14. Diverticular Disease

Question 1

Outpouchings of the colon

Answer 1

Diverticulosis

Question 2

Etiology of diverticulosis.

Answer 2

Abnormal intermittent high pressure in the colon.

Question 3

Weakest point of the colon.

Answer 3

Vasi recti

*common location for diverticula

Question 4

Where do diverticula occur?

Answer 4

At the point where the artery penetrates the muscle wall, resulting in a break in the integrity of the colonic wall.

• Think “hernia”-but not actually

Question 5

What is the difference between false diverticulum and true diverticulum?

Answer 5

False: only a protrusion of the mucosa and submucosa through the muscle wall.

True: Saclike herniatior of the ENTIRE bowel wall

Question 6

What is the primary function of the colon?

Answer 6

• Reabsorb WATER + SODIUM
• Secrete POTASSIUM + BICARBONATE
• Store FECAL MATERIAL

Question 7

Which part of the colon is retroperitoneal?

Answer 7

ASCENDING and DESCENDING

Question 8

Which part of the colon is intraperitoneal?

Answer 8

TRANSVERSE and SIGMOID COLON

Question 9

The SMA supplies blood to the:

Answer 9

CECUM, ASCENDING, and TRANSVERSE colon

Question 10

The IMA supplies blood to:

Answer 10

LEFT COLIC, SIGMOID, and SUPERIOR HEMORRHOIDAL ARTERIES

Question 11

What is causing diverticulosis around the world?

Answer 11

Poor diet.

*NEED TO EAT MORE FIBER

Question 12

When is diverticulosis diagnosed?

Answer 12

Routine colonoscopy screening.

*No Sx

Question 13

1st step after diagnosing diverticulosis.

Answer 13

HIGH-FIBER DIET!

Question 14

What is the most common cause of lower GI bleeding in the colon?

Answer 14

Diverticulosis

Question 15

What is the standard protocol for diverticulosis?

Answer 15

Monitor

* Most are self limiting

Question 16

Inflammatory condition caused by perforation of one of the sacs.

Answer 16

Diverticulitis

Question 17

Complications of diverticulitis.

Answer 17

• Abscess
• Perforation
• Stricture
• Fistula
• Rectal bleeding or hemorrhage

Question 18

A patient presents with ACUTE ONSET OF LLQ ABDOMINAL PAIN. Think:

Answer 18

Diverticulitis

Question 19

A patient presents with generalized peritonitis and abdominal distension, this is and indication of:

Answer 19

Perforation

*SEVERE PAIN!

Question 20

An abnormal connection between two epitheliazed surfaces.

Answer 20

Fistula

Question 21

This type of fistula may present with pneumaturia, fecaluria, pyuria, or UTI symptoms.

Answer 21

Colovesical fistula: common

Question 22

This type of fistula may present with stool passing through the vagina.

Answer 22

Colovaginal fistula.

Question 23

This type of fistula may present with malabsorption/diarrhea.

Answer 23

Coloenteric

Question 24

These usually result from recurrent inflammation resulting in lumen narrowing. May present as large bowel obstruction.

Answer 24

Stricture

Question 25

Diagnostic image of choice for diverticulitis diagnosis.

Answer 25

CT scan of abdomen/pelvis

Question 26

What might you see on a CT scan of diverticulitis?

Answer 26

Pericolic fat infiltration, thickened colon wall, fat stranding.

Question 27

What might you see on a complicated diverticulitis CT scan?

Answer 27

Abscess Stricture Fistula Free air if perforated

Question 28

What is another exam of choice after diverticulitis attack?

Answer 28

Colonoscopy * Exclude colon cancer or confirm diagnosis of complicated diverticulitis * 6 weeks after attack

Question 29

Tx for uncomplicated diverticulitis

Answer 29

Empiric antimicrobial therapy | *Cipro & Metronidazole

Question 30

Diverticulitis tx for inpatient

Answer 30

IV antibiotics and IV analgesics

Question 31

Options for preventing recurrence of diverticulitis

Answer 31

Dysbiosis (microbial imbalance in the body)> Probiotics

Question 32

A perforated diverticulitis with a confined parabolic abscess. Stage?

Answer 32

Stage 1

Question 33

Perforated diverticulitis that has closed spontaneously with distant/larger abscess formation. Stage?

Answer 33

Stage II

Question 34

Perforated diverticulitis with purulent peritonitis. Stage?

Answer 34

Stage III

Question 35

Perforation and free communication with the peritoneum, resulting in fecal peritonitis. Stage?

Answer 35

Stage IV

Question 36

Stage I and II management.

Answer 36

Managed with antibiotics + percutaneous drainage of abscess. | *Resection 6+ wks later. Abscess >3cm can be drained

Question 37

Hinchey II & IV management

Answer 37

Directly to surgery

Question 38

Surgical management goals for diverticulitis.

Answer 38

1) Control SEPSIS 2) Eliminate complications 3) Remove diseased segment 4) Restore continuity