2: Diverticular Disease Flashcards

(39 cards)

1
Q

What is a diverticulum

A

Outpouching of the bowel wall

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2
Q

What is diverticulosis

A

Presence of diverticula

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3
Q

What is diverticular disease

A

Symptomatic diverticula

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4
Q

What is diverticulitis

A

Inflammation of diverticula

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5
Q

What is a diverticular bleed

A

When diverticulum erodes a large blood vessel causing a bleed

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6
Q

How does the incidence of diverticular disease change with age

A

Increases with age

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7
Q

In which gender is diverticular disease more common.

A

Males

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8
Q

In which countries is diverticular disease more common

A

Developed countries

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9
Q

What are 4 RF for diverticular disease

A

Low Fibre Diet
Smoking
FH
Obesity

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10
Q

How will diverticulosis present

A

Asymptomatic.

Found incidentally on colonoscopy or CT

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11
Q

What are 5 symptoms of diverticular disease

A
  1. Colicky LIF pain
  2. Pain relieved by defecation
  3. Change bowel habit
  4. Flatulence
  5. Nausea
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12
Q

What will diverticulitis present

A

Acute abdominal pain - sharp and localised to LIF. Worse on movement. Systemic upset including loss of appetite, nausea and pyrexia.

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13
Q

What is a sign of perforated diverticlum

A

Generalised peritonitis

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14
Q

How can diverticulitis be classified

A

Simple

Complicated

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15
Q

What is complicated diverticulitis

A

Diverticulitis with presence of one of:

  • perforation
  • fistula
  • stricture
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16
Q

What is the most common site of diverticula

A

sigmoid colon

17
Q

Explain pathophysiology of diverticulosis

A
  • Bowel wall gradually weakness with age
  • Increase in intra-luminal pressure will cause weaker areas to out pouch - predominantly where vessels enter bowel wall
  • bacteria can grow in out pouch to cause inflammation - which may result in perforation
18
Q

What is the most common site for diverticular to form

A

sigmoid colon

19
Q

what blood tests should individuals with diverticular disease have

20
Q

What additional 2 blood tests are done in diverticulitis

A

VBG

Group and Save

21
Q

What imaging should be done in diverticular disease

22
Q

When should colonoscopy never be performed and why

A

Diverticulitis - as increases risk of perforation

23
Q

What imaging is performed in diverticulitis

A

CT abdomen-pelvis

24
Q

What classification system is used to determine the severity of diverticulitis on CT

A

Hinchey Classification

25
What is stage I on Hinchey classification
Para-colic abscess
26
What is stage 2 Hinchey classification
Pelvic abscess
27
What is stage 3 Hinchey classification
Purulent peritonitis
28
What is stage 4 Hinchey classification
Faecal peritonitis
29
How is diverticular disease managed
NSAIDs Oral Fluids Increase dietary fibre
30
How is diverticulitis managed
Medical: IV Fluids Bowel rest Antibiotics
31
What is the surgical management of diverticulitis
Hartmann's procedure
32
What is Hartmann procedure indicated for
Diverticular perforation causing faecal peritonitis (Hinchey 4) or sepsis
33
What does Hartman procedure involve
Sigmoid colectomy - with formation of end-colostomy bag and rectal stump. May be re-anastamosed at later point
34
What is the main complication of diverticulitis
Recurrence
35
What are 3 complications of diverituclar disease
1. Para-colic abscess 2. Stricture resulting in bowel obstruction 3. Fistula: colovesical or colovaginal
36
How are para-colic abscesses manage
- Antibiotics - Bowel rest - CT-guided drainage
37
What is a colovesical fistula
Abnormal connection between bladder and bowel
38
How will colovesical fistula present
Pneumoturia Faeces in urine Recurrent UTI
39
How will colovaginal fistulas present
Increase vaginal discharge | Recurrent UTIs