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Terms in this set (22)
Infection or perforation of a diverticulum
What is diverticulosis?
Condition in which diverticula can be found within the colon, especially the sigmoid; diverticula are actually false diverticula in that only mucosa and submucosa herniate through the bowel musculature; true diverticula involve all layers of the bowel wall and are rare in the colon
Describe the pathophysiology of diverticulosis?
Weakness in the bowel wall develops at points where nutrient blood vessels enter between antimesenteric and mesenteric taeniae; increased intraluminal pressures then cause herniation through these areas
What is the pathophysiology of diverticulitis?
Obstruction of diverticulum by a fecalith leading to inflammation and microperforation
What are the signs/ symptoms?
LLQ pain (cramping or steady), change in bowel habits (diarrhea), fever, chills, ano- rexia, LLQ mass, nausea/vomiting, dysuria
What are the associated lab findings?
What are the associated radiographic findings?
On x-ray: ileus, partially obstructed colon, air-fluid levels, free air if perforated
On abdominal/pelvic CT scan: swollen, edematous bowel wall; particularly helpful in diagnosing an abscess
What are the associated barium enema findings?
Barium enema should be avoided in acute cases
Is colonoscopy safe in an acute setting?
No, there is increased risk of perforation
What are the possible complications?
Abscess, diffuse peritonitis, fistula, obstruction, perforation, stricture
What is the most common fistula with diverticulitis?
Colovesical fistula (to bladder)
What is the best test for diverticulitis?
What is the initial therapy?
IV fluids, NPO, broad-spectrum antibiotics with anaerobic coverage, NG suction (as needed for emesis/ileus)
When is surgery warranted?
Obstruction, fistula, free perforation, abscess not amenable to percutaneous drainage, sepsis, deterioration with initial conservative treatment
What is the lifelong risk of recurrence after: First episode?
What are the indications for elective resection?
Case by case decisions, but usually after two episodes of diverticulitis; should be considered after the first episode in a young, diabetic, or immunosuppressed patient or to rule out cancer
What surgery is usually performed ELECTIVELY for recurrent bouts?
One-stage operation: resection of involved segment and primary anastomosis (with preoperative bowel prep)
What type of surgery is usually performed for an acute case of diverticulitis with a complication (e.g., perforation, obstruction)?
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)
What is the treatment of diverticular abscess?
Percutaneous drainage; if abscess is not amenable to percutaneous drainage, then surgical approach for drainage is necessary
How common is massive lower GI bleeding with diverticulitis?
Very rare! Massive lower GI bleeding is seen with diverticulosis, not diverticulitis
What are the most common causes of massive lower GI bleeding in adults?
Diverticulosis (especially right sided), vascular ectasia
What must you rule out in any patient with diverticulitis/ diverticulosis?
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