In intestine theres is a blind pouch/sac extending out from GI tract, occurs when there is a breakdown in the muscular layer of the GI mucosa and as a results there is a protrusion of mucosa and submucosa to form a pouch -this creates "False diverticula" bc it doesn't contain all layers of GI tract -THis overs where vasa recta penetrates muscularis of the colon, which creates opportunity for mucosa and submucosa to form a pouch
-The muscular layer breaks down and then forms a hole, so the submucosa and mucosa poke through and form a blind pouch or FALSE diverticula
-"True Diverticula" is when that much extends through all three layers of GI intestine (mucosa, submucosa, and muscularis) RARE
-When there are many diverticuli in GI tract
-Usually in the SIGMOID
-Caused by straining to pass stool (wall stress) that can POP the submucoas and mucosa through a weakening in the muscular layer
-caused by chronic recurrent increased intra abdominal pressure
-Happens in lower fiber diet which creates hard stools which leads to diverticulosis
Diverticular Disease Complications
LOWER GI BLEED
-hematochezia, diverticula can bleed and cause bloody stool
-Inflammation of diverticulum and bacteria
Diverticulitis Characteristic Findings
-Inflammation of a diverticulum
-Fever, High WBC from inflammation
-CLASSIC LLQ pain bc sigmoid colon common area "Left sided apendicitis"
-Occult blood in stool, cant see with your eyes but you can see it when you use a doody cahhd
-Ct scan, you can see inflamed diverticulum
-Surgery to remove infected portion of colon
Bowel Obstruction. Fistula. Perforation. Abcess.
-diverticulitis that doesnt improve with abx, requires surgery
-Inflammation narrows intestinal lumen and obstructs passage of air, feces, and fluids
-pt p/w n.v, abdominal distention, constipation
-most commonly to bladder "Colovesical fistula"
-p/w pneumaturia (air), feacluria, or dysuria (in urine)
-result in peritonitis and patient will preent with diffuse abdominal painw ith rigid abdomen
Bowel Obstruction Presentation
-Much more common in small intetine (75%)
-pw abdominal pain, nausea, vomitting, abdominal distention
-If you tap on there belly it echoes
-obstipation (inablity to pass stool)
Bowel Obstruction Common Causes
SBO (most common) ABC
-B.. Buldge (hernia)
Bowel Obstruction Xray
-upright xray will show dilated bowel loops
-Air fluid levels
Symptomatic Uncomplicated Diverticulitis TX
- ABX: trimethoprim/sulfamethoxazole or ciprofloxacin and metronidazoletargeting aerobic gram-negative rods and anaerobic bacteria. addition of ampicillin to this regimen for nonresponders is recommended.
-Single-agent therapy with a third-generation penicillin such as IV piperacillin or oral penicillin/clavulanic acid may be effective. The usual course of antibiotics is 7–10 days, although this length of time is being investigated. Patients should remain on a limited diet until their pain resolves.
Surgical Options Diverticulitis
Surgical objectives include removal of the diseased sigmoid down to the rectosigmoid junction. Failure to do this may result in recurrent disease. The current options for uncomplicated diverticular disease include an open sigmoid resection or a laparoscopic sigmoid resection. The benefits of laparoscopic resection over open surgical techniques include early discharge (by at least 1 day), less narcotic use, less postoperative complications, and an earlier return to work.
Surgery for Complicated Diverticulitis
(1) proximal diversion of the fecal stream with an ileostomy or colostomy and sutured omental patch with drainage,
(2) resection with colostomy and mucous fistula or closure of distal bowel with formation of a Hartmann’s pouch,
(3) resection with anastomosis (coloproctostomy), or
(4) resection with anastomosis and diversion (coloproctostomy with loop ileostomy or colostomy). Laparoscopic techniques have been used for complicated diverticular disease; however, higher conversion rates to open techniques have been reported.