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Diverticulitis/hemor
Diverticulitis and hemorrhoids
| Question | Answer |
|---|---|
| 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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