Surgery - Diverticula disease Flashcards

1
Q

> 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

A

b.diverticulitis

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2
Q

diverticulosis

A

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

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3
Q

diverticulitis

A

inflamed/infected diverticula

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4
Q

where are most diverticula found

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

A

a.sigmoid colon

(LHS of tummy pain)

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5
Q

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

A

bladder
small bowel

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6
Q

causes of diverticulitis

A

low fibre diet
low collagen and motility of bowel

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7
Q

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

A

diverticulitis

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8
Q

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

A

e.emergency surgery

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9
Q

classification of diverticula

A

hinchey classification

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10
Q

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

A

a.1a

no operation

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11
Q

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

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

A

b.1b

no operation

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12
Q

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

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

A

d.3

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13
Q

patient with diverticulitis with peritonitis what hinchey classification is this

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

A

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

surgical intervention needed

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14
Q

at what hinchey classification is the threshold for surgery

A

greater than 2

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15
Q

investigation first for suspected diverticulitis

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

A

a.WCC

raised

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16
Q

investigation second for suspected diverticulitis

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

A

b.CT pelvis and abdo with contrast

will see..

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

17
Q

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

A

e.emergency surgery

18
Q

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

A

c.colonoscopy

wait 6 weeks after acute attack to avoid perforation risk

19
Q

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

A

a.high fibre diet and bulk forming laxative

20
Q

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

A

b. IV antibiotics

thn resus and analgesia
antispasmodics
rest and fluids only

21
Q

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

A

hartmanns procedure

22
Q
A
23
Q

complications of diverticula

A

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