Sundry Disorders of the Intestines Flashcards
colonic diverticulosis
*herniation of the mucosa and submucosa through the muscularis propria
*occurs at sites of relative weakness of the wall of the colon, where the vasa recta penetrate the muscularis propria
*most commonly seen in the sigmoid colon
complications of diverticulosis
*diverticulitis
*diverticular hemorrhage
diverticulitis - overview
*microperforation of a diverticulum at a site of mucosal erosion
*inflammatory process typically contained by pericolonic fat and omentum
diverticulitis - clinical presentation
*progressive steady LLQ abdominal PAIN & fever
*typically with altered bowel habits (constipation or diarrhea)
*leukocytosis on CBC
note - bleeding is NOT part of diverticulitis
diverticulitis - treatment
*antibiotics to cover gram negative rods and anaerobes (ciprofloxacin & metronidazole)
complications of diverticulitis
*abscess
*colovesical fistula
*stricture
note - all of these complications require surgical intervention
diverticular hemorrhage - overview
*rupture of the vasa recta associated with a diverticulum, due to thinning of the vessel wall where it crosses over the dome of the diverticulum (arterial bleeding)
*most common cause of major lower GI bleeding
diverticular hemorrhage - clinical presentation
*abrupt onset of PAINLESS hematochezia (rectal bleeding) and significant blood loss, requiring hospitalization and blood transfusion
*typically stops spontaneously with supportive care
*dx is made by colonoscopy
intestinal ischemia syndromes
*acute mesenteric ischemia
*chronic mesenteric ischemia
*ischemic colitis
celiac artery
provides arterial blood to foregut:
-stomach
-duodenum
-pancreas
-liver/GB
-spleen
superior mesenteric artery
provides arterial blood to midgut:
-jejunum
-ileum
-R colon
inferior mesenteric artery
provides arterial blood to hindgut:
-left colon (distal transverse to proximal rectum)
blood supply to rectum
branches of internal iliac artery
acute mesenteric ischemia - overview
*predominantly caused by embolic phenomena (esp in the SMA)
*embolic events are typically associated with sudden onset of severe abdominal pain
*abdominal pain is poorly localized, with severity “out of proportion to findings on physical exam”
*suspect emboli in patients in CHRONIC ATRIAL FIBRILLATION
nonocclusive mesenteric ischemia (NOMI)
*low flow state associated with hypotension, CHF, vasopressors, cocaine, and digitalis
*microvascular vasoconstriction, with patent large vessels
*pain is not as prominent as with other forms of acute mesenteric ischemia