Mod 5-4 LB Diverticula

Question 1

The conditions of __________ and __________ are referred to as diverticular disease.

Answer 1

diverticulosis; diverticulitis

Question 2

What is diverticular disease?

Answer 2

An extremely common condition characterized by the presence of small outpouchings or diverticulae of the wall of the large intestine.

Question 3

Where can diverticula occur?

Answer 3

Any portion of the GI tract with the exception of teh mouth. However, diverticula are much more prevalent in teh large bowel.

Question 4

What is the cause of diverticula?

Answer 4

The exact cause is unknown. May be congenital but more often it is acquired.

Question 5

Diverticula becomes more common with ____ and appears to what?

Answer 5

age; run in families

Question 6

Why is the diet of those in North America thought to be a major factor of diverticula?

Answer 6

• Because it is low fiber and higher in refined food products.
• Much less prevalent in underdeveloped countries where highly refined food products are unavailable.

Question 7

When there is inadequate bulk in the diet, the bowel tends to become irritable and spastic. When sections of the bowel go into spasm, what happens?

Answer 7

The area between the spasms may be subjected to very high pressure, causig small areas of the bowel to bulge out. The bulges become diverticulae and permanent.

Question 8

Define diverticulum

Answer 8

• single defect
• a single outpouching of bowel wall

Question 9

Define diverticulae

Answer 9

• multiple defects
• multiple outpouchings

Question 10

Define diverticulosis

Answer 10

• Having defects.
• Presence of multiple diverticula.
• Does not imply a pathology.

Question 11

Define diverticulitis

Answer 11

• infected or inflamed diverticulae
• Inflamation and infection of one or more diverticulum

Question 12

What will the clnical picture depend on with diverticla?

Answer 12

On whether the patient has diverticulosis or diverticulitis

*symptoms also very considerably from patient to patient.

Question 13

Diverticulosis may be asymptomatic. T/F?

Answer 13

True

Question 14

What are some symptoms of diverticulosis

Answer 14

• Cramping (chronic or intermittent lower left quadrant)
• Comstipation
• Diarrhea
• Stool sample will most likely be guaiac (negative)

Question 15

What are some symptoms of diverticulitis?

Answer 15

• Acute abdominal pain
• Fever
• Chills
• Tachycardia
• Nausea and vomiting
• Develops over hours to days
• Left lower quadrant pain
• anorexia
• Rebound tenderness with a palpable mass
• Blood in stool (guaiac positive)

Question 16

How does diverticula appear when imaging during a barium enema?

Answer 16

The outpouchings appear as round or oval collections of barium projecting beyond the confines of the bowel lumen.

Question 17

What are typical sizes of diverticula?

Answer 17

They vary from barely visible to giant tics of up to 25 centimeters in diameter.

Question 18

Where are most diverticula seen?

Answer 18

In the sigmoid colon

Question 19

What characteristic will multiple ‘tics produce?

Answer 19

A saw-tooth configuration

Question 20

___________ is considered a complication of diverticulosis.

Answer 20

Diverticulitis

Question 21

What will happen occasionally when diverticulum becomes inflamed and perforates?

Answer 21

Commonly creates a pericolic abscess.

Question 22

The inflammatory process of diverticulitis can extend to what?

Answer 22

To involve adjacent ‘tics, resulting in teh creation of a longitudinal sinus tract along the wall of the bowel.

Question 23

What is a common complication of diverticulitis?

Answer 23

The formation of fistulas to adjacent organs.

Question 24

Where might fistulas form in diverticulitis?

Answer 24

• bladder
• vagina
• ureter
• small bowel

Question 25

What must be present to make a radiographic diagnosis of diverticulitis?

Answer 25

Evidence that a diverticulum has perforated because extravasation of barium is the most reliable sign of perforation.

Question 26

Escaped barium from the tip of a diverticula or collected in a percolic abscess will be visualized _______ ___ _____ of the bowel, free in the peritoneum of the abdomen, which means that bowel content has escaped into the ______ ______ when the diverticula ruptured.

Answer 26

outside the lumen; peritoneal cavity

*This is a major complication

Question 27

What is a more common radiographic sign, but perhaps more confusing?

Answer 27

• The presence of a narrowed segment of bowel with or without the demosntrated prsence of a divertiucula.
• Narrowing represents a filling defect caused by edema generated by the inflammatory process and may mimic bowel cancer.

Question 28

Are there radiographic markers that indicate narrowed lumen representing diverticula abscess rather than cancer?

Answer 28

Yes, but those markers are beyond this discussion.

Question 29

What is given to control inflamation and infection of __________.

Answer 29

Antiobiotics are given; diverticulitis

Question 30

What must be done when an abscess has been identified?

Answer 30

• Drainage via CT or ultrasound may be necessary.
• Surgery may be required if peritonitis develops or patient fails to improve after several days of treatment or there is a recurrence.

Question 31

What is the effect of radiographic technique on diverticular disease?

Answer 31

There is no effect