Surgery - Diverticula disease

Question 1

> 40 yrs patient with pain over the lower abdomen, gradual onset sharp pain patient also has bleeding from the back passage , tender left iliac fossa ,what likely

a.bowel cancer
b.diverticulitis
c.haemorrhoids
d.coeliac

Answer 1

b.diverticulitis

Question 2

diverticulosis

Answer 2

common and normal prescence of diverticula (thin outpouchings with no muscularis layer)

Question 3

diverticulitis

Answer 3

inflamed/infected diverticula

Question 4

where are most diverticula found

a.sigmoid colon
b.transverse colon
c.small bowel
d.large bowel

Answer 4

a.sigmoid colon

(LHS of tummy pain)

Question 5

diverticula that are inflammed can perforate and form fistula to ..

Answer 5

bladder
small bowel

Question 6

causes of diverticulitis

Answer 6

low fibre diet
low collagen and motility of bowel

Question 7

persistent left iliac fossa pain, patient reports bright red blood in stools , examination shows distention and tenderness on DRE

Answer 7

diverticulitis

Question 8

if patient has all signs of diverticulitis but on exam shows generalised peritonitis what should be done

a.bloods
b.CT pelvis abdo with contrast
c.colonoscopy
d.IV antibiotics
e.emergency surgery

Answer 8

e.emergency surgery

Question 9

classification of diverticula

Answer 9

hinchey classification

Question 10

patient with diverticulitis with mild inflammation and a contained abcess what hinchey classification is this

a.1a
b.1b
c.2
d.3
e.4

Answer 10

a.1a

no operation

Question 11

patient with diverticulitis with an abcess <4cm what hinchey classification is this

a.1a
b.1b
c.2
d.3
e.4

Answer 11

b.1b

no operation

Question 12

patient with diverticulitis with an abcess >4cm localised what hinchey classification is this

a.1a
b.1b
c.2
d.3
e.4

Answer 12

d.3

Question 13

patient with diverticulitis with peritonitis what hinchey classification is this

a.1a
b.1b
c.2
d.3
e.4

Answer 13

d.3 - liquid discharge
e.4- faecal discharge

surgical intervention needed

Question 14

at what hinchey classification is the threshold for surgery

Answer 14

greater than 2

Question 15

investigation first for suspected diverticulitis

a.WCC
b.CT pelvis and abdo with contrast
c.colonoscopy
d.aXR
e.biopsy

Answer 15

a.WCC

raised

Question 16

investigation second for suspected diverticulitis

a.WCC
b.CT pelvis and abdo with contrast
c.colonoscopy
d.aXR
e.biopsy

Answer 16

b.CT pelvis and abdo with contrast

will see..

bowel wall thickening
abcess - if yes needle to aspirate
black - diverticula
infiltrate to mesentry

Question 17

patient with suspected diverticulitis and ct abdo and pelvis shows free air in the sigmoid colon what should be done

a.bloods
b.resus and analgesia
c.colonoscopy
d.IV antibiotics
e.emergency surgery

Answer 17

e.emergency surgery

Question 18

what should be done 6 weeks post acute attack for diverticulitis

a.bloods
b.resus and analgesia
c.colonoscopy
d.IV antibiotics
e.emergency surgery

Answer 18

c.colonoscopy

wait 6 weeks after acute attack to avoid perforation risk

Question 19

first line management for diverticulitis chronic

a.high fibre diet and bulk forming laxative

b. IV antibiotics

c.resus and analgesia

d.antispasmodics

e.rest and fluids only

Answer 19

a.high fibre diet and bulk forming laxative

Question 20

first line management for diverticulitis acute attack

a.high fibre diet and bulk forming laxative

b. IV antibiotics

c.resus and analgesia

d.antispasmodics

e.rest and fluids only

Answer 20

b. IV antibiotics

thn resus and analgesia
antispasmodics
rest and fluids only

Question 21

if a patient has a 3/4 hinsheys what procedure is done in surgery

Answer 21

hartmanns procedure

Question 23

complications of diverticula

Answer 23

pain, perforation, peritonitis, intestinal obstruction, fistula, haemorrhage