Diverticulitis Of The Colon Flashcards
Difference between diverticulosis and diverticulitis
Diverticulosis = bleeding diverticula disease
- also is usually non-inflamed
- other than bleeding, there is usually no other symptoms
- the bleeding is most common in the right colon
Diverticulitis = non-bleeding diverticula Disease
- also is usually inflamed
- there are symptoms but no bleeding
Is it inflamed or non-inflamed diverticuli more likely to bleed?
Non-inflammed
What is an ileus?
Ileus = intestines remain dilated and don’t undergo peristalsis
- is painful and is caused by distention
Hinchey staging system
Classifies a colonic perforation due to diverticular diseases
- doesnt really helps treatment, but helps determine how bad or how severe it is (determines if emergency surgery is needed which is almost always in 3/4)
Hinchey 1 = localized abscesses that are para-colonic
Hinchey 2= pelvic abscesses
Hinchey 3 = Purulent peritonitis (usually without feces
Hinchey 4 = feculent peritionits (Purulent with feces
What are diverticula
Are out-pouching or protrusions of all or a portion of the wall of a intestines
True = all layers of the intestinal wall
False = not all layers of the intestinal wall
- *they can occur anywhere in the GI tract but most commonly seen in:
- esophagus
- jejunum
- ileum
- colon
- ***sigmoid colon = 90%
meckels = true diverticula
Pulsion vs traction diverticula
Pulsion = occurs due to increases intraluminal pressure often caused by spastic motility
- usually false diverticula
Traction = occurs due to extrinsic inflammation or forces/motility disorders that pulls the wall outwards
- usually true diverticula
If a diverticulum is of congenital origin, is it likely true or false?
True diverticulum
What’s one easy way to to differentiate acute from chronic diverticula?
Chronic = usually shows narrowing/strictures of the colon
How to diagnose diverticula
Colonoscopy
Palpable on exam
Barium enema
Symptoms of diverticula
usually asymptomatic
Symptoms:
- dull ache or sharp pain in the left lower quadrant
- usually acute onset of pain
- low grade fever
- (+/-) N/V
- narrowing of the stool
Specific Pathology of colon diverticula
Believed to be primarily increased luminal pressure which causes herniation of the bowel wall at the weakest points
- usually between the antimesenteric longitudinal taenia coli muscle bands and between the circular muscle rings
- this is often the site where blood vessels are located also
Common known causes of increased risk for diverticula
Low fiber diets**
- however, high fiber diets = frequent bowel movements so both sides of the spectrum increase diverticula
Alcohol consumption
Elevated elastin levels
Frequent bowel movements
- Note:**
- high body mass index, lack of physical activity, lack of bowel habits ARE NOT associated with an increase in diverticula
What is the most common colonic diverticula for children?
Right sided colonic diverticula or decal diverticulosis
How to diagnose colonic diverticulitis
Any of the following can be used:
- barium enema
- colonoscopy (#2)
- abdominal CT scan (#1)
- nuclear medicine bleeding scans (only if actively ruptured)
- angiography
endoscopy and CT scan are especially useful for pharyngeal,esophageal and small intestinal diverticula
active bleeding requires angiography or bleeding scans usually
barium enemas should be used with caution since the barium can impact in the diverticula and cause damage
What is the most common site of diverticula in adults?
Sigmoid colon
What is the saint triad?
A relationship between the following which often occur together (especially in the western world)
1) cholelithiasis (gallstones)
2) hiatal hernia
3) Diverticulitis
isnt really used diagnostically however
Diverticula disease symptoms
Symptoms:
- painless bleeding (diverticulosis only)
- fever
- leukocytosis
- lower ab pain (usually LLQ)
- tenesmus
- diarrhea or constipation
- urinary symptoms (if fistula is present usually)
sometimes is called “left sided appendicitis”
Can diverticulosis occur in the rectum?
NO
- diverticulosis is limited to a portion of the colon above the pelvic peritoneal reflection (aka sigmoid colon and above)
What are the most common complications of diverticula disease
1) infections/abscess
- #1 most common complication
2) bleeding
3) Fistula formation
- **most common is colo-vesical (bladder with colon)
4) stricture obstruction
- long term inflammation causes narrowing of the bowel
5) perforation and sepsis/peritonitis
What is the hinchey classification
Useful in describing severity of diverticula disease and its staging
- not overly useful for treatment consideration though
Stages:
1) localized pericolic abscess are present
2) pelvic abscess is present and is sealed off/contained
- there is usually bacteria in the peritoneal cavity though
3) perforated diverticulum are present and results in Purulent peritonitis that is not walled off
- either one diverticula or abscess is perforated and spilling into peritoneal cavity
4) perforated diverticulum are present with fecal and pus peritonitis
- the perforation is gross and there is fecal spillage directly into the peritoneal cavity
How to deal with bleeding in diverticulosis
- note: roughly 80% will stop without intervention*
- usually just treat conservatively
Options if conservative options dont work:
- angiographic control
- colonoscopic injection with saline and epinephrine
- barium enemas
- surgical resection
When should someone’s first colonoscopy begin?
Either (age of first degree relatively diagnosed with colon cancer -10yrs) or once you hit 50 yrs
- which ever is less
Treatment of infectioous diverticulitis
Uncomplicated (no perforation, obstruction or fistula present)
- GI tract rest and IV antibiotics
- ciprofloxacin is the #1 used
Complicated
- IV antibiotics, GI tract rest and either surgical intervention or bowel resection
What is the Hartmann procedure?
Resection of diverticulitis colon and then rectum is diverted through the umbilicus (colostomy bag is needed)
