Diverticulitis

Question 1

Condition in which diverticula can be found within the colon

Answer 1

Diverticulosis

Question 2

The most common part of the colon to get diverticula?

Answer 2

Sigmoid colon

95%

Question 3

Diverticular are actually ____(true or false) diverticula in that only the ____ and ____ herniate through the bowel musculature

Answer 3

false

mucosa and submucosa

Question 4

What are true diverticula?

Are they common or rare in the colon?

Answer 4

Involves all layers of the bowel wall

Rare in the colon

Question 5

Where do the weaknesses in the bowel wall development with diverticula?

Answer 5

At points where nutrient blood vessels enter between antimesenteric and mesenteric taeniae

Question 6

What can cause the herniations through the bowel wall in diverticula?

Answer 6

increased intraluminal pressures

Question 7

_____% of diverticula incidence in the US by age 60

_____% become symptomatic

Answer 7

50-60%

10-20%

Question 8

What puts people at risk for diverticula?

Answer 8

low fiber diets

chronic constipation

positive family history

also increases with age

Question 9

Sx/complications seen with diverticula?

Answer 9

Bleeding; may be massive

Diverticulitis (asx in 80% of cases)

Question 10

What diagnostic testing do you do if a patient is bleeding with diverticula?

Answer 10

If they don’t have signs of inflammation: colonoscopy

Question 11

What diagnostic tool do you use if the patient is having pain and signs of inflammation?

Answer 11

Abdominal/pelvic CT scan

Question 12

Tx of diverticulosis?

Answer 12

High fiber diet recommended

Question 13

Indications for operation with diverticulosis?

Answer 13

Complications of diverticulitis (eg fistula, obstruction, stricture)

recurrent episodes

hemorrhage

suspected carcinoma

prolonged sx

abscess not drainable by percutaneous approach

Question 14

When is it safe to get a colonoscopy or barium enema/signmoidoscopy?

Answer 14

Due to risk of perforation - 6 weeks after inflammation is resolved to rule out Colon Ca

Question 15

infection or perforation of a diverticulum

Answer 15

Diverticulitis

Question 16

What is the pathophys of diverticulitis?

Answer 16

obstruction of diverticulum by a fecalith leading to inflammation and microperforation

Question 17

Signs/sx of diverticulitis?

Answer 17

LLQ pain (cramping or steady)

change in bowel habits (diarrhea)

fever

chills

anorexia

LLQ mass

nausea/vomiting

dysuria

Question 18

Associated lab findings with diverticulitis?

Answer 18

Increased WBCs

Question 19

Associated radiographic findings of diverticulitis?

Answer 19

X-ray: ileus, partially obstructed colon, air-fluid levels, free air if perforated

Abdominal/pelvic CT: swollen, edematous bowel wall; patricularly helpful in diagnosing an abscess

Question 20

Should you do a barium enema in acute cases of diverticulitis?

Answer 20

NO!

Question 21

Is it safe to do a colonoscopy in acute diverticulitis?

Answer 21

NO! - increased risk of perforation

Question 22

Complications of diverticulitis?

Answer 22

abscess

diffuse peritonitis

fistula

obstruction

perforation

stricture

Question 23

What is the most common fistula with diverticulitis?

Answer 23

Colovesical fistula (to the bladder)

Question 24

What is the best test/diagnostic study for diverticulitis?

Answer 24

CT

Question 25

Initial therapy for diverticulitis?

Answer 25

IV fluids NPO broad spectrum antibiotics with anaerobic coverage NG suction (as needed for emesis/ileus)

Question 26

When is surgery warranted for diverticulitis?

Answer 26

obstruction fistula free perforation abscess not amenable to percutaneous drainage sepsis deterioration with inital conservation treatment

Question 27

\_\_% have a lifelong risk of diverticulitis recurrence after the first episode

Answer 27

33%

Question 28

\_\_% have a lifelong risk of reccurence of diverticulitis after the second episode

Answer 28

50%

Question 29

Indications for elective resection in diverticulitis?

Answer 29

Two episodes of diverticulitis should be considered after first episode in young, diabetic or immunosuppressed patient

Question 30

what surgery is performed ELECTIVELY for reccurent bouts of diverticulitis?

Answer 30

One-stage operation: resection of involved segment and primary anastomosis (with pre-operative bowel prep

Question 31

What type of surgery is usually performed for an acute case of diverticulitis with a complication?

Answer 31

**Hartmann's procedure:** resection of involved segment with an end colostomy and stapled rectal stump (will need subsequent reanastomosis of colon usually after 2-3 postoperative months)

Question 32

What is the treatment for a diverticular abscess?

Answer 32

Percutaneous drainage If not amenable to percutaneous drainage - surgical approach for drainage is necessary

Question 33

How common is a massive lower GI bleeding with diverticulitis?

Answer 33

VERY RARE Massive lower GI bleed seen with diverticulosis - not diverticulitis

Question 34

What are the most common causes of massive lower GI bleeding in adults?

Answer 34

Diverticulosis (especially right sided) Vascular ectasia

Question 35

What ut you rule out in any patient with diverticulitis/diverticulosis?

Answer 35

colon cancer