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Y3R6: Surgery I 👨‍⚕️ > L16: Diverticular Diseases > Flashcards

L16: Diverticular Diseases Flashcards

1
Q

Def of Diverticula

A
  • Sac-like blind pouches that protrude from the gastrointestinal wall and communicate with the lumen
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2
Q

Def of Diverticulosis

A

The presence of multiple diverticulae without Evidence of infection

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3
Q

Def of Diverticulitis

A

Inflammation or infection of diverticula

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4
Q

Types of Diverticula

A
  • Congeinatal
  • Acquired
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5
Q

Nature of Congenital Diverticula

A

True diverticulum

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6
Q

What is a true Diverticula?

A

Affects al 3 layers of the gut
(Includes the muscles)

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7
Q

Examples of True Diverticula

A
  • Meckel diverticulum
  • Appendix
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8
Q

Nature of Pulsion diverticulum

A

False diverticulum or Pseudodiverticulum

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9
Q

What does Pulsion diverticulum affect?

A
  • Involves only mucosa & submucosa
  • Does not contain muscular layer (through the muscles)
  • They cannot evacuate themselves > stasis, infection & complications.
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10
Q

Types of Acquired diverticula

A

Pulsion & Traction

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11
Q

Examples of Pulsion diverticulum

A

Colonic diverticulum

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12
Q

Causes of Traction diverticulum

A

Due to Traction on gut wall by nearby Fibrosis

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13
Q

Examples of Traction diverticulum

A

TB lymphadenitis

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14
Q

Site of diverticulua

A
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15
Q

Pharyngeal diverticulae

A

Zenker’s diverticulum (Pharyngeal pouch).

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16
Q

Esophageal Diverticula

A
  • Congenital diverticulum.
  • Pulsion diverticulum.
  • Traction diverticulum.
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17
Q

Stomach diverticulua

A

Gastric diverticulum.

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18
Q

SI diverticulua

A
  • Duodenal.
  • Jejunal and ileal.
  • Meckel diverticulum.
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19
Q

Colonic diverticulua

A
  • Caecal diverticulum.
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20
Q

What is the most common site of diverticulua?

A

Sigmoid

MCQ

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20
Q

diverticulua can occur anywhere but …….

A

Rectum

MCQ

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21
Q

What is another name of Diverticular Disease of Colon?

A

Diverticulosis Coli

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22
Q

Type of Diverticular Disease of Colon

A

Acquired pulsion diverticula

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23
Q

Mechanism of Diverticular Disease of Colon

A
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24
Q

Fibers & Diverticular Disease of Colon

A
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25
Q

Where do Diverticular Disease of Colon originate?

A
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26
Q

Site of Diverticular Disease of Colon

(Organs)

A
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27
Q

Number of Diverticular Disease of Colon

A
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28
Q

Type of Patient in Diverticular Disease of Colon

A
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29
Q

What diet is associated by Diverticular Disease of Colon?

A
  • Common in western countries (American,European) > Low residue diet.
  • Rare in African, Asian > Natural Fibers.
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30
Q

Stages of Diverticular Disease of Colon

A
  • Non Complicated Diverticular Disease (Diverticulosis)
  • Acute Divertuculitis
  • Chronic Divertuculitis
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31
Q

Non Complicated Diverticular Disease of Colon

A
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32
Q

Acute divertuculitis

A
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33
Q

Chronic Diverticulitis

A
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34
Q

Complications of Diverticular Disease of Colon

A
  • Perforation
  • Chronic intestinal obstruction
  • Fistula formation
  • Hemorrhage
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35
Q

Complications of Diverticular Disease of Colon

  • Perforation
A

Obstruction of neck of diverticula -> Progressive inflammation -» Perforation (Localized “Abscess” OR generalized peritonitis)

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36
Q

Complications of Diverticular Disease of Colon

  • ## Chronic Intestinal Obstruction
A

Recurrent acute diverticulitis & chronic diverticulitis -» Colonic fibrosis & stricture -> Large intestinal obstruction

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37
Q

Complications of Diverticular Disease of Colon

  • Fistula Formation
A
  • External > Colocutaneous fistula
  • Internal —> Colovesical - Colovaginal - Coloenteric
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38
Q

Complications of Diverticular Disease of Colon

  • Hemorrhage
A
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39
Q

CP of Uncomplicated diverticulosis

A
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40
Q

Investigations in Uncomplicated diverticulosis

A
  • Barium enema
  • Sigmoidscopy
  • CT
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41
Q

Bariam in Uncomplicated diverticulosis

A
  • The best investigation
  • Appearas Multiple globular shadows (outpouchings) in relation to the colon
  • Sometimes no diverticula are seen, but only saw teeth appearance of the “pre diverticular state” due to segmental spasm.
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42
Q

Sigmoidoscopy in Uncomplicated diverticulosis

A
  • Gives little information apart from narrowing of Lumen
  • Recommended to exclude malignancy
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43
Q

CT in Uncomplicated diverticulosis

A

May be helpful

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44
Q

TTT of Uncomplicated diverticulosis

A
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45
Q

CP of Uncomplicated diverticulitis

A

Symptoms:
- As appendicitis, But pain starts at umbilicus & then localizes in the left iliac fossa

Signs:
1. Temperature high
2. Tenderness & rigidity in left iliac fossa
3. Tenderness on P/R

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46
Q

INVx of Uncomplicated diverticulitis

A
47
Q

TTT Options in Uncomplicated diverticulitis

A
  • Conservative
  • Surgical
48
Q

Consercative TTT of Uncomplicated diverticulitis

A
49
Q

Oschner-Sherren Regimen

A
50
Q

What to do when acute attack of Uncomplicated diverticulitis subsides?

A
51
Q

What to do after 6 weeks of discharge of a patient with Uncomplicated diverticulitis?

A
52
Q

Indications of Surgical Managment Uncomplicated diverticulitis

A

In recurrent acute - persistent chronic diverticulitis.

53
Q

Options of Surgical TTT of Uncomplicated diverticulitis

A
  • One stage resection
  • Reilly sigmoid myotomy:
54
Q

What is the ideal surgery option of Uncomplicated diverticulitis?

A

One stage resection

55
Q

Reilly sigmoid Myotomy

A
56
Q

Types of myotomy

A
57
Q

CP of Perforation of DDC

A
58
Q

Investigations in Perforation of DDC

A
59
Q

Managment of Perforation of DDC

A
60
Q

Managment of Stage I Perforation of DDC

A
61
Q

managment of Stage II of Perforation of DDC

A
62
Q

Managment of Type III Perforation of DDC

A
63
Q

managment of Stage IV Perforation of DDC

A
64
Q

Surgical TTT of Perforation of DDC

A

All of the following procedures must be accompanied by drainage of abdomen.

  • 1 Stage
  • 2 Stage
  • 3 Stage
65
Q

One Stage Procedure

A

Iry resection anastomosis of inflamed bowel after on table lavage of colon

66
Q

Two Stage Procedure in Perforation of DDC

A
67
Q

Three Stage Procedure in Perforation of DDC

A
68
Q

Complications of 1 stage Procedure for Perforation of DDC

A

Especially in Lt Side

  • Carries high risk of leakage from anastomotic line.
  • With fatal faecal peritonitis & fistula
69
Q

Causes of Complications of 1 stage Procedure for Perforation of DDC

A
  1. High bacterial contents.
  2. Poor vascularity (Vasa recta are end arteries)
  3. Thin wall of large gut (Longitudinal muscle layer being condensed in 3 strips taenia coli)
  4. Incomplete serous covering

Intestinal Obstruction is missing —-> Study From Notes

70
Q

Types of Fistula of DDC

A
71
Q

Investigations of Fistula of DDC

A
72
Q

Barium Enema in Fistula of DDC

A

Precise delineation of fistula occ3urs in only 30% of cases.

73
Q

Colonoscopy in Fistula of DDC

A

Limited to use due to Low diagnostic vields (20%)

74
Q

Cystography in Fistula of DDC

A

Limited to use due to Low diagnostic vields (20%)

75
Q

Cystoscopy of Fistula of DDC

A

The highest diagnostic yield (80-95%)

76
Q

CT in Fistula of DDC

A

Useful in diagnosing Colo-vesical fistula with accuracy approaching that of cystcscopy

77
Q

TTT of Fistula of DDC

A
78
Q

CP of Bleeding DDC

A
79
Q

Investigations of Bleeding DDC

A
80
Q

TTT algorithm in Bleeding DDC

A
81
Q

TTT Options of Bleeding DDC

A
  • Conservative
  • If Conservative Fails
82
Q

Conservative TTT of Bleeding DDC

A
83
Q

TTT of Bleeding DDC if conservative TTT Failed

A
84
Q

Types of Esophageal Divertula

A
84
Q

TTT of Bleeding DDC in severe Diverticular Bleeding

A
85
Q

Etiology of Mid-thoracic diverticula

A
86
Q

Pathology of Mid-thoracic diverticula

A
87
Q

CP of Mid-thoracic diverticula

A
88
Q

Investigations for Mid-thoracic diverticula

A
89
Q

TTT of Mid-thoracic diverticula

A
90
Q

Etiology of Epiphrenic diverticulum

A
91
Q

Pathology of Epiphrenic diverticulum

A
92
Q

CP of Epiphrenic diverticulum

A
93
Q

Investigations for Epiphrenic diverticulum

A
94
Q

TTT of Epiphrenic diverticulum

A
95
Q

Etiology of Gastric Diverticula

A

Usually Congenital

96
Q

Pathology of Gastric Diverticula

A

Number: Itisusually solitary.

Site: occurs mainly in posterior surface of cardia or fundus

97
Q

CP of Gastric Diverticula

A
98
Q

Investigations for Gastric Diverticula

A
  • Upper GIT endoscopy.
  • Barium meal
99
Q

TTT of Gastric Diverticula

A

If Symptomatic: Removed either open or laparoscopically.

100
Q

Types of Intestinal Diverticula

A
101
Q

Etiology of 1ry Duedonal Divertucla

A

Pulsion diverticulae

102
Q

Pathology of 1ry Duedonal Divertucla

A
103
Q

CP of 1ry Duedonal Divertucla

A
104
Q

Investigations for 1ry Duedonal Divertucla

A
  1. Upper GIT endoscopy.
  2. Barium meal
105
Q

TTT of 1ry Duedonal Divertucla

A
106
Q

Etiology of Jejunal & Ileal diverticula

A

Pulsion diverticuluae due to Motility disturbance of involved intestine

107
Q

Pathology of Jejunal & Ileal diverticula

A
108
Q

Type of Patient in Jejunal & Ileal diverticula

A
109
Q

CP of Jejunal & Ileal diverticula

A
110
Q

Investigations for Jejunal & Ileal diverticula

A

Barium follow through (the most important).

111
Q

TTT of Jejunal & Ileal diverticula

A
  • Conservative
  • Surgical
112
Q

Conservative TTT of Jejunal & Ileal diverticula

A
113
Q

Surgical TTT of Jejunal & Ileal diverticula

A
114
Q

Doneeee

A

….

Y3R6: Surgery I 👨‍⚕️ (30 decks)

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