GI-Divertic&Hpylori Flashcards
What is common contained microperforation of your colon in Western Civil, developed world, increase w/ age, ASx, rise 2-4 rows on mesenteric side?
Diverticulosis
Size 5mm- very large
Parallel rows
Not all layers
What is relationship of blood vessels and polyps?
Occurs where blood vessel pop through colon wall
Vascular penetration MC
Pseduo diverticula- go through MSK/Omenta tenia (straight line on colon) wall
Why are diverticula common on L side?
Passage way of bowel
L/t semi colon
But ASIANs- R SIDE
Why is elastin likely cause instead of atherosclerosis?
more elastin in your colon, your colon will squeeze more and then the pressure gets higher and then they get pockets
High risk:
Marfans
Ehlers-Danlos
Which patient have higher risk of Diverticulous?
High motility
slow transit- corn
Wynne-Jones: westernized urban lifestyle “impressive of flatus”_air retention _ Squeeze more increased intraluminal pressures w/ tic formation
Does low fiber diet inc. risk of diverticulous?
NO- But higher fiber dec complication of TICS
Inc. transit time- mouth to anus
Brits longer
Ugandas shorter time
Seed and nuts= fine, protective, less risk
Genetic risk
LESS RISK <4serving red meat/wk >23g fiber/day >2hr vig/wk BMI 18.5-24.9 NO smoking
How does posture during defecation increase the risk of DD?
Sitting during defecation
Western type toilet
To optimize the anorectal angle, placing a footstool
Does Incidentally discovered diverticulosis require intervention or treatment?
Pt asymptomatic is MC, uncomplicatd
NO EBM treat
Suggest INC fiber diet and stool
Mr. Stool has lower abdominal symptoms w/ INC markers of inflammation but absent overt vital signs, labs, CT.
LABS- INC CRP, ESR, RBCW, lactate dehydrogenase (LDH), sunstance P, TNF INC.
Symptomatic Uncomplicated Diverticular Disease (SUDD)
D/T;
Tic damaging nerves- visceral hypersensitivity
INC intraluminal pressure
MSK hypertrophy tinea
Microbiota changes
What is management for SUDD
EBM
Fiber +
Cyclic Rifaximin- 400mg BID, 7 d/month, oral abx that is absorbed in the colon
NO good data for probiotics
What is treatment for ulcerative colitis and SUDD?
Mesalamine- BUT Doesn’t help SUDD or AD
What is condition when result of perforation of a single diverticulum, d/t obstruction by thicken stool?
Complicated diverticulosis – Diverticulitis
Inflammation/ infection associated w/ diverticula fecolith impacted.
Bacteria breach mucosa L/t perforation
Thicken wall of colon inc. risk
Like chittlng, wall normal thin**
What should be checked for PE w. suspected CDD?
LLQ,- Pain and tenderness, No localized bc innervation isn’t consistent in colon.
Asians RLQ suprapubic. ROS- Altered bowel habits, N/A/V RARE Hematochezia- bright red blood per rectum (BRBPR) Fever MC INC WBC common;
What ROS regarding urination is special with CDD?
Dysuria: sympathetic cystitis
If the issue is sigmoid, it will irritate the bladder and cause you to urinate a lot
What are Lower Abdomin pain DDX?
i. Acute Appendicitis
ii. Crohn’s Disease
iii. Colonic carcinoma
iv. Pseudomembranous or ischemic colitis
v. Ovarian cyst / abscess / torsion
vi. Ectopic pregnancy
What will help to confirm DX of CDD?
CT
Abd, Pelvic scans; oral / rectal / IV contrast
RESULTS- pericolic infiltration of fatty tissues, wall thickening, abscess
Severity predict prognosis
Who get admitted for CDD?
PT 1- 67 yo immunosuppressed, comorbid illness, or high WBC, fevers
or
PT 2-45 yo Mild symptoms, no peritoneal signs, tolerating POs
Elderly, immunosuppressed, comorbid illness, or evidence of severe disease (high WBC or fevers):
What is most important with treating DD with RX?
Selectively….+/- ABX for Pt only confirmed w/ CT and complicated DD S
cover gut organisms -GNRs, anaerobes, E. coli
ii. ++Augmentin, Bactrim T/S or ciproflozin+ flagyl
iii.IV: 1.aminoglycoside/2. aztreonam/3. 3rd gen ceph + metronidazole or clindamycin.
++Unasyn
RX- 7-10 days
+-MAYBE
What is the only way to stop reoccurence?
Surgery- especially for 2-4th occurrence
EBM- Colectomy after fourth (rather than 2nd) episode
AFter resolution of sx- complete colonic to R/O cancer
What is phlegmon/abscess extends or ruptures into adjacent organ, w/ One organ connecting another organ?
Complicated diverticulosis Fistulas
TX- Surgery resection/closure
What happens when pocket pops and collection of pus
Complicated diverticulosis (Abscess)- fever or WBC
ED- CT
TX- Stage 1 small non surgical
Stage 2- CT-guided percutaneous drainage
What is MC of Lower gastrointestinal bleeding LGIB where Arterial bleed from vasa recta coursing over dome of tic? What inc risk?
Complicated diverticulosis Hemorrhage I
Bleed often from R side tic
RISK-NSAID use- abd pain, cramp, upset stomach ticking time bomb.
Ms. Alexis has abrupt, painless of maroon / red blood or clot, w/ Mild lower abd cramps and urge to defecate?
Complicated diverticulosis Hemorrhage II
RARE w/ DD
Surgery- recurrent
What bacteria is a major cause factor in peptic ulcer disease, gastric cancer, and gastric MALT lymphoma?
H. Pylori
Gram NEG
Curved, spiral
Flagella
