EOR GI part 7- diverticular dz, volvulus Flashcards
Diverticulosis
Condition in which diverticula can be found within the colon, especially the sigmoid; diverticula are actually false diverticula in that only mucosa and submucosa herniate through the bowel musculature; tree diverticula involve all layers of the bowel wall and are rare in the colon
Pathophys of diverticulosis
Weakness in the bowel wall develops at points where nutrient blood vessels enter between antimesenteric and mesenteric teniae; increased intraluminal pressures then cause herniation through these areas
What is the MC site of diverticulosis?
95% of people with diverticulosis have sigmoid colon involvement
Who is at risk for diverticulosis?
People with low-fiber diets
Chronic constipation
Pos FHx
Incidence increases with age
What are the sx/complications of diverticulosis?
Bleeding: may be massive
Diverticulitis, asymptomatic (80% of cases)
What is the diagnostic approach for bleeding in diverticulosis?
Without signs of inflammation: colonoscopy
What is the diagnostic approach for pain and signs of inflammation in diverticulosis?
Abdominal/pelvic CT scan
What is the tx of diverticulosis?
High-fiber diet is recommended
What are the indications for operation with diverticulosis?
Complications of diverticulitis Recurrent episodes Hemorrhage Suspected carcinoma Prolonged sx Abscess not drainable by percutaneous approach
When is it safe to get a colonoscopy or barium enema/sigmoidoscopy for diverticulosis?
D/t risk of perforation, this is performed 6 wks after inflammation resolves to r/o colon CA
Diverticulitis
Infection or perforation of a diverticulum
Pathophys of diverticulitis
Obstruction of diverticulum by a fecalith leading to inflammation and microproliferation
S/sx of diverticulitis
LLQ pain (crampy or steady) Change in bowel habits Fever Chills Anorexia LLQ mass N/V Dysuria
What are the associated lab findings of diverticulitis?
Increased WBCs
What are the associated radiographic findings of diverticulitis?
On X-ray: Ileus Partially obstructed colon Air-fluid levels Free air if perforated On abdominal/pelvic CT scan: Swollen, edematous bowel wall, particularly helpful in diagnosing an abscess
What are the associated barium enema findings with diverticulitis?
Barium enema should be avoided in acute cases?
Is colonoscopy safe in an acute setting with diverticulitis?
No, there is increased risk of perforation
What are the possible complications of diverticulitis?
Abscess Diffuse peritonitis Fistula Obstruction Perforation Stricture