Exam 2: Chapter 47 - Diverticulitis

Question 1

What is diverticulum?

Answer 1

A saclike herniation of the lining of the bowel that extends through a defect in the muscle layer

Question 2

Where is Diverticula most common?

Answer 2

Can occur anywhere in GI tract, but most common is colon particularly in the sigmoid colon

Question 3

What is Diverticulosis?

Answer 3

Defined by the presence of multiple diverticula wihtout inflammation or symptoms

Question 4

Risk Factors of Diverticulosis?

Answer 4

Low intake of dietary fiber,

obesity,

history of cigarette smoking,

regular use of NSAIDs

positive family history

Question 5

What is Diverticulitis?

Answer 5

When a diverticulum becomes inflamed, causing perforation and potential complications such as obstruction, abscess, fistula, peritonitis, and hemorrhage.

Question 6

Diverticula form when

Answer 6

Form when the mucosal and submucosal layers of the colon herniate through the mucular wall because of high intraluminal pressure, low volume in the colon, and decreased msucle strength in the colon wall. Bowels content can accumulate in the diverticulum and decompose, causing inflammation and infection

Question 7

What happens in Diverticular Disease?

Answer 7

Sacs are enlarged. This could be because a piece of corn got stuck in there and caused damage to the diverticulum.

Question 8

What pain do patients report in diverticulitis?

Answer 8

Up to 70% of patients report an acute onset of mild to severe pain in the left lower quadrant.

Question 9

Acute complications of diverticulitis?

Answer 9

Abscess formation, bleeding, and peritonitis.

If abscess develops, the associated findings are tenderness, palpable mass, fever, and leukocytosis.

Inflamed diverticulum that perforates results in abdominal pain localized over the involved segment, usually the sigmoid

Question 10

Chronic complications of diverticulitis include

Answer 10

fistula formation, colovesicular fistulas, colovaginal fistulas.

This leads to a colon that may narrow with scar tissue and fibrotic strictures

Question 11

Diverticulosis is typically diagnoses by

Answer 11

colonscopy, which permits visualization of the extent of diverticular disease

Question 12

Laboratory tests for diverticulosis include

Answer 12

CBC, revealing an elevated white blood cell count.

Question 13

What is the test of choice to confirm diverticulitis?

Answer 13

An abdominal CT scan with contrast agent. It can also reveal perforation and abscesses.

Question 14

Abdominal X Rays may demonstrate

Answer 14

free air under the diaphragm if a perforation has occured from the diverticulitis

Question 15

Results from radiologic tests confirm

Answer 15

whether or not the patient has uncomplicated diverticulitis or complicated diverticulitis that require surigcal inntervention

Question 16

Treatment for patients with uncomplicated diverticulitis include

Answer 16

an outpatient basis with diet and medication. Rest, oral fluids, and analgesic emdications.

This is for 80% of patients

Question 17

Diet when you have inflammation?

Answer 17

Clear liquid diet is consumed until inflammation subsides; then a high fiber low-fat diet is recommended.

Question 18

diet when you have acute diverticulitis

Answer 18

Withhholding oral intake, administering IV fluids, and instuting nasogastric suctioning if vomiting or distention occurs are used to rest the bowels. Antibiotics may be prescribed for pain relief. In these cases, the patient is hospitialized

Question 19

Symptoms of Diverticular Disease?

Answer 19

Alternating Diarrhea with Constipation Pain LLQ Nausea Vomiting Fever Chills

Question 20

Potential Complications?

Answer 20

Perforation

Peritonitis

Absecess Formation

Bleeding

Question 21

Two types of surgery considered?

Answer 21

One-Stage REsection (Inflamed area is removed and a primary end-to-end anastomsis is completed)

Multiple-stage procedures for complications such as obstruction or perforation

When possible, the area of diverticulitis is resected and the remaining bowel is joined end to end.

Two stage resection may be performed in patients with Hinchey Stage IV.

Question 22

Fluid and food intake recommendation?

Answer 22

2 L/day of liquid

Foods that are soft but have increased fiber (prepared cereals or soft-cooked vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation)

Question 23

What does a X-Ray show for this disease?

Answer 23

SHows if there is any free air. Air can get into the abdominal cavity.