Colon - Diverticulitis Flashcards Preview

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Flashcards in Colon - Diverticulitis Deck (18):
0

Plan for patient with diverticulitis?

IV antibiotics, CT scan to exclude paracolic abscess or fistula

1

Diverticulum?

Herniation of the mucosa and submucosa through a weakness of the muscle

2

Diverticulosis versus diverticulitis?

Un-Inflamed diverticula versus inflamed particular

3

Symptoms of diverticulosis?

Usually asymptomatic but may resemble IBS or may have a cute symptoms

4

Complications of diverticulosis?

Acute diverticulitis
Hemorrhage
Obstruction

5

Diverticular hemorrhage presents as?

Painless bright red blood

6

Treatment of diverticulosis?

Dietary measures
Increase fiber
In some patients colonic segment resection

7

Stages of diverticulitis?

Stage 1: small, confined paracolic abscess
Stage 2: distant abscess (retroperitoneal or pelvic)
Stage 3: peritonitis from rupture of abscess (Noncommunicating with Bowl lumen)
Stage 4. Peritonitis caused by free communicating perforation

8

Mechanism of acute diverticulitis?

Fecaliths obstruct diverticula neck, leading to inflammation, diminished venous outflow, bacterial overgrowth

9

Pathognomonic finding for colovesicular fistula?

Pneumaturia or fecaluria

10

Differential for diverticulitis?

GI: Painful diverticular disease without diverticulitis, appendicitis, Crohn's disease, colon carcinoma, ischemic colitis, IBS

Gyn: ruptured ovarian cyst, endometriosis, ectopic pregnancy, PID

11

If suspect acute diverticulitis, use this test? avoid these tests?

CT scan with contrast

1. Contrast enema (fear of perforation and spillage of contrast into Abdominal cavity)
2. Endoscopy (wait for six weeks after resolution of the attack

12

When to admit patients for diverticulitis?

Need for narcotics to control pain, comorbid illnesses, inability to tolerate oral liquids, abscess or peritonitis

13

Indications for emergent surgical intervention?

1. Generalized peritonitis
2. Uncontrolled sepsis
3. Perforation

14

Treatment for diverticulitis as outpatients?

Broad-spectrum antibiotics:
1. Bactrim/Cipro/Levo + flagyl
2. Augmentin

15

Treatment in hospitalized patients?

IV antibiotics:
1. Zosyn
2. Timentin

16

Suspect Abscess when? Treatment?

Tender mass, persistent fever, leukocytosis, despite adequate therapy

Nothing (if small) or CT guided percutaneous drainage

17

Treatment of fistula?

Surgery for Fistula closure and primary anastomoses

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