L14: Diverticular Diseases Flashcards
Def of Diverticula
- Sac-like blind pouches that protrude from the gastrointestinal wall and communicate with the lumen
Def of Diverticulosis
The presence of multiple diverticulae without Evidence of infection
Def of Diverticulitis
Inflammation or infection of diverticula
Types of Diverticula
- Congeinatal
- Acquired
Nature of Congenital Diverticula
True diverticulum
What is a true Diverticula?
Affects al 3 layers of the gut
(Includes the muscles)
Examples of True Diverticula
- Meckel diverticulum
- Appendix
Nature of Pulsion diverticulum
False diverticulum or Pseudodiverticulum
What does Pulsion diverticulum affect?
- Involves only mucosa & submucosa
- Does not contain muscular layer (through the muscles)
- They cannot evacuate themselves > stasis, infection & complications.
Types of Acquired diverticula
Pulsion & Traction
Examples of Pulsion diverticulum
Colonic diverticulum
Causes of Traction diverticulum
Due to Traction on gut wall by nearby Fibrosis
Examples of Traction diverticulum
TB lymphadenitis
Site of diverticulua
Pharyngeal diverticulae
Zenkerβs diverticulum (Pharyngeal pouch).
Esophageal Diverticula
- Congenital diverticulum.
- Pulsion diverticulum.
- Traction diverticulum.
Stomach diverticulua
Gastric diverticulum.
SI diverticulua
- Duodenal.
- Jejunal and ileal.
- Meckel diverticulum.
Colonic diverticulua
- Caecal diverticulum.
What is the most common site of diverticulua?
Sigmoid
MCQ
diverticulua can occur anywhere but β¦β¦.
Rectum
MCQ
What is another name of Diverticular Disease of Colon?
Diverticulosis Coli
Type of Diverticular Disease of Colon
Acquired pulsion diverticula
Mechanism of Diverticular Disease of Colon
Fibers & Diverticular Disease of Colon
Where do Diverticular Disease of Colon originate?
Site of Diverticular Disease of Colon
(Organs)
Number of Diverticular Disease of Colon
Type of Patient in Diverticular Disease of Colon
What diet is associated by Diverticular Disease of Colon?
- Common in western countries (American,European) > Low residue diet.
- Rare in African, Asian > Natural Fibers.
Stages of Diverticular Disease of Colon
- Non Complicated Diverticular Disease (Diverticulosis)
- Acute Divertuculitis
- Chronic Divertuculitis
Non Complicated Diverticular Disease of Colon
Acute divertuculitis
Chronic Diverticulitis
Complications of Diverticular Disease of Colon
- Perforation
- Chronic intestinal obstruction
- Fistula formation
- Hemorrhage
Complications of Diverticular Disease of Colon
- Perforation
Obstruction of neck of diverticula -> Progressive inflammation -Β» Perforation (Localized βAbscessβ OR generalized peritonitis)
Complications of Diverticular Disease of Colon
- ## Chronic Intestinal Obstruction
Recurrent acute diverticulitis & chronic diverticulitis -Β» Colonic fibrosis & stricture -> Large intestinal obstruction
Complications of Diverticular Disease of Colon
- Fistula Formation
- External > Colocutaneous fistula
- Internal β> Colovesical - Colovaginal - Coloenteric
Complications of Diverticular Disease of Colon
- Hemorrhage
CP of Uncomplicated diverticulosis
Investigations in Uncomplicated diverticulosis
- Barium enema
- Sigmoidscopy
- CT
Bariam in Uncomplicated diverticulosis
- The best investigation
- Appearas Multiple globular shadows (outpouchings) in relation to the colon
- Sometimes no diverticula are seen, but only saw teeth appearance of the βpre diverticular stateβ due to segmental spasm.
Sigmoidoscopy in Uncomplicated diverticulosis
- Gives little information apart from narrowing of Lumen
- Recommended to exclude malignancy
CT in Uncomplicated diverticulosis
May be helpful
TTT of Uncomplicated diverticulosis
CP of Uncomplicated diverticulitis
Symptoms:
- As appendicitis, But pain starts at umbilicus & then localizes in the left iliac fossa
Signs:
1. Temperature high
2. Tenderness & rigidity in left iliac fossa
3. Tenderness on P/R
INVx of Uncomplicated diverticulitis
TTT Options in Uncomplicated diverticulitis
- Conservative
- Surgical
Consercative TTT of Uncomplicated diverticulitis
Oschner-Sherren Regimen
What to do when acute attack of Uncomplicated diverticulitis subsides?
What to do after 6 weeks of discharge of a patient with Uncomplicated diverticulitis?
Indications of Surgical Managment Uncomplicated diverticulitis
In recurrent acute - persistent chronic diverticulitis.
Options of Surgical TTT of Uncomplicated diverticulitis
- One stage resection
- Reilly sigmoid myotomy:
What is the ideal surgery option of Uncomplicated diverticulitis?
One stage resection
Reilly sigmoid Myotomy
Types of myotomy
CP of Perforation of DDC
Investigations in Perforation of DDC
Managment of Perforation of DDC
Managment of Stage I Perforation of DDC
managment of Stage II of Perforation of DDC
Managment of Type III Perforation of DDC
managment of Stage IV Perforation of DDC
Surgical TTT of Perforation of DDC
All of the following procedures must be accompanied by drainage of abdomen.
- 1 Stage
- 2 Stage
- 3 Stage
One Stage Procedure
Iry resection anastomosis of inflamed bowel after on table lavage of colon
Two Stage Procedure in Perforation of DDC
Three Stage Procedure in Perforation of DDC
Complications of 1 stage Procedure for Perforation of DDC
Especially in Lt Side
- Carries high risk of leakage from anastomotic line.
- With fatal faecal peritonitis & fistula
Causes of Complications of 1 stage Procedure for Perforation of DDC
- High bacterial contents.
- Poor vascularity (Vasa recta are end arteries)
- Thin wall of large gut (Longitudinal muscle layer being condensed in 3 strips taenia coli)
- Incomplete serous covering
Intestinal Obstruction is missing β-> Study From Notes
Types of Fistula of DDC
Investigations of Fistula of DDC
Barium Enema in Fistula of DDC
Precise delineation of fistula occ3urs in only 30% of cases.
Colonoscopy in Fistula of DDC
Limited to use due to Low diagnostic vields (20%)
Cystography in Fistula of DDC
Limited to use due to Low diagnostic vields (20%)
Cystoscopy of Fistula of DDC
The highest diagnostic yield (80-95%)
CT in Fistula of DDC
Useful in diagnosing Colo-vesical fistula with accuracy approaching that of cystcscopy
TTT of Fistula of DDC
CP of Bleeding DDC
Investigations of Bleeding DDC
TTT algorithm in Bleeding DDC
TTT Options of Bleeding DDC
- Conservative
- If Conservative Fails
Conservative TTT of Bleeding DDC
TTT of Bleeding DDC if conservative TTT Failed
Types of Esophageal Divertula
TTT of Bleeding DDC in severe Diverticular Bleeding
Etiology of Mid-thoracic diverticula
Pathology of Mid-thoracic diverticula
CP of Mid-thoracic diverticula
Investigations for Mid-thoracic diverticula
TTT of Mid-thoracic diverticula
Etiology of Epiphrenic diverticulum
Pathology of Epiphrenic diverticulum
CP of Epiphrenic diverticulum
Investigations for Epiphrenic diverticulum
TTT of Epiphrenic diverticulum
Etiology of Gastric Diverticula
Usually Congenital
Pathology of Gastric Diverticula
Number: Itisusually solitary.
Site: occurs mainly in posterior surface of cardia or fundus
CP of Gastric Diverticula
Investigations for Gastric Diverticula
- Upper GIT endoscopy.
- Barium meal
TTT of Gastric Diverticula
If Symptomatic: Removed either open or laparoscopically.
Types of Intestinal Diverticula
Etiology of 1ry Duedonal Divertucla
Pulsion diverticulae
Pathology of 1ry Duedonal Divertucla
CP of 1ry Duedonal Divertucla
Investigations for 1ry Duedonal Divertucla
- Upper GIT endoscopy.
- Barium meal
TTT of 1ry Duedonal Divertucla
Etiology of Jejunal & Ileal diverticula
Pulsion diverticuluae due to Motility disturbance of involved intestine
Pathology of Jejunal & Ileal diverticula
Type of Patient in Jejunal & Ileal diverticula
CP of Jejunal & Ileal diverticula
Investigations for Jejunal & Ileal diverticula
Barium follow through (the most important).
TTT of Jejunal & Ileal diverticula
- Conservative
- Surgical
Conservative TTT of Jejunal & Ileal diverticula
Surgical TTT of Jejunal & Ileal diverticula
Doneeee
β¦.