321 Diverticular

Question 1

Saclike herniation of the entire bowel wall

Answer 1

True diverticulum

Question 2

Protrusion of the mucosa and submucosa through the muscularis propria of the colon

Answer 2

Pseudodiverticulum

Question 3

Part usually spared by diverticular disease

Answer 3

Rectum

Question 4

Commonly affected sites of diverticular diseases

Answer 4

Left colon and sigmoid

Question 5

In Asian populations, where are 79% of diverticula seen?

Answer 5

Right colon and cecum

Question 6

Most common cause of hematochezia in patients more than 60 years old

Answer 6

Hemorrhage from colonic diverticulum

Question 7

How many of patient with diverticular disease develop GI bleeding

Answer 7

20%

Question 8

Characteristic of patient at increased risk for bleeding

Answer 8

Hypertensive
Atherosclerosis
Aspirin use
NSAID use

Question 9

True or false. Most diverticular bleeds are self limited and stop spontenously with bowel rest

Answer 9

True

Question 10

When will a patient with diverticular disease need surgery

Answer 10

6 units bleed in 24 hours and unstable vital signs

Question 11

Surgery if bleeding has been defined

Answer 11

Segmental resection

Question 12

Surgery if site of bleeding has not been definitely identified

Answer 12

Subtotal colectomy

Question 13

Surgery if patient had no severe comorbidities

Answer 13

Surgical resection with primary anastomosis

Question 14

When is higher anastomotic leak reported

Answer 14

In patients who receive more than 10 units of blood

Question 15

What is the CT scan finding diagnostic of diverticular disease

Answer 15

Sigmoid diverticula, thickened colonic wall more than 4 mm and inflammation within the periodic fat with or without collection of contrast material or fluid

Question 16

What defines complicated diverticular disease?

Answer 16

Diverticular disease associated with abscess or perforation

Question 17

Hinchey classification of diverticular disease. Stage I

Answer 17

Stage I: perforated diverticulitis with confined paracolic abscess

Question 18

Hinchey classification of diverticular disease. Stage II

Answer 18

Stage II: perforated diverticulitis that has closed spontaneously with distant abscess formation

Question 19

Hinchey classification of diverticular disease. Stage III

Answer 19

Stage III: noncommunicating perforated diverticulitis with focal peritonitis

Question 20

Hinchey classification of diverticular disease. Stage IV

Answer 20

Stage IV: perforation and free communication with peritoneum, resulting in fecal peritonitis

Question 21

Common fistula formation in diverticular disease

Answer 21

Cutaneous, vaginal, vesicle fistulas

Question 22

Fistula common in women who has undergone hysterectomy

Answer 22

Colo vaginal fistula

Question 23

Recommended fiber per day in diverticular disease

Answer 23

30 grams fiber per day

Question 24

Recommend antibacterial coverage for diverticular disease

Answer 24

TMP SMX
Metronidazole
Ciprofloxacin
–cover aerobic gram Negative rods and anaerobic bacteria

Question 25

Alternative single agent therapy

Answer 25

3rd generation penicillin: IV Piperacillin or oral penicillin/clavulanic acid

Question 26

Probiotics found to be beneficial in diverticular disease

Answer 26

Lactobacillus acidophilus | Bifidobacterium

Question 27

When is CT guided percutaneous drainage of diverticular abscess done

Answer 27

Abscess greatet than 3 cm and have well defined wall

Question 28

What is the treatment of abscess less than 3 cm

Answer 28

Antibiotic therapy

Question 29

How is Hinchey Stage III managed

Answer 29

Hartmanns procedure

Question 30

True or false. Rectal prolapse is 6x more common in men than in women

Answer 30

False. Women > men

Question 31

Test done if child has rectal prolapse

Answer 31

Sweat Chloride test

Question 32

Comorbidity in 20% of children with rectal prolapse

Answer 32

Cystic fibrosis

Question 33

Circumferential full thickness protrusion of the rectal wall through the anal orifice

Answer 33

Rectal prolapse (procidentia)

Question 34

Conditions associated with rectal prolapse

Answer 34

Redundant sigmoid colon Pelvic laxity Deep rectovaginal septum

Question 35

Pathophysiology of rectal prolapse

Answer 35

Damage to pudendal nerve from repeated stretching with straining to defecate

Question 36

True or false. Unilateral pudendal nerve injury is more significantly associated with prolapse and incontinence than bilateral nerve injury

Answer 36

False. Bilateral > unilateral

Question 37

Result of attempting to defecate against a closed pelvic floor

Answer 37

Animus

Question 38

Mainstay treatment of rectal prolapse

Answer 38

Surgical correction

Question 39

Involuntary passage of fecal material at least 1 month in an individual with a development age of at least 4 years

Answer 39

Fecal incontinence

Question 40

Major cause of fecal incontinence

Answer 40

Obstetric injury to the pelvic floor