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GK F3 E3 > Diverticulitis Popcorn > Flashcards

Diverticulitis Popcorn Flashcards

1
Q

Which condition?

  • Prevalence incr. w/ age
  • Sigmoid colon = LLQ pain
  • Asymptomatic
  • Discovered incidentally
A

Diverticulosis

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2
Q

S/S of which condition?

  • Abdominal cramping
  • Constipation
  • Diarrhea
  • Bloating
A

Diverticulosis

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3
Q

2 complications of Diverticulosis?

A
  • Diverticulitis
  • Bleeding
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4
Q

PE of which condition?

  • Completely normal exam
  • LLQ pain
A

Diverticulosis

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5
Q

Tx for diverticulosis?

A
  • Higher fiber diet
  • Hydration
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6
Q

What is NOT recommended as part of tx for diverticulosis?

A

Avoidance of seeds/nuts

(literature does not support avoiding seeds/nuts)

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7
Q

What is used to dx diverticulosis?

A

Nothing, usually found incidentally

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8
Q

Microperforation

A

Simple/Uncomplicated Diverticulitis

(Most common - 85%)

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9
Q

Macroperforation

A

Complicated Diverticulitis

(least common - 15%)

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10
Q

S/S of which condition?

  • Progressive, steady aching pain (LLQ)
  • Fever / Chills
  • N / V / Change in bowel habits
  • Irritative urinary sxs (pneumaturia or fecaluria if colovesical fistula)
A

Diverticulitis

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11
Q

What diagnostic studies are needed for Diverticulitis?

A
  • CBC = Leukocytosis
  • BMP/CMP, amylase/lipase
  • UA / urine culture
  • HCG if childbearing age
  • Stool cultures if diarrhea +
  • CT w/ contrast
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12
Q

Leukocytosis is seen in which condition?

A

Diverticulitis w/ CBC.

May be absent in elderly though…

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13
Q

What is the Test of Choice for dx diverticulitis?

A

CT scan of A/P w. contrast

  • localized bowel wall thickening/fat stranding
  • colonic diverticula
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14
Q

What 2 studies are contraindicated in patients w/ Diverticulitis??

A
  • Flex Sigmoidoscopy / Colonoscopy –> risk of perforation
  • Barium enema –> barium fluid could leak through perforation & worsen the peritonitis
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15
Q

PE of which condition?

  • Low grade fever
  • BS normal / abnormal
  • LLQ tenderness / mass
  • Peritoneal signs
  • Mass/Tenderness on DRE
  • Guaiac
  • Pelvic for women
A

Diverticulitis

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16
Q

Tx for uncomplicated Diverticulitis?

A

Outpatient tx

  • Oral abx: 500mg PO TID x10 days
    • Metronidazole + Ciprofloxacin
    • Metronidazole + Bactrim
    • Clear liquid / low fiber diet (low residue)
    • High fiber diet AFTER acute episode resolves
17
Q

What is follow up for Diverticulitis and what tests are needed?

A
  • 2 days FU (close FU)
  • Repeat imaging not needed if pt improving
  • 6 - 8 weeks after resolution of acute diverticulitis –> colonoscopy to eval for extent and r/o cancer & IBD
18
Q

Tx for complicated Diverticulitis?

A

Inpatient tx:

  • Admission, NPO, IV fluids
  • IV abx, then PO to complete 10-14 day course
  • Analgesics
  • Consult GI & surgery
  • If pt not improving in 2-3 days of abx –> repeat imaging
19
Q

3 indications for surgery in pts w/ diverticulitis

A
  1. Perforation w/ peritonitis
  2. Deteriorates / fails to improve within 72 hours of therapy
  3. Complicated diverticulitis
20
Q

4 complications of diverticulitis

A
  • Abscess
  • Fistula
  • Obstruction
  • Perforation

FOPA

21
Q

Which condition?

  • Overt lower GI bleed
  • Resolves spontaneously
  • Where is MC source of bleed????
A

Diverticular Bleeding

  • Right Colon MC source of bleed
22
Q

Main symptom of Diverticular Bleeding?

  • What are 3 others? +/-
A

PAINLESS hematochezia

  • +/- bloating
  • +/- cramping
  • +/- fecal urgency
23
Q

What diagnostic studies are used to r/o upper GI source bleed in Diverticular Bleeding?

A
  • EGD lavage (esophagogastroduodenoscopy)
  • NG lavage (nasogastric)
24
Q

What lab should NOT be elevated in pts w/ colonic diverticular bleeding?

A

BUN

25
Q

Diagnostic tests to locate source of bleed AFTER initial resuscitation is complete

A
  • Flex Sig / Colonoscopy
  • Tagged RBC scan / Angiography
26
Q

2 exam findings of Diverticular Bleeding

A
  • Blood on DRE
  • Abnormal vital signs
27
Q

Tx for Diverticular Bleeding

A
  • Resuscitation / Hospitalization (maintain blood volume and transfusions PRN)
  • Tx bleeding site w/ endoscopic therapy, angiographic therapy, surgery

GK F3 E3 (24 decks)

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