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Diverticular disease
Fichas del conjunto (5)
- 1Diverticulum: Diverticulosis: Diverticulitis:Diverticulum: An outpouching.
Diverticulosis: A condition in which diverticulum form in the wall of the colon.
Diverticulitis: Inflammation of diverticula - 2Diverticulum Epidemiology: Pathophysiology: Risk factors: Clinical presentation: Hx: Ex: Severity: Complications: Investigation: Management: Treatment:Epidemiology:
Prevalence is age dependent; increases with increasing age (65% by age 85)
95% involve the sigmoid colon (site of highest pressure)
Pathophysiology:
Risk factors:
Lifestyle: low fibre diet, inactivity and obesity
Muscle wall weakness for aging and illness (e.g Ehler-Danlos, Marfan’s)
High intraluminal pressures cause outpouching to occur at the point of greatest weakness, most commonly were the vasa recta penetrate the circular muscle layer, therefore there is a risk of haemorrhage.
Clinical presentation:
Hx: Episodic abdominal pain (often LLQ), bloating, flatulence, constipation, diarrhoea.
Obs: Absence of fever
Ex: None or poorly localized LLQ tenderness.
Severity: Non-symptomatic or complicated
Complications: Abscess, obstruction, perforation, fistula, painless rectal bleeding, diverticular colitis
Investigation:
Mild elevation of WBC
Management:
Mild: Diet modification and oral antibiotics
Severe: Fever, worsening or severe abdominal pain, can’t tolerate fluids; antibiotics and IV fluids
Dx:
Imaging
Barium enema
CT scan
Treatment:
Surgery either sigmoidoscopy or col - 3Diverticulitis Epidemiology: Pathogenesis:Epidemiology:
95% left sided in patients of western countries, 75% right sided in Asian population.
Pathogenesis:
Erosion of the wall due to increased intraluminal pressure or inspissated food particles causes inflammation and focal necrosis resulting in micro or macroscopic perforation.
There is usually mild inflammation with perforation walled off by pericolic fat and mesentery; abscess, fistula or obstruction can ensue.
Poor contamination results in free perforation and peritonitis. - 4Diverticulitis Clinical features: Hx: Complications: Investigations:Clinical features:
Depends on the severity of inflammation and presence of complications; ranges from asymptomatic to generalized peritonitis.
Hx: LLQ pain and tenderness (⅔ of patients) several days before admission. Constipation, nausea and vomiting, urinary symptoms.
Ex: LLQ tenderness
Complications:
Abscess: palpable tender abdominal mass
Fistula: Colovesical (most common), coloenteric, colovaginal, colocutaneous.
Colonic obstruction: due to scarring from repeated inflammation.
Perforation: generalized peritonitis.
Investigations:
AXR, upright CXR;
CT scan (test of choice)
Increased soft tissue density with pericolic fat secondary to inflammation, diverticula secondary to inflammation, bowel wall thickening, soft tissue mass, fistula - 5Diverticulitis treatment:Hinchey staging:
Stage 1: Small pericolic abscess; medical.
Stage 2: Large abscess/fistula; medical, abscess drainage +/- resection with primary anastomosis.
Stage 3: Purulent peritonitis (ruptured abscess); resection or Hartmann's.
Stage 4: Feculent peritonitis; Hartmann's.
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- Surgery Fichas sobre Diverticular disease, creado por Ashutosh Kumar el 06/02/2018.
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- Ashutosh Kumar
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