FN: Divertivular disease Flashcards

1
Q

Diverticulum

A

Out-pouching of tubuar structure

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2
Q

True diverticulum

A

Composed of complete wall (e.e. Meckels)

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3
Q

False diverticulum

A

Composed of mucosa only (pharyngeal, colonic)

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4
Q

Diverticular disease

A

Symptomatc diverticulosis

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5
Q

Diverticulitis

A

Inflammation of diverticular

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6
Q

Epi

A

30% westerners have diverticulosis by 60yrs

F>M

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7
Q

Path

A
  1. Association with raised intraluminal pressure - low fibre diet: n osmotic effect to keep stool wet
  2. Mucosa herniates through muscularis propria at points of weakness where perforating arteries enter
  3. Most commonly loacted in sigmoid colon
  4. Commoner in obese pts.
    - -> Uniting factors in Saints triad
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8
Q

Saints triad

A

Hiatus hernia
Cholelithiasis
Diverticular disease

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9
Q

Symptoms of Diverticular disease

A
  1. Altered bowel habit ± left-sided colic - relieved by defecation
  2. Nausea
  3. Flatulence
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10
Q

Rx

A

High fibre diet, mebeverine may help

Elective resectino for chronic pain

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11
Q

Diverticulitis

A

Inspissated faeces - obstruction of diverticulum

Elderly pt. with previous Hx of constipation

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12
Q

Presentation

A

Andominal pain and tenderness

  • typically LIF
  • Localised peritonitis

Pyrexia

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13
Q

Investigations

A

Bloods
Imaging
Endoscopy

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14
Q

Bloods shows

A

Raised WCC
Raised CRP/ESR
Amylase
G+S/x-match

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15
Q

Imagng

A

Erect CXR: look for perforation
AXR: fluid level/air in bowel wall
Contrast CT
Gastrogaffin enema

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16
Q

Endoscopy

A

Flexi sig

ColonoscopyL not in acute attack

17
Q

Grading system

A

Hinchey grading

18
Q

Managemt of acute Diverticulitis

A

Mild attacs
Admit if
Medical
surgical

19
Q

Mild attacks Rx

A

Can be treated at home with bwel rest (luids only) and augmentin ! metronidazole

20
Q

Admit if

A

Unwell
Fluids cnat be tolerated
Pain cant be controlled

21
Q

Medical Rx

A
NBM
IV fluids
Analgesia
Antibiotics: cefuroxime + metronidazole
Most cases settle
22
Q

Surgical indications

A

Perforation
Large haemorhage
Stricture - obstruction

23
Q

Surgical procedure

A

Hartmanns to resect disease bowel

24
Q

Other Complications

A
Perforation
Haemorrhage
Abscess
Fistulae
Strictures
25
Q

Perforation

A

sudden onset pain ! preceding diverticulitis

Generalised peritonitis and shock

26
Q

CXR perforation

A

Free air under diaphragm

27
Q

Perforation Rx

A

Hartmanns

28
Q

Haemorrhage

A

Sudden, painless bright red PR bleed

29
Q

Investigations for Haemorrhage

A

Mesenteric angiography or colonoscopy

30
Q

Treatment of Hemorrhage

A
Usually stops spontaneously
May need transfusion
Colonscopy ± diathermy/adrenaline
Embolisation
Resection
31
Q

Abscess

A

Walled off perforation
swinging fever
Localising signs e.g. boggy rectal mass
Leukocytosis

32
Q

Treatment of abcess

A

Abx +CT/US-guided drainage

33
Q

Fistulae

A

Enterocolic
Colovaginal
Colovesicular: pneumaturia + intractable UTIs

34
Q

Fistulae Rx

A

Resection

35
Q

Strictures

A

After diverticulitis, colon may heal with fibrous strictures

36
Q

Stricture management

A

Resectio (usually with primary anastomosis)

Stenting