Diverticulosis Flashcards Preview

Clin Med 2 > Diverticulosis > Flashcards

Flashcards in Diverticulosis Deck (19):
1

Def diverticulosis

- sac like protrusion
- mucosa and submucosa herniate through muscle later
- in areas of high pressure (sigmoid)

2

Def diverticular bleed

Painless bleeding of diverticula

3

Diverticulitis

inflammation of diverticulum

4

Diverticulosis mainly found

sigmoid

5

What is strongly correlated with diverticulosis

W. diet

6

RF diverticulosis

Age
Constipation
Diet- High fat and red meat
Obesity
Genetics (connective tissue disorders)
Physical Inactivity

7

Dx diverticulosis

colonoscopy

8

Clinical Diverticulitis

- Abdominal pain –LLQ: Constant, several days
- Nausea/vomiting
- Fever
- Change in bowel habits
- Constipation to diarrhea or vice versa
- Dysuria
- Guarding, rigidity, rebound LLQ
- Tender palpable mass

9

Dx diverticulitis

- CBC w/diff- leukocytosis with left shift
- BMP
- Urinalysis
- Abdominal CT abdomen/pelvis with IV contrast +/- PO contrast

10

Tx diverticulitis medical

Antibiotics – Coverage Enterobacteriaciae & Gram Neg Anaerobe (B.Frag)
- Cipro & Flagyl (IV or PO) (first line)
- Augmentin PO
- Ertapenem (IV)
- Zosyn (IV)
- 2nd or 3rd Cephalosporin plus Flagyl IV

IVF (admitted)
Analgesia & Antiemetics PRN (IV vs PO)
NPO/Clear diet

11

Tx diverticulitis Surgical

One Stage Procedure
- Colon Resection with primary anastomosis
- Patients that are elective

Two-stage Procedure (two different procedures)
- Colonic Resection with end colostomy (Hartmann’s procedure)
- Primary anastomosis with diverting ileostomy

12

Who gets surgical diverticulitis tx

Emergent Surgery: free perforation, +/- bowel obstruction
Urgent Surgery: failure of medical treatment; colonic obstruction; abscess failing non-operative intervention

13

Diverticulitis Follow-up

Colonoscopy if new diagnosis diverticulitis or haven't had in past year
- Approx. 6 weeks post-infection to r/o colon cancer and assess diverticular disease
Diet Modifications:
- Consume high fiber diet or long-term fiber supplementation

14

What is most common cause of LGIB

diverticular bleed

15

Where is diverticular bleed most common

R. colon

16

Cause diverticular bleed

vasa recta recurrent injury leading to weakness, and bleeding

17

Clinical diverticular bleed

- Painless hematochezia
- Painless maroon-color blood mixed with stool
- Bloating, cramping, urge to defecate
- Hemodynamically unstable: syncope, lightheadedness, postural dizziness
- Abdomen – benign; soft and non-tender

18

Dx diverticular bleed

CBC
- Hemoglobin/Hct – normal to decreases (MCV normal)
BMP
- Bun/creatinine normal
Colonoscopy
- After initial resuscitation

19

Tx diverticular bleed

Resuscitation if bleeding hasn’t stopped
o Two large bore IV
o IVF NS
o Type and Cross for blood
o Transfuse pRBCS PRN
Colonoscopy (first step)
- Treat active bleeding with submucosal epinephrine or endoscopic tamponade
Angiography (2nd step)
- Alternative to colonoscopy if bleeding cannot be found
Surgical Intervention (Segmental Colectomy)
- Hemodynamically unstable