Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AIP: Abdominal pain > Diverticulitis > Flashcards

Diverticulitis Flashcards

1
Q

What is the difference between diverticulosis, diverticular disease and diverticulitis?

A

diverticulosis just describes the presence of multiple outpouchings of the bowel wall, and diverticular disease is when these patients are symptomatic. diverticulitis is the infection of a diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In what region do the diverticula of diverticulosis most commonly occur?

A

sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 2 ways that diverticulosis can present?

A
  1. Painful diverticular disease: altered bowel habit, colicky left sided abdominal pain
  2. Diverticulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is usually recommended to minimise symptoms of painful diverticular disease?

A

high fibre diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are possible 8 features of the presentation of diverticulitis?

A
  1. Left iliac fossa pain and tenderness
  2. Anorexia, nausea and vomiting
  3. Change in bowel habit: constipation most common, also diarrhoea
  4. Features of infection (pyrexia, raised WBC and CRP)
  5. Urinary frequency, urgency or dysuria
  6. PR bleeding
  7. Pneumaturia or faecaluria due to colovesical fistula
  8. Vaginal passage of faeces or flatus due to colovaginal fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 2 types of management of diverticulitis?

A
  1. Mild attacks can be treated with oral antibiotics in the community e.g. 7 days co-amoxiclav
  2. More significant episodes managed in hospital; NBM, IV fluids, IV antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which 2 IV antibiotics are typically given for the management of more significant episodes of diverticulosis?

A

cephalosporin + metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 5 examples of complications of diverticulitis?

A
  1. Abscess formation
  2. Peritonitis
  3. Obstruction
  4. Perforation
  5. Fistula formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is diverticular disease?

A

common surgical problem consisting of herniation of colonic mucosa through the muscular wall of the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which layers of the colon are affected by diverticular disease and how does this determine which region it affects?

A
  • the usual site is between the taenia coli where vessels pierce the muscle to supply the mucosa.
    • the taenia coli are the longitudinal ribbons of smooth muscle on the outside of the ascending, transverse, descending and sigmoid colons
  • therefore the rectum, which lacks taenia, is often spared
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 3 symptoms of diverticular disease?

A
  1. Altered bowel habit
  2. Bleeding
  3. Abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 6 complications of diverticular disease?

A
  1. Diverticulitis
  2. Haemorrhage
  3. Development of fistula
  4. Perforation and faecal peritonitis
  5. Perforation and development of abscess
  6. Development of diverticular phlegmon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is a diagnosis of diverticular disease usually made in the outpatient setting? 3 ways

A
  • patients will undergo either a:
    • colonoscopy,
    • CT cologram or
    • barium enema
  • all tests can identify diverticular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When diagnosing diverticular disease using imaging techniques, what can be difficult about making the diagnosis?

A

while the techniques can identify diverticular disease, it’s difficult to confidently exclude cancer, particularly in diverticular strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 3 important investigations of suspected diverticular disease in acutely unwell surgical patients?

A
  1. Plain abdominal x-ray
  2. Erect chest x-ray
    • these 2 will help identify perforation
  3. Abdominal CT scan (not a CT cologram) with oral and IV contrast will help identify whether acute inflammation present, and presence of local complications such as abscess formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the benefit of performing abdominal and chest x-rays in suspected diverticular disease?

A

will identify perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the benefit of performing abdominal CT san with oral and IV contrast in suspected diverticular disease? 2 things

A
  1. Will help identify whether acute inflammation present
  2. Will help identify presence of local complications such as abscess formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What severity classification can be used for diverticular disease?

A

Hinchey classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 4 stages of Hinchey classification?

A
  1. Para-colonic abscess
  2. Pelvic abscess
  3. Purulent peritonitis
  4. Faecal peritonitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are 5 aspects of the management of diverticular disease?

A
  1. Increase dietary fibre intake
  2. Mild attacks of diverticulitis may be managed conservatively with antibiotics
  3. Pericolonic abscesses should be drained either surgically or radiologically
  4. Recurrent episodes of acute diverticulitis requiring hospitalisation = relative indication for segmental resection
  5. Hinchey IV perforations (generalised faecal peritonitis) require resection and usually a stoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the management of pericolonic abscesses associated with diverticular disease?

A

should be drained either surgically or radiologically

22
Q

What is the management of recurrent episodes of acute diverticulitis requiring hospitalisation?

A

relative indication for a segmental resection

23
Q

What is the management of Hinchey IV perforations (i.e. generalised faecal peritonitis)?

A

will require a resection and usually a stoma

24
Q

What is usually required in patients with Hinchey IV perforations, in addition to resection + stoma and why?

A

usually require HDU admission due to the high risk of post-operative complications

25
Q

How can less severe perforations due to diverticular disease be managed?

A

may be managed by laparoscopic washout and drain insertion

26
Q

What is thought to be the cause of diverticula?

A

thought to be due to increased intra-colonic pressure - occur at weaker areas of wall such as where the penetrating arteries enter the colonic wall

27
Q

In which group of patients may diverticula be found outside of the sigmoid colon, and where?

A

in Asian patients, may be found in the right colon

28
Q

How commmon are diverticula, and how common are the symptoms?

A

very common - 30% of Westerners thought to have diverticula by age 60

only 25% of people with diverticulosis will experience symptoms, but 75% of these will experience an episode of diverticulitis

29
Q

What is the average age of presentation of diverticulitis?

A

50-70 years (80% over 50)

30
Q

What are 6 risk factors for diverticulitis?

A
  1. Age
  2. Lack of dietary fibre
  3. Obesity: especially in younger patients
  4. Sedentary lifestyle
  5. Smoking
  6. NSAID use
31
Q

What are 3 things in the history of patients with diverticular disease?

A

chronic history of:

  1. intermittent abdominal pain, particularly in the left lower quadrant
  2. bloating
  3. change in bowel habit: constipation or diarrhoea
32
Q

What may cause nausea and vomiting in acute diverticulitis?

A

may be due to ileus or complicated diverticulitis with colonic obstruction

33
Q

When change of bowel habit occurs in acute diverticulitis, which type of change is more common?

A

constipation seen in 50%, diarrhoea in 25%

34
Q

What proportion of patients with acute diverticulitis report frequency, urgency or dysuria and why do these symptoms occur?

A

10-15%; due to irritation of the baldder by the inflamed bowel

35
Q

What are 7 signs on examination of acute diverticulitis?

A
  1. Low grade pyrexia
  2. Tachycardia
  3. Tender LIF
  4. Tender palpable mass in LIF
  5. Reduced bowel sounds (sometimes)
  6. Guarding, rigidity and rebound tenderness if complicated diverticulitis with perforation
  7. Lack of improvement with treatment in seemingly uncomplicated diverticulitis - may suggest presence of abscess
36
Q

What can cause a palpable mass on examination in acute diverticulitis, and what proportion of patients will have this?

A

inflammation or an abscess; present in 20%

37
Q

What can lack of improvement with treatment of acute diverticulitis when it is seeminly uncomplicated suggest?

A

presence of abscess

38
Q

What are 6 investigations necessary to perform in the workup for acute diverticulitis? What will each show?

A
  1. FBC: raised WCC
  2. CRP: raised
  3. Erect CXR: may show pneumoperitoneum in cases of perforation
  4. AXR: may show dilated bowel loops, obstruction or abscesses
  5. CT: best modality in suspected abscesses
  6. Colonoscopy: should be avoided intially due to increased risk of perforation in diverticulitis
39
Q

What are 3 things that abdominal x-ray may show in acute diverticulitis?

A
  1. Dilated bowel loops
  2. Obstruction
  3. Abscesses
40
Q

When is CT scan the best modality for acute diverticulitis?

A

in suspected abscesses

41
Q

Why should colonoscopy be avoided initially in acute diverticulitis?

A

increased risk of perforation

42
Q

What is the management of mild cases of acute diverticulitis?

A

oral antibiotics, liquid diet and analgesia

43
Q

When should you consider admitting a patient with diverticulitis to hospital?

A

if symptoms don’t settle within 72 hours, or initially present with more severe symptoms

44
Q

What is the hospital management of acute diverticulitis?

A

IV antibiotics (usually metronidazole + cephalosporin), nil by mouth, IV fluids

45
Q

What is the management of abscess formation secondary to diverticulitis?

A

in first instance this is managed with bowel rest, broad spectrum antibiotics ± CT-guided percutaneous drainage

surgical management considered if medical management fails

46
Q

What is the management of suspected perforation secondary to diverticulitis?

A

urgent exploratory laparotomy

47
Q

How are colovesical fistulae diagnosed?

A

cystoscopy or cystography

48
Q

What management is required for colovesical fistulae?

A

surgical repair

49
Q

In total what are 5 types of fistulae that may occur secondary to diverticulitis?

A
  1. Colovesical
  2. Colovaginal
  3. Coloenteric
  4. Colouterine
  5. Colorethral
50
Q

Why can diverticulitis lead to bowel obstruction?

A

patients at risk of fibrosis secondary to inflammation, resulting in strictures + obstruction

51
Q

When there is mild diverticulitis, what is an example of an antibiotic regimen that can be used?

A

7 days oral co-amoxiclav

52
Q

What is the management if there is acute rectal bleeding in diverticulitis?

A

haemodynamic stabilisation of patient followed by endoscopic haemostasis

surgery if bleeding continues despite endoscopy

AIP: Abdominal pain (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions