

First 2 years (the five 2s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)


Question 24

A 16-month-old girl has had melena for the past 7 weeks, and sometimes clutches her RLQ. What test can confirm the most likely diagnosis?


Answer 24

Pertechnetate uptake by ectopic gastric mucosa to confirm Meckel diverticulum (in some cases, appendicitis may need to be ruled out)


Question 25

A patient with a Meckel diverticulum has significant pain. What is most likely to be causing it?


Answer 25

Gastric acid secretion from ectopic tissue growth (gastric and/or pancreatic)


Question 26

A newborn has a cystic dilation of the vitelline duct found on exam. Do you need to perform a pertechnetate study?


Answer 26

No, as this finding is more consistent with an omphalomesenteric cyst rather than a Meckel diverticulum