Diverticulitis Flashcards
Condition in which diverticula can be found within the colon
Diverticulosis
The most common part of the colon to get diverticula?
Sigmoid colon
95%
Diverticular are actually ____(true or false) diverticula in that only the ____ and ____ herniate through the bowel musculature
false
mucosa and submucosa
What are true diverticula?
Are they common or rare in the colon?
Involves all layers of the bowel wall
Rare in the colon
Where do the weaknesses in the bowel wall development with diverticula?
At points where nutrient blood vessels enter between antimesenteric and mesenteric taeniae
What can cause the herniations through the bowel wall in diverticula?
increased intraluminal pressures
_____% of diverticula incidence in the US by age 60
_____% become symptomatic
50-60%
10-20%
What puts people at risk for diverticula?
low fiber diets
chronic constipation
positive family history
also increases with age
Sx/complications seen with diverticula?
Bleeding; may be massive
Diverticulitis (asx in 80% of cases)
What diagnostic testing do you do if a patient is bleeding with diverticula?
If they don’t have signs of inflammation: colonoscopy
What diagnostic tool do you use if the patient is having pain and signs of inflammation?
Abdominal/pelvic CT scan
Tx of diverticulosis?
High fiber diet recommended
Indications for operation with diverticulosis?
Complications of diverticulitis (eg fistula, obstruction, stricture)
recurrent episodes
hemorrhage
suspected carcinoma
prolonged sx
abscess not drainable by percutaneous approach
When is it safe to get a colonoscopy or barium enema/signmoidoscopy?
Due to risk of perforation - 6 weeks after inflammation is resolved to rule out Colon Ca
infection or perforation of a diverticulum
Diverticulitis
What is the pathophys of diverticulitis?
obstruction of diverticulum by a fecalith leading to inflammation and microperforation
Signs/sx of diverticulitis?
LLQ pain (cramping or steady)
change in bowel habits (diarrhea)
fever
chills
anorexia
LLQ mass
nausea/vomiting
dysuria
Associated lab findings with diverticulitis?
Increased WBCs
Associated radiographic findings of diverticulitis?
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
Should you do a barium enema in acute cases of diverticulitis?
NO!
Is it safe to do a colonoscopy in acute diverticulitis?
NO! - increased risk of perforation
Complications of diverticulitis?
abscess
diffuse peritonitis
fistula
obstruction
perforation
stricture
What is the most common fistula with diverticulitis?
Colovesical fistula (to the bladder)
What is the best test/diagnostic study for diverticulitis?
CT
Initial therapy for diverticulitis?
IV fluids
NPO
broad spectrum antibiotics with anaerobic coverage
NG suction (as needed for emesis/ileus)
When is surgery warranted for diverticulitis?
obstruction
fistula
free perforation
abscess not amenable to percutaneous drainage
sepsis
deterioration with inital conservation treatment
__% have a lifelong risk of diverticulitis recurrence after the first episode
33%
__% have a lifelong risk of reccurence of diverticulitis after the second episode
50%
Indications for elective resection in diverticulitis?
Two episodes of diverticulitis
should be considered after first episode in young, diabetic or immunosuppressed patient
what surgery is performed ELECTIVELY for reccurent bouts of diverticulitis?
One-stage operation: resection of involved segment and primary anastomosis (with pre-operative bowel prep
What type of surgery is usually performed for an acute case of diverticulitis with a complication?
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)
What is the treatment for a diverticular abscess?
Percutaneous drainage
If not amenable to percutaneous drainage - surgical approach for drainage is necessary
How common is a massive lower GI bleeding with diverticulitis?
VERY RARE
Massive lower GI bleed seen with diverticulosis - not diverticulitis
What are the most common causes of massive lower GI bleeding in adults?
Diverticulosis (especially right sided)
Vascular ectasia
What ut you rule out in any patient with diverticulitis/diverticulosis?
colon cancer
