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Unit 2 Clin Med III > L7: Diverticular Disease > Flashcards

L7: Diverticular Disease Flashcards

1
Q

The most common location of the Diverticulosis?

A

sigmoid colon

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2
Q

Factors that increase likelihood of Diverticulosis

A

Age

Connective tissue disorders: Marfan, Ehlers-Danlos

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3
Q

Progression of Diverticulosis

A

Low fiber diet→ constipation→ intraluminal pressure→ muscular hypertrophy→ mucosa/submucosa predisposed to herniate

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4
Q

Complications of diverticulosis

A

Bleeding

Diverticulitis

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5
Q

Presentation of diverticulosis

A

Generally asymptomatic, discovered incidentally
+/- abdominal cramping,C/D, bloating
+/-normal exam

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6
Q

How do you manage the asymptomatic diverticulosis patient?

A

High fiber diet:
0-35 g/days)
Increases stool bulk reducing work of colon for bowel movement
Adequate hydration

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7
Q

What used to be part of the treatment for asymptomatic diverticulosis, but no longer is?
(paradigm shift)

A

Avoiding seeds and nuts

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8
Q

Diverticulitis progression/pathophysiology

A

Insipissated debris obstructs the neck of the diverticulum or increased luminal pressure→ erosion of diverticular wall→ inflammation and focal necrosis→ perforation
→ microperforation
→ macroperforation→ +/- free air/peritonitis

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9
Q

A patient comes in complaining of progressive, steady, achy LLQ pain, fever, and change in bowel habits. On exam they (might) have peritoneal signs. DRE (might) show a mass or tenderness.

A

Diverticulitis

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10
Q

“Complicated” diverticulitis

A

Abscess
Fistula
Obstruction
Perforation

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11
Q

A diverticulitis patient comes in complaining of irritative urinary symptoms such as pneumaturia or fecaluria, what do they have?

A

Colovesical fistula

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12
Q

Definity don’t do these diagnostic studies for diverticulitis

A

Flex sig/colonoscopy→ risk of perforation

Barium enema→ barium leaks→ exacerbate peritonitis

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13
Q

Labs for diverticulitis

A 
CBC→ +/- mild to moderate leukocytosis (absent in elderly)
BMP/CMP 
\+/- amylase/lipase
UA/urine culture
Urine HCG
Diarrhea→ stool studies
Stool for occult blood
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14
Q

Imaging for diverticulitis

A

CT scan of A/P with contrast (test of choice)
localized bowel wall thickening (sigmoid mesocolon)/fat stranding
induration of perisigmoid fat
presence of colonic diverticular
+/- complications, other causes
findings may be difficult to distinguish from carcinoma

Abdominal/Chest xray→ nonspecific, obstruction or perforation

Ultrasound

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15
Q

Diverticulitis presentations that have to be admitted

A 
CT shows complicated
diverticulitis
Significant leukocytosis
High fever > 102.5°F
Severe or increasing
abdominal pain
Peritoneal signs
Significant comorbidities /
Immunocompromised
Inability to tolerate PO Noncompliance/unreliability/lack of support system
Failed outpatient treatment
Elderly
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16
Q

Diverticulitis that needs to be referred to surgery

A

Perforation with peritonitis
Complicated
Deteriorates or fails to improve within 72 hours of tx

17
Q

Treatment of uncomplicated diverticulitis

A

+/- Oral abx→ paradigm shift– selective vs routine use
G-/anaerobic coverage x 7-10 days
Clear liquids/low residue diets→ advance as tolerated to high fiber diet after resolution
Follow up in 2 days
Call for worsening symptom

18
Q

Treatment of complicated diverticulitis

abscess, fistula, obstruction, perforation

A

Admit→ Consult GI, surgery
NPO, IV fluids + abx→ transition to PO x 10-14 days
Analgesics
IV abx 2-3 days w/o improvement→ repeat imaging

19
Q

You’ve successfully treated your patient for diverticulitis so don’t forget to…

A

Do a Colonoscopy 6-8 weeks after tx
evaluate extent of diverticular disease exclude concomitant colon cancer or IBD
+/- Elective prophylactic colonic resection if recurrent (optional→ paradigm shift)

20
Q

Diverticular bleeding prognosis

A

usually resolves spontaneously

21
Q

Diverticular bleeding pathophysiology

A

Penetrating artery draped over dome of diverticulum→ easily exposed to injury
Usually right colon→ diverticulum are wider and more exposure of vasa recta

22
Q

Painless hematochezia=

A

Diverticular bleeding

23
Q

Presentation of diverticular bleeding

A 
*Painless hematochezia*
\+/- bloating, cramping, fecal urgency
\+/- abnormal vital signs
Normal abdominal exam +/- TTP
Blood on rectal exam
24
Q

Labs for diverticular bleeding

A

CBC→ trend H/H

BMP→ BUN/Cr should not be elevated

25
Q

Imaging to find the source of diverticular bleeding

A

Flex sig/ colonoscopy

+/-tagged RBC scan/ angiography

26
Q

You’ve done labs and found the source of diverticular bleeding but you’ve still got to do one thing

A

EGD/NG lavage→ rule out upper GI

27
Q

Diverticular bleed management

A 
Resuscitation/hospitalization
Transfusion PRN→ maintain blood volume
Treat bleeding site
1. Endoscopic therapy
2. Angiographic therapy
3. +/- surgical intervention

Unit 2 Clin Med III (9 decks)

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