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Surgery M4 part 2 > Colonic Diverticula > Flashcards

Colonic Diverticula Flashcards

1
Q

What are the types of colonic diverticula?

A
  • congenital/true -> all layers (Meckle’s diverticulum)

- aquired/false -> only mucosa & submucosa (sigmoid colon)

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2
Q

What are the causes of diverticula in the colon?

A
  • diet low in fiber & rich in fat & red meat
  • obesity
  • low physical activity
  • chronic constipation
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3
Q

What is the pathophysiology of colonic diverticula?

A
  • increased intraluminal pressure
  • altered collagen structure with aging (>60)
  • weakness of intestinal wall (occurs in the gaps where the blood vessels penetrate)
  • in sigmoid colon most common: highest pressure & narrowest lumen
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4
Q

What is the clinical presentation of colonic diverticula?

A
  • asymptomatic
  • distention
  • flatulence
  • heaviness in left iliac fossa
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5
Q

When should colonoscopy be used?

A

only if symptomatic

- diffuse diverticulosis

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6
Q

How is colonic diverticula managed?

A
  • no treatment unless symptoms are severe -> sigmoidectomy
  • prevention of progression
  • > high fiber diet
  • > physical activity
  • > bulk-forming laxative
  • > antispasmodics
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7
Q

What are the complications of colonic diverticula?

A
  • hemorrhage
  • diverticulitis
  • abscess
  • peritonitis
  • fistula -> colovesical
  • intestinal obstruction
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8
Q

What is the presentation of diverticulitis?

A
  • persistent LIF pain
  • fever
  • diarrhea or constipation
  • hematochezia
  • tender palpable LIF mass
  • shock & peritoneal signs: perforation peritonitis
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9
Q

What is the classification of diverticulitis?

A

GRADE I -> mesenteric or pericolic abscess
GRADE II -> pelvic abscess
GRADE III -> purulent peritonitis
GRADE IV -> faecal peritonitis

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10
Q

What workups should be done for diverticulitis?

A
  • CBC
  • CRP
  • if shock: ABG, LFT, coagulation
  • abdominal x-ray -> if perforation pneumoperitoneum
  • CT abdomen & pelvis with IV contrast
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11
Q

How is mild diverticulitis (Hinchey 0-1) managed?

A
  • > antibiotics (ciprofloxacin + metronidazole)
  • > analgesics
  • > NPO or clear fluid diet for 48 hours then low fiber diet till recovery
  • > colonoscopy 6-8 weeks after recovery
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12
Q

How is Hinchey 2 (abscess ) managed?

A
  • percutaneous drainage if abscess is >4-5cm
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13
Q

How is Hinchey 3-4 (peritonitis) managed?

A
  • urgent surgery
  • Hartmann’s procedure -> sigmoidectomy + end colostomy
    mortality rate 50%
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14
Q

How is recurrent diverticulitis treated (0-2)?

A
  • elective sigmoidectomy with colorectal anastomosis (laparoscopic)
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15
Q

What is the presentation of a colovesical fistula?

A
  • fecaluria
  • pneumaturia
  • recurrent UTI
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16
Q

What is the presentation of colovaginal fistula?

A
  • common after hysterectomy

- vaginal gas/fecal emission

17
Q

What will a retroperitoneal fistula lead to?

A

psoas abscess

Surgery M4 part 2 (36 decks)

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