Diverticuli Flashcards
What is a diverticulum?
A blind pouch leading off of the alimentary tract that communicates with the lumen of the tract
What is the difference between a true diverticulum and a false diverticulum?
True diverticulum contains three layers (mucosa, submucosa, serosa), whereas false diverticulum contains only two layers (mucosa, submucosa)
A 62-year-old man with known diverticulosis has a screening colonoscopy. Where would you most expect to observe a diverticulum?
The sigmoid colon
What is the etiology of diverticulosis?
Increased intraluminal pressure combined with focal weakness of the colonic wall
A patient is concerned about her likelihood of developing diverticulosis. What dietary change do you suggest?
Increase the amount of dietary fiber
A 57-year-old woman presents with vague abdominal discomfort and painless rectal bleeding. What is the most likely diagnosis?
Diverticulosis
Diverticulitis classically causes pain in what region of the abdomen?
The left lower quadrant (most commonly occurs in the sigmoid colon)
A man with fevers and rectal bleeding is found to have diverticulitis. What are the four most common potential complications?
Perforation, peritonitis, abscess formation, and bowel stenosis
A 73-y/o man admitted for LLQ pain and rectal bleeding develops pneumaturia on day 4 of hospitalization. What complication has occurred?
Colovesical fistula (one of the more common complications of diverticulitis)
After being diagnosed with diverticulitis, your patient asks about the mainstay of treatment. What do you respond?
Antibiotics, although surgery may be required
A patient’s vasa recta perforate the muscularis externa. What is the diagnosis?
Pseudodiverticulum or false diverticulum
An 80-year-old woman has vague GI discomfort and hematochezia, along with many people her age. She will most likely have what diagnosis?
Diverticulosis
A patient has symptoms similar to appendicitis but instead has the pain on the left side. What is highest on your differential?
Diverticulitis (left-sided appendicitis)
What is a Zenker diverticulum?
Herniation of mucosal tissue at Killian triangle, between the thyropharyngeal/cricopharyngeal parts of the inferior pharyngeal constrictor
Is Zenker diverticulum a true or false diverticulum?
False diverticulum (it contains only the mucosa and submucosa—a true diverticulum involves all three layers)
A patient presents with halitosis and decreased oral intake due to discomfort on swallowing. What is the most likely diagnosis?
Zenker diverticulum
In what age and gender group is Zenker diverticulum most common?
Elderly men
What is the most common congenital anomaly of the gastrointestinal tract?
Meckel diverticulum
A 19-month-old boy has a congenital anomaly causing melena and RLQ pain. What are some potential complications?
Intussusception, volvulus, colonic obstruction (this is a Meckel diverticulum)
Approximately what size is a typical Meckel diverticulum?
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)
How far are Meckel diverticula typically located from the ileocecal valve?
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)
In approximately what percentage of the population can Meckel diverticula be found?
2% (the five 2s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)
When in life do Meckel diverticula typically present?
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)
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?
Pertechnetate uptake by ectopic gastric mucosa to confirm Meckel diverticulum (in some cases, appendicitis may need to be ruled out)
A patient with a Meckel diverticulum has significant pain. What is most likely to be causing it?
Gastric acid secretion from ectopic tissue growth (gastric and/or pancreatic)
A newborn has a cystic dilation of the vitelline duct found on exam. Do you need to perform a pertechnetate study?
No, as this finding is more consistent with an omphalomesenteric cyst rather than a Meckel diverticulum
