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General Surgery > Diverticulum > Flashcards

Diverticulum Flashcards

1
Q

what is a true diverticulum?

A

an outpouching covered by all the layers of the bowel wall (e.g. Meckels diverticulum, jejunal diverticulum)

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2
Q

what is a false diverticulum?

A

lacking the normal muscle coat of the bowel (e.g. colonic diverticula)

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3
Q

What are diverticula?

A

plural of diverticulum

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4
Q

What is diverticulosis?

A

the presence of (usually colonic) diverticula

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5
Q

What is diverticular disease?

A

complicated diverticulosis, the presence of symptoms resulting from the existence of diverticula in the large intestine

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6
Q

What is diverticulitis?

A

inflammation of a diverticulum

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7
Q

what are the causes of diverticulosis?

A
  • Low fibre diet
  • Structural abnormalities: Marfans, Ehlers-Danlos, polycystic kidney disease
  • Abnormal motility and increased intraluminal pressure
  • Smoking, NSAIDS?
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8
Q

what is the process of diverticula formation?

A

hypertrophy of the sigmoid colon causes spams and increase pressure leading to herniation between the teniae coli alongside blood vessels

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9
Q

what is acute diverticulosis?

A

If something is stuck inside an diverticula can lead to infection

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10
Q

what are the different presentations of diverticula?

A 
Diverticulosis
Diverticular Disease
Diverticulitis
Large Bowel Obstruction
Haemorrhage
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11
Q

what are the symptoms of diverticulosis?

A

symptomless

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12
Q

what are the symptoms of diverticular disease

A

erratic bowel habits (diarrhoea)

left iliac fossa pain (colicky)

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13
Q

what can diverticulitis result in?

A

perforation

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14
Q

Where can the bowel perforate in diverticulitis?

A

o Peritoneal cavity to cause peritonitis
o Pericolic tissues forming a pericolic abscess
o Adjacent structures forming fistula

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15
Q

what are the symptoms of a bladder fistula in diverticulitis?

A

cystitis, pneumaturia, recurrent UTIs, faecal matter in urine

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16
Q

what are the symptoms of small bowel fistula in diverticular disease?

A

diarrhoea

17
Q

what are the symptoms of a large bowel obstruction?

A

absolute constipation, colicky bowel pain, vomiting

18
Q

what are the investigations used in diverticula disease?

A

clinical examination
barium enema
ultrasound
sigmoidoscopy

19
Q

when is sigmoidoscopy useful in diverticula disease investigations?

A

if other investigations have been inconclusive

20
Q

what is the investigation of choice in diverticula disease?

A

barium enema

21
Q

when should barium enemas not be used in diverticula disease investigations?

A

should not be used if there are active complications.

22
Q

what is the management of asymptomatic diverticular disease?

A

no direct treatment – recommend high fibre diet and high fluid intake

23
Q

what is the management of symptomatic diverticular disease?

A

o Analgesics
o Laxatives
o Anticholinergics
o Surgery

24
Q

what are the clinical features of acute diverticulitis?

A 
o	Left iliac fossa pain 
o	Malaise / fever
o	Palpable mass
o	Abdominal distension
o	Tachycardia
o	“left sided appendicitis”
25
Q

what investigations are used for acute diverticulitis?

A

CRP and ESR

US/CT

26
Q

what will the CRP and ESR be in acute diverticulitis?

A

raised

27
Q

what will a US/CT show in acute diverticulitis?

A

can show wall thickening, diverticula, and also abscess or perforation

28
Q

what is the management of acute diverticulits?

A

o Antibiotics – metronidazole
o Fluids
o Analgesia

29
Q

what is the Rule of 2 in Meckels Diverticulum

A
  • 2% (of the population)
  • 2 feet (proximal to the ileocecal valve)
  • 2 inches (in length)
  • 2 types of common ectopic tissue (gastric and pancreatic)
  • 2 years is the most common age at clinical presentation
  • 2:1 male: female ratio
30
Q

what is the cause of Merkels Diverticulum?

A

remnant of the vitellointestinal duct becoming infected or obstructed

31
Q

where is Merkels Diverticulum located?

A

Lies on the antimesenteric border of the ileum, distal ileum

32
Q

what does Merkels Diverticulum contain?

A

Contains ectopic ileal, gastric or pancreatic mucosa - risk of peptic ulceration

33
Q

what is the blood supply for Merkels Diverticulum?

A

omphalomesenteric artery

34
Q

what are the symptoms of Merkels Diverticulum?

A 
abdominal pain mimicking appendicitis
rectal bleeding
intestinal obstruction or volvulus 
asymptomatic
perforation - peritonitis
peptic ulcer - melaena
Raspberry tumour at the umbilicus
35
Q

how can merkels diverticulum be diagnosed?

A
  • technetium scan
  • barium follow-through or small bowel enema
  • CT
36
Q

how can Merkels be treatment?

A

• Resection of the diverticulum

37
Q

what are the indications for surgical resection in Merkels Diverticulum?

A

if narrow neck or symptomatic

38
Q

what are the complications of Merkels?

A
  • haemorrhage
  • intestinal obstruction
  • diverticulitis
  • umbilical anomalies
  • neoplasm

General Surgery (14 decks)

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