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SURGERY ROTATION! > Diverticulitis > Flashcards

Diverticulitis Flashcards

1
Q

Condition in which diverticula can be found within the colon

A

Diverticulosis

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2
Q

The most common part of the colon to get diverticula?

A

Sigmoid colon

95%

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3
Q

Diverticular are actually ____(true or false) diverticula in that only the ____ and ____ herniate through the bowel musculature

A

false

mucosa and submucosa

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4
Q

What are true diverticula?

Are they common or rare in the colon?

A

Involves all layers of the bowel wall

Rare in the colon

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5
Q

Where do the weaknesses in the bowel wall development with diverticula?

A

At points where nutrient blood vessels enter between antimesenteric and mesenteric taeniae

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6
Q

What can cause the herniations through the bowel wall in diverticula?

A

increased intraluminal pressures

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7
Q

_____% of diverticula incidence in the US by age 60

_____% become symptomatic

A

50-60%

10-20%

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8
Q

What puts people at risk for diverticula?

A

low fiber diets

chronic constipation

positive family history

also increases with age

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9
Q

Sx/complications seen with diverticula?

A

Bleeding; may be massive

Diverticulitis (asx in 80% of cases)

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10
Q

What diagnostic testing do you do if a patient is bleeding with diverticula?

A

If they don’t have signs of inflammation: colonoscopy

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11
Q

What diagnostic tool do you use if the patient is having pain and signs of inflammation?

A

Abdominal/pelvic CT scan

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12
Q

Tx of diverticulosis?

A

High fiber diet recommended

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13
Q

Indications for operation with diverticulosis?

A

Complications of diverticulitis (eg fistula, obstruction, stricture)

recurrent episodes

hemorrhage

suspected carcinoma

prolonged sx

abscess not drainable by percutaneous approach

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14
Q

When is it safe to get a colonoscopy or barium enema/signmoidoscopy?

A

Due to risk of perforation - 6 weeks after inflammation is resolved to rule out Colon Ca

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15
Q

infection or perforation of a diverticulum

A

Diverticulitis

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16
Q

What is the pathophys of diverticulitis?

A

obstruction of diverticulum by a fecalith leading to inflammation and microperforation

17
Q

Signs/sx of diverticulitis?

A

LLQ pain (cramping or steady)

change in bowel habits (diarrhea)

fever

chills

anorexia

LLQ mass

nausea/vomiting

dysuria

18
Q

Associated lab findings with diverticulitis?

A

Increased WBCs

19
Q

Associated radiographic findings of diverticulitis?

A

X-ray: ileus, partially obstructed colon, air-fluid levels, free air if perforated

Abdominal/pelvic CT: swollen, edematous bowel wall; patricularly helpful in diagnosing an abscess

20
Q

Should you do a barium enema in acute cases of diverticulitis?

A

NO!

21
Q

Is it safe to do a colonoscopy in acute diverticulitis?

A

NO! - increased risk of perforation

22
Q

Complications of diverticulitis?

A

abscess

diffuse peritonitis

fistula

obstruction

perforation

stricture

23
Q

What is the most common fistula with diverticulitis?

A

Colovesical fistula (to the bladder)

24
Q

What is the best test/diagnostic study for diverticulitis?

A

CT

25
Q

Initial therapy for diverticulitis?

A

IV fluids

NPO

broad spectrum antibiotics with anaerobic coverage

NG suction (as needed for emesis/ileus)

26
Q

When is surgery warranted for diverticulitis?

A

obstruction

fistula

free perforation

abscess not amenable to percutaneous drainage

sepsis

deterioration with inital conservation treatment

27
Q

__% have a lifelong risk of diverticulitis recurrence after the first episode

A

33%

28
Q

__% have a lifelong risk of reccurence of diverticulitis after the second episode

A

50%

29
Q

Indications for elective resection in diverticulitis?

A

Two episodes of diverticulitis

should be considered after first episode in young, diabetic or immunosuppressed patient

30
Q

what surgery is performed ELECTIVELY for reccurent bouts of diverticulitis?

A

One-stage operation: resection of involved segment and primary anastomosis (with pre-operative bowel prep

31
Q

What type of surgery is usually performed for an acute case of diverticulitis with a complication?

A

Hartmann’s procedure: resection of involved segment with an end colostomy and stapled rectal stump (will need subsequent reanastomosis of colon usually after 2-3 postoperative months)

32
Q

What is the treatment for a diverticular abscess?

A

Percutaneous drainage

If not amenable to percutaneous drainage - surgical approach for drainage is necessary

33
Q

How common is a massive lower GI bleeding with diverticulitis?

A

VERY RARE

Massive lower GI bleed seen with diverticulosis - not diverticulitis

34
Q

What are the most common causes of massive lower GI bleeding in adults?

A

Diverticulosis (especially right sided)

Vascular ectasia

35
Q

What ut you rule out in any patient with diverticulitis/diverticulosis?

A

colon cancer

36
Q
A

SURGERY ROTATION! (4 decks)

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