Exam 2 Diverticular Disease

Question 1

Saclike herniation of the lining of the bowel that extends to muscle

Answer 1

Diverticulum

Question 2

Diverticulum

Answer 2

Saclike herniation of the lining of the bowel that extends to muscle

Question 3

occur ___________ small intestine or colon BUT most commonly ______ colon

Answer 3

occur anywhere small intestine or colon BUT most commonly sigmoid colon

Question 4

Asian heritage develop Right colon

Answer 4

Exception

Question 5

Multiple diverticula without inflammation or symptoms

Answer 5

Diverticulosis

Question 6

Diverticulosis

Answer 6

Multiple diverticula without inflammation or symptoms

Question 7

Predisposing factors

Answer 7

decreased intake of dietary fiber

Question 8

when food and bacteria retained in the diverticulum produce infection and inflammation

Answer 8

Diverticulitis

Question 9

Diverticulitis

Answer 9

when food and bacteria retained in the diverticulum produce infection and inflammation

Question 10

Symptoms

Answer 10

Abscess, fistula formation, obstruction, perforation, peritonitis and hemorrhage

Question 11

Abscess, fistula formation, obstruction, perforation, peritonitis and hemorrhage

Answer 11

Symptoms

Question 12

developed countries; increases with age
lead to perforation or abscess
If occurs at less than 50 years of age – may be related to obesity

Answer 12

random

Question 13

acute onset of mild to severe pain in left lower quadrant with nausea, vomiting, chills and leukocytosis

Answer 13

With diverticulitis

Question 14

With diverticulitis

Answer 14

acute onset of mild to severe pain in left lower quadrant with nausea, vomiting, chills and leukocytosis

Question 15

t/f diverticular is proceeded by chronic constipation

Answer 15

true

Question 16

If left untreated

Answer 16

can result in peritonitis and septicemia

Question 17

can result in peritonitis and septicemia

Answer 17

If left untreated

Question 18

Generally mild
Bowel irregularity – intervals of diarrhea, nausea, anorexia, bloating, abdominal distention
If bowel is repeatedly inflamed, results in narrowing in bowel, cramps, narrow stools, increased constipation and increased risk for obstruction
Weakness, fatigue and anorexia

Answer 18

Signs and Symptoms:

Question 19

Signs and Symptoms:

Answer 19

Generally mild
Bowel irregularity – intervals of diarrhea, nausea, anorexia, bloating, abdominal distention
If bowel is repeatedly inflamed, results in narrowing in bowel, cramps, narrow stools, increased constipation and increased risk for obstruction
Weakness, fatigue and anorexia

Question 20

Diverticulosis is diagnosed with…

Answer 20

colonoscopy

Question 21

Diverticulitis is diagnosed with…

Answer 21

CT with contrast to reveal abscesses
Abdominal x-ray – reveals free air under the diaphragm if perforation is present
Labs: CBC – look at: increased WBC (infection), Increased ESR (inflammation)

Question 22

what is contraindicated acute diverticulitis

Answer 22

Colonscopy Contraindicated in acute diverticulitis because the risk of perforation in the presence of local infection may result in sepsis

Question 23

will have tenderness, palpable mass, fever, leukocytosis

Answer 23

Abscess

Question 24

Abscess

Answer 24

will have tenderness, palpable mass, fever, leukocytosis

Question 25

abdominal pain localized over involved segment; often will follow with peritonitis

Answer 25

Perforation

Question 26

Perforation

Answer 26

abdominal pain localized over involved segment; often will follow with peritonitis

Question 27

abdominal pain, board-like abdomen, loss of bowel sounds, shock

Answer 27

Peritonitis

Question 28

Peritonitis

Answer 28

abdominal pain, board-like abdomen, loss of bowel sounds, shock

Question 29

abnormal passageway between body structures like bladder and bowel

Answer 29

Fistula

Question 30

Fistula

Answer 30

abnormal passageway between body structures like bladder and bowel

Question 31

due to inflamed diverticula eroding areas adjacent to arterial branches

Answer 31

Massive rectal bleeding

Question 32

Massive rectal bleeding

Answer 32

due to inflamed diverticula eroding areas adjacent to arterial branches

Question 33

Symptoms are less pronounced in an older adult May not have abdominal pain until infections occurs Overlook blood in the stool because they cannot see it due to visual changes, physical inability to inspect stools, or fear of knowing what blood is from

Answer 33

Gerontological Considerations:

Question 34

Rest, analgesic meds, antispasmodic agents Clear diet until inflammation subsides High fiber, low fat diet: increases stool volume, decreases colonic transit time, increases intraluminal pressure Antibiotics x 7-10 days Bulk-forming laxative NO seeds

Answer 34

Dietary and Pharmacologic Management:

Question 35

Dietary and Pharmacologic Management:

Answer 35

Rest, analgesic meds, antispasmodic agents Clear diet until inflammation subsides High fiber, low fat diet: increases stool volume, decreases colonic transit time, increases intraluminal pressure Antibiotics x 7-10 days Bulk-forming laxative NO seeds

Question 36

For older adults, immunocompromised or taking corticosteroids

Answer 36

Acute diverticulitis: Inpatient hospitalization: For

Question 37

NPO, IV fluids, NG suctioning if vomiting or distention, put on bowel rest Broad spectrum antibiotics x 7-10 days Opioids or other analgesics for pain Oral intake increased as: symptoms subside Probiotics: to restore normal flora

Answer 37

Acute diverticulitis:

Question 38

Propantheline bromide: antimuscarinic agent for cramps, stomach spasms and intestines Oxyphencyclimine (Daricon) – antimuscarinic and anticholinergic

Answer 38

Acute diverticulitis: Antispasmodic agents:

Question 39

Acute diverticulitis: Antispasmodic agents:

Answer 39

Propantheline bromide: antimuscarinic agent for cramps, stomach spasms and intestines Oxyphencyclimine (Daricon) – antimuscarinic and anticholinergic

Question 40

Needed immediately for: perforation, peritonitis, hemorrhage or obstruction Use CT guided percutaneous drainage for abscess formation without peritonitis, hemorrhage or obstruction IV Antibiotics

Answer 40

Surgical Management:

Question 41

Surgical Management:

Answer 41

Needed immediately for: perforation, peritonitis, hemorrhage or obstruction Use CT guided percutaneous drainage for abscess formation without peritonitis, hemorrhage or obstruction IV Antibiotics

Question 42

inflamed area is removed, then end to end anastomosis is completed

Answer 42

One stage resection surgery

Question 43

inflamed area is removed, then end to end anastomosis is completed

Answer 43

One stage resection surgery

Question 44

Multiple stage procedure surgery

Answer 44

More likely on diseased colon Resection with anastomosis Bowel is brought to abdominal wall and the distal end is closed over and left in the abdomen = colostomy Re-anastomosed later if possible