FN: Divertivular disease Flashcards Preview

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Flashcards in FN: Divertivular disease Deck (36):
1

Diverticulum

Out-pouching of tubuar structure

2

True diverticulum

Composed of complete wall (e.e. Meckels)

3

False diverticulum

Composed of mucosa only (pharyngeal, colonic)

4

Diverticular disease

Symptomatc diverticulosis

5

Diverticulitis

Inflammation of diverticular

6

Epi

30% westerners have diverticulosis by 60yrs
F>M

7

Path

1. Association with raised intraluminal pressure - low fibre diet: n osmotic effect to keep stool wet

2. Mucosa herniates through muscularis propria at points of weakness where perforating arteries enter
3. Most commonly loacted in sigmoid colon
4. Commoner in obese pts.
--> Uniting factors in Saints triad

8

Saints triad

Hiatus hernia
Cholelithiasis
Diverticular disease

9

Symptoms of Diverticular disease

1. Altered bowel habit ± left-sided colic - relieved by defecation
2. Nausea
3. Flatulence

10

Rx

High fibre diet, mebeverine may help
Elective resectino for chronic pain

11

Diverticulitis

Inspissated faeces - obstruction of diverticulum
Elderly pt. with previous Hx of constipation

12

Presentation

Andominal pain and tenderness
- typically LIF
-Localised peritonitis

Pyrexia

13

Investigations

Bloods
Imaging
Endoscopy

14

Bloods shows

Raised WCC
Raised CRP/ESR
Amylase
G+S/x-match

15

Imagng

Erect CXR: look for perforation
AXR: fluid level/air in bowel wall
Contrast CT
Gastrogaffin enema

16

Endoscopy

Flexi sig
ColonoscopyL not in acute attack

17

Grading system

Hinchey grading

18

Managemt of acute Diverticulitis

Mild attacs
Admit if
Medical
surgical

19

Mild attacks Rx

Can be treated at home with bwel rest (luids only) and augmentin ! metronidazole

20

Admit if

Unwell
Fluids cnat be tolerated
Pain cant be controlled

21

Medical Rx

NBM
IV fluids
Analgesia
Antibiotics: cefuroxime + metronidazole
Most cases settle

22

Surgical indications

Perforation
Large haemorhage
Stricture - obstruction

23

Surgical procedure

Hartmanns to resect disease bowel

24

Other Complications

Perforation
Haemorrhage
Abscess
Fistulae
Strictures

25

Perforation

sudden onset pain ! preceding diverticulitis
Generalised peritonitis and shock

26

CXR perforation

Free air under diaphragm

27

Perforation Rx

Hartmanns

28

Haemorrhage

Sudden, painless bright red PR bleed

29

Investigations for Haemorrhage

Mesenteric angiography or colonoscopy

30

Treatment of Hemorrhage

Usually stops spontaneously
May need transfusion
Colonscopy ± diathermy/adrenaline
Embolisation
Resection

31

Abscess

Walled off perforation
swinging fever
Localising signs e.g. boggy rectal mass
Leukocytosis

32

Treatment of abcess

Abx +CT/US-guided drainage

33

Fistulae

Enterocolic
Colovaginal
Colovesicular: pneumaturia + intractable UTIs

34

Fistulae Rx

Resection

35

Strictures

After diverticulitis, colon may heal with fibrous strictures

36

Stricture management

Resectio (usually with primary anastomosis)
Stenting

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