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Gen Med: GI > Diverticulosis/Diverticulitis > Flashcards

Diverticulosis/Diverticulitis Flashcards

1
Q

What are the large bowel disorders?

A 
Diverticular Disease
Irritable Bowel Syndrome
Constipation
Colon Polyps
Colorectal Cancer
Toxic Megacolon
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2
Q

What is colonic diverticulosis?

A

Described as out-pouching of diverticula in colon

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3
Q

What are the age characteristics of diverticulosis?

A

Colonic diverticulosis increases with age

>50% over age 80 years

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4
Q

What are the general characteristics of diverticulosis?

A

Most are asymptomatic
1. Discovered incidentally on colonoscopy or barium enema

  1. Vary in number & size from a few mm to several cm
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5
Q

define diverticulosis

A
  1. Diverticula present

2. Asymptomatic

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6
Q

Define diverticulitis?

A
  1. Inflamed diverticula

2. May cause potentially fatal obstruction, infection or hemorrhage

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7
Q

What are the most common sites for diverticula?

A
  1. Sigmoid colon

2. Descending colon

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8
Q

What may be involved in complicated diverticulitis?

A
  1. Abscess
  2. Obstruction
  3. Perforation
  4. Fistula
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9
Q

What is the etiology of diverticulosis?

A

Unknown

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10
Q

What are contributing factors for diverticulosis?

A
  1. Diminished colon motility & increased intraluminal pressure
  2. Low fiber diet
  3. Connective tissue disorders
    A. Scleroderma
    B. Marfan Syndrome
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11
Q

What is the pathophys of diverticulosis?

A
  1. Diverticula result from high intraluminal pressure on area of weakness in GI wall where blood vessels enter
  2. Diet may be contributing factor
  3. Insufficient fiber reduces fecal residue -> narrows bowel lumen -> leads to high intra-luminal pressure during defecation
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12
Q

What are the sxs of diverticulosis?

A
  1. Most asymptomatic
  2. Some pts may have nonspecific complaints:
    A. Chronic constipation
    B. Abd pain
    C. Fluctuating bowel habits
  3. Exam usually unremarkable
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13
Q

What imaging is used for uncomplicated diverticulosis?

A

No imaging needed for uncomplicated disease

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14
Q

True/false: colonoscopy is helpful in dx diverticulosis?

A

Colonoscopy less sensitive in detecting diverticula

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15
Q

What imaging may be used for complicated diverticulosis?

A

Diverticula best seen on barium enema or CT abd & pelvis w/contrast

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16
Q

What is the treatment for diverticulosis?

A
  1. High fiber diet or fiber supplements reduce likelihood of complications
  2. Avoid nuts/seeds
17
Q

What is diverticulitis?

A

Defined as inflammation of diverticula caused by obstructing matter

18
Q

Who is at risk for developing diverticulitis?

A

Patients with diverticulosis are at risk of developing diverticulitis

19
Q

What is the pathophys of diverticulitis?

A
  1. Undigested food & bacteria accumulate in diverticular sac

2. Hard mass cuts off blood supply to thin walls of sac -> increased risk of infection

20
Q

What can untreated diverticulitis lead to?

A

increased risk of perforation

21
Q

What are the sxs of diverticulitis?

A 
1. Abd pain
A. Sudden onset
B. Usually LLQ (site of tics)
2. +/- fever
3. Diarrhea OR constipation
4. N / V
5. +/- distention
6. Palpable tenderness
A. +/- mass in affected area
B. Guarding
C. +/- rebound tenderness
7. DRE may be tender
22
Q

What is the ddx for diverticulitis?

A
  1. Perforated colon CA
  2. Crohn’s Disease
  3. Appendicitis
  4. Ischemic colitis
  5. C. Difficile colitis
  6. GYN disorders
    A. Ectopic pregnancy
    B. Ovarian cyst
    C. Ovarian torsion
23
Q

What dx studies are used for diverticulitis?

A
  1. Guaiac (+) stool common
  2. Mild-mod leukocytosis
  3. CT Abd/pelvis w/ contrast
24
Q

Who is a CT Abd/pelvis w/ contrast recommended for? Why?

A
  1. Recommended in pts who do not respond to empiric therapy after 2-4 days
  2. Evaluates extent of disease and R/O underlying colon CA
25
Q

Why should barium enema and colonoscopy be avoided in acute diverticulitis?

A

Barium enema & colonoscopy should be avoided during acute phase due to risk of perforation & peritonitis

26
Q

What are the results of a CT abd/pelvis with contrast in a pt with diverticulitis?

A
  1. Colonic diverticuli & wall thickening: indicative of inflammation
  2. Peri-colic fat infiltration
  3. Abscess formation
  4. Extraluminal air
27
Q

When is a colonoscopy or barium enema recommended for a pt w/ diverticulitis? Why?

A
  1. ColonoscopyorBE done ≈ 6 weeks later
    A.R/O IBD orcolonCA
    B. Evaluate extent of tics/obstruction risk
28
Q

What is the rx for mild diverticulitis?

A
  1. Clear liquid / BRAT / Low residue diet
  2. Add antibx if persistent
    A. Broad spectrum antibiotics x 7-10 days
    B. Fluoroquinolones/Ciprofloxin (Cipro) 500 mg po bid
    +
    Metronidazole (Flagyl) 500 mg po tid
29
Q

What is the rx for moderate diverticulitis?

A
  1. Hospitalization & NPO
  2. IV antibiotics x 5-7 days [gram (+), gram (-) & anaerobic coverage]
    A. Cefotaxime (Claforan) or piperacillin (Zosyn)
    OR
    B. Metronidazole (Flagyl) + ceftriaxone (Rocephin)
  3. Bowel rest (NPO)
  4. Analgesia
  5. NG tube if ileus develops
30
Q

What is the tx for severe diverticulitis or refractory to treatment?

A
  1. Surgery
  2. Two stage procedure:
    A. Diseased colon resected, proximal colon brought out to form temp colostomy; distal stump closed
    B. 3-6 months later, after inflammation subsides, colon can be reconnected electively
31
Q

What are the indications for diverticulitis surgery?

A
  1. Peritonitis
  2. Large abscess
  3. Fistulas
  4. Obstruction

Gen Med: GI (16 decks)

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