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Diverticulitis and hemorrhoids

Mucosal herniations, smooth muscle and muscosal layers, mc in colon wall Diverticula
Presence of diverticula, no inflammation and asymptomatic Diverticulosis
Epidemiology of Diverticulosis >85yo=65%, MC in western and devloped countries (diet and lifestyle), smoking^risks
What are complications of diverticulosis abscess, obstruction, perforation, fistula
How many have complicated cases? Simple? C: 25% S: 75%
Inflammation of diverticula or diverticui Diverticulitis
Causes of diverticulitis inspissated food or feces, vascular compromise, ^intraluminal pressure=necrosis
Pt hx of HPI diverticulitis abd pain, location dependent on location of diverticui, 70% LLQ pain,
Sxs of divertiulitis N/V/D/C bloating, flatulence
R sided diverticultis confused w/ what? appendicitis, (and can also be mistaken for diverticulitis) PUD, pancreatitis, cholelithiasis, cholecyctiis (almost all abd. pain causes)
How is dx usually made for diverticulitis? H&P maybe leukocytosis, consider other lab tests to evaluate fxn of other organs and R/O other infections/dz's
Inflammation markers to lead toward diverticultis CRP <50: perforation unlikely >200 Strong indicator of perforation
Helpful clinical signs of diverticulitis tenderness confined to LLQ, abscence of vomiting, CRP elevation (not an exact sign)
When would imagaing for diverticulitis be warranted Without LLQ pain, no vomiting, and CRP elevation
Radiologic tests for diverticulitis plain XR films, (perforation: free air), CT most appropriate w/ rectal contrast
Is use of endoscopy for diverticulitis recommended NOT usually, risk of perforation
Hinchey's classification Stg I: sm or confined Stg II: lg abcess (confined to pelvis) Stg III: perforated diverticulitis w/ gen. purulent peritonitis Stg. IV: rupture of diverticuli w/ fecal contamination
Tx of Stg I diverticulitis Outpt, CL diet, advance slowly, broad-spectrum Abx, Colonoscopy after wellness
Tx non-operative inpatient indicated w/ systemic signs of infection: NPO, IV fluids, broad-spectrum IV abx, pain control (morphine)
D/C abx w/ diverticulitis as pt. can tolerate CL diet and fever reduced
Tx for operative diverticulitis Repeat CT scan who don't improve: CT guided percutaneous drainage for peridiverticular abscesses >4cm (Stg. II)
Surgical intervention for diverticulitis indications Stg III or IV, uncontrolled sepsis, failing med therapy, intestinal obstruction 2 to diverticulitis, or inability to R/O carcinoma
Prevention of diverticulosis progression high-fiber diets, nuts don't seem to effect the inflammation of diverticuli
Seperates internal hemorrhoid plexus and external hemorrhoid plexus (sensation seperation) Dentate line
Most common cause of lower GI bleeding hemorrhoids
Varacosity in blood vessel in rectal area Hemorrhoids
Painless hemorroids visible from external anus Prolapsed internal hemorroids
Tx internal hemorroids rubber band ligation, infrared coagulation, sclerotherapy, excision
causes of hemorroids Pregnancy, sitting long time, obesity
Maintenance of hemorrhoids baby wipes, don't linger or push, witch hazel astringent
Created by: becker15
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