L14: Diverticular Diseases Flashcards
(116 cards)
1
Q
Def of Diverticula
A
- Sac-like blind pouches that protrude from the gastrointestinal wall and communicate with the lumen
2
Q
Def of Diverticulosis
A
The presence of multiple diverticulae without Evidence of infection
3
Q
Def of Diverticulitis
A
Inflammation or infection of diverticula
4
Q
Types of Diverticula
A
- Congeinatal
- Acquired
5
Q
Nature of Congenital Diverticula
A
True diverticulum
6
Q
What is a true Diverticula?
A
Affects al 3 layers of the gut
(Includes the muscles)
7
Q
Examples of True Diverticula
A
- Meckel diverticulum
- Appendix
8
Q
Nature of Pulsion diverticulum
A
False diverticulum or Pseudodiverticulum
9
Q
What does Pulsion diverticulum affect?
A
- Involves only mucosa & submucosa
- Does not contain muscular layer (through the muscles)
- They cannot evacuate themselves > stasis, infection & complications.
10
Q
Types of Acquired diverticula
A
Pulsion & Traction
11
Q
Examples of Pulsion diverticulum
A
Colonic diverticulum
12
Q
Causes of Traction diverticulum
A
Due to Traction on gut wall by nearby Fibrosis
13
Q
Examples of Traction diverticulum
A
TB lymphadenitis
14
Q
Site of diverticulua
A
15
Q
Pharyngeal diverticulae
A
Zenker’s diverticulum (Pharyngeal pouch).
16
Q
Esophageal Diverticula
A
- Congenital diverticulum.
- Pulsion diverticulum.
- Traction diverticulum.
17
Q
Stomach diverticulua
A
Gastric diverticulum.
18
Q
SI diverticulua
A
- Duodenal.
- Jejunal and ileal.
- Meckel diverticulum.
19
Q
Colonic diverticulua
A
- Caecal diverticulum.
20
Q
What is the most common site of diverticulua?
A
Sigmoid
MCQ
20
Q
diverticulua can occur anywhere but …….
A
Rectum
MCQ
21
Q
What is another name of Diverticular Disease of Colon?
A
Diverticulosis Coli
22
Q
Type of Diverticular Disease of Colon
A
Acquired pulsion diverticula
23
Q
Mechanism of Diverticular Disease of Colon
A
24
Fibers & Diverticular Disease of Colon
25
Where do Diverticular Disease of Colon originate?
26
Site of Diverticular Disease of Colon
(Organs)
27
Number of Diverticular Disease of Colon
28
Type of Patient in Diverticular Disease of Colon
29
What diet is associated by Diverticular Disease of Colon?
- Common in western countries (American,European) > Low residue diet.
- Rare in African, Asian > Natural Fibers.
30
Stages of Diverticular Disease of Colon
- Non Complicated Diverticular Disease (Diverticulosis)
- Acute Divertuculitis
- Chronic Divertuculitis
31
Non Complicated Diverticular Disease of Colon
32
Acute divertuculitis
33
Chronic Diverticulitis
34
Complications of Diverticular Disease of Colon
- Perforation
- Chronic intestinal obstruction
- Fistula formation
- Hemorrhage
35
Complications of Diverticular Disease of Colon
- Perforation
Obstruction of neck of diverticula -> Progressive inflammation -» Perforation (Localized “Abscess” OR generalized peritonitis)
36
Complications of Diverticular Disease of Colon
- Chronic Intestinal Obstruction
-
Recurrent acute diverticulitis & chronic diverticulitis -» Colonic fibrosis & stricture -> Large intestinal obstruction
37
Complications of Diverticular Disease of Colon
- Fistula Formation
- External > Colocutaneous fistula
- Internal —> Colovesical - Colovaginal - Coloenteric
38
Complications of Diverticular Disease of Colon
- Hemorrhage
39
CP of **Uncomplicated diverticulosis**
40
Investigations in **Uncomplicated diverticulosis**
- Barium enema
- Sigmoidscopy
- CT
41
Bariam in **Uncomplicated diverticulosis**
- The best investigation
- Appearas Multiple globular shadows (outpouchings) in relation to the colon
- Sometimes no diverticula are seen, but only saw teeth appearance of the “pre diverticular state” due to segmental spasm.
42
Sigmoidoscopy in **Uncomplicated diverticulosis**
- Gives little information apart from narrowing of Lumen
- Recommended to exclude malignancy
43
CT in **Uncomplicated diverticulosis**
May be helpful
44
TTT of **Uncomplicated diverticulosis**
45
CP of Uncomplicated diverticulitis
**Symptoms:**
- As appendicitis, But pain starts at umbilicus & then localizes in the left iliac fossa
**Signs:**
1. Temperature high
2. Tenderness & rigidity in left iliac fossa
3. Tenderness on P/R
46
INVx of **Uncomplicated diverticulitis**
47
TTT Options in **Uncomplicated diverticulitis**
- Conservative
- Surgical
48
Consercative TTT of **Uncomplicated diverticulitis**
49
Oschner-Sherren Regimen
50
What to do when acute attack of ****Uncomplicated diverticulitis**** subsides?
51
What to do after 6 weeks of discharge of a patient with **Uncomplicated diverticulitis**?
52
Indications of Surgical Managment **Uncomplicated diverticulitis**
In recurrent acute - persistent chronic diverticulitis.
53
Options of Surgical TTT of **Uncomplicated diverticulitis**
- One stage resection
- Reilly sigmoid myotomy:
54
What is the ideal surgery option of **Uncomplicated diverticulitis**?
One stage resection
55
Reilly sigmoid Myotomy
56
Types of myotomy
57
CP of **Perforation of DDC**
58
Investigations in **Perforation of DDC**
59
Managment of **Perforation of DDC**
60
Managment of Stage I **Perforation of DDC**
61
managment of Stage II of **Perforation of DDC**
62
Managment of Type III **Perforation of DDC**
63
managment of Stage IV **Perforation of DDC**
64
Surgical TTT of **Perforation of DDC**
All of the following procedures must be accompanied by drainage of abdomen.
- 1 Stage
- 2 Stage
- 3 Stage
65
One Stage Procedure
Iry resection anastomosis of inflamed bowel after on table lavage of colon
66
Two Stage Procedure in **Perforation of DDC**
67
Three Stage Procedure in **Perforation of DDC**
68
Complications of 1 stage Procedure for **Perforation of DDC**
**Especially in Lt Side**
- Carries high risk of leakage from anastomotic line.
- With fatal faecal peritonitis & fistula
69
Causes of Complications of 1 stage Procedure for **Perforation of DDC**
1. High bacterial contents.
2. Poor vascularity (Vasa recta are end arteries)
3. Thin wall of large gut (Longitudinal muscle layer being condensed in 3 strips taenia coli)
4. Incomplete serous covering
## Footnote
Intestinal Obstruction is missing ----> **Study From Notes**
70
Types of **Fistula of DDC**
71
Investigations of **Fistula of DDC**
72
Barium Enema in **Fistula of DDC**
Precise delineation of fistula occ3urs in only 30% of cases.
73
Colonoscopy in **Fistula of DDC**
Limited to use due to Low diagnostic vields (20%)
74
Cystography in **Fistula of DDC**
Limited to use due to Low diagnostic vields (20%)
75
Cystoscopy of **Fistula of DDC**
The highest diagnostic yield (80-95%)
76
CT in **Fistula of DDC**
Useful in diagnosing Colo-vesical fistula with accuracy approaching that of cystcscopy
77
TTT of **Fistula of DDC**
78
CP of **Bleeding DDC**
79
Investigations of **Bleeding DDC**
80
TTT algorithm in **Bleeding DDC**
81
TTT Options of **Bleeding DDC**
- Conservative
- If Conservative Fails
82
Conservative TTT of **Bleeding DDC**
83
TTT of **Bleeding DDC** if conservative TTT Failed
84
Types of **Esophageal Divertula**
84
TTT of **Bleeding DDC** in severe Diverticular Bleeding
85
Etiology of Mid-thoracic diverticula
86
Pathology of Mid-thoracic diverticula
87
CP of Mid-thoracic diverticula
88
Investigations for Mid-thoracic diverticula
89
TTT of Mid-thoracic diverticula
90
Etiology of Epiphrenic diverticulum
91
Pathology of Epiphrenic diverticulum
92
CP of Epiphrenic diverticulum
93
Investigations for Epiphrenic diverticulum
94
TTT of Epiphrenic diverticulum
95
Etiology of **Gastric Diverticula**
Usually Congenital
96
Pathology of **Gastric Diverticula**
Number: Itisusually solitary.
Site: occurs mainly in posterior surface of cardia or fundus
97
CP of **Gastric Diverticula**
98
Investigations for **Gastric Diverticula**
- Upper GIT endoscopy.
- Barium meal
99
TTT of **Gastric Diverticula**
If Symptomatic: Removed either open or laparoscopically.
100
Types of Intestinal Diverticula
101
Etiology of **1ry Duedonal Divertucla**
Pulsion diverticulae
102
Pathology of **1ry Duedonal Divertucla**
103
CP of **1ry Duedonal Divertucla**
104
Investigations for **1ry Duedonal Divertucla**
1. Upper GIT endoscopy.
2. Barium meal
105
TTT of **1ry Duedonal Divertucla**
106
Etiology of Jejunal & Ileal diverticula
Pulsion diverticuluae due to Motility disturbance of involved intestine
107
Pathology of Jejunal & Ileal diverticula
108
Type of Patient in **Jejunal & Ileal diverticula**
109
CP of **Jejunal & Ileal diverticula**
110
Investigations for Jejunal & Ileal diverticula
Barium follow through (the most important).
111
TTT of Jejunal & Ileal diverticula
- Conservative
- Surgical
112
Conservative TTT of Jejunal & Ileal diverticula
113
Surgical TTT of **Jejunal & Ileal diverticula**
114
Doneeee
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