CC March 2017 Acute diverticulitis

echoecho's version from 2018-04-30 12:30


Question Answer
Define colonic diverticula?Small herniations of the mucosa through the muscular lining of the intestine
They occur due to what?Increased colonic pressure at weak points of the colon where blood vessels (vasta recto) penetrate the muscularis propria
In the Western world, most diverticula are found in what 2 parts of the colon?1) sigmoid. 2) descending colon
List the risk factors for this?1) increasing age 2) low-fiber 3) high-fat diet 4)constipation
Define diverticulitis?Inflammation and infection of diverticula
What is the classic presentation of diverticulitis?1) lower quadrant pain 2) fever 3) anorexia 4) diarrhea 5) nausea
Bright red blood per rectum is more consistent with _______ bleeding rather than acute diverticulitis?Diverticula
What does diverticula rupture lead to?1) peritonitis with hypotension 2) tachycardia 3) rigid abdomen
Another common complication is what?Abscess formation
Localized tenderness in the left lower quadrant has a positive likelihood ratio (LR) for diverticulitis of what?10.4
What is common but not specific as to lab work?Leukocytosis
What studies should be done?1) Urine studies to r/o UTI 2) HCG to r/o ectopic pregnancy in women of childbearing age
CRP levels of > ____ mg/L are suggestive of acute divertiulitis when LLL quadrant pain is present?50
Is routine imaging required in all patients w/ mild disease and a typical presentation?No
If perforation is suspected, what imaging studies should be done? What would it show? Which imaging modality is more sensitive for the diagnosis of diverticulitis?1) upright plain radiographs or a series of radiographs 2) may show free air. 3) CT abdomen
***What is the benefit of an abdominal CT scan?1) aids in the diagnosis of unclear cases 2) shows the extent of the disease 3) excludes other etiologies of abdominal pain 4) demonstrates complications of acute diverticulitis such as perforation or abscess
Describe by US has limited usefulness? What is it good for?1) it can not show free air. 2) limited in obese patients 3) it has good diagnostic accuracy for inflammation
What are the disadvantages and advantages of using MRI?1) it is expensive and takes longer than CT and may not appropriate for critically ill patients 2) it is accurate
Why is colonoscopy not performed acutely in the cases of diverticulitis?Due to the increased risk of perforation
If an indication for screening colonoscopy is present (like age > 50 y.o. For routine colorectal cancer screening), when should it be performed?4-6 weeks after resolution of diverticulitis
Is isolated diverticulitis an indication for colonoscopy?No
In mild cases of acute diverticulitis, patients can be treated in what setting?Ambulatory
What type of diet would one recommend?Relative bowel rest w/ clear liquid diet that is advanced as tolerated
Are oral antibiotics (which are traditionally given to all patients w/ acute diverticulitis) necessary in all patients with mild disease w/o complications?No
*** Two randomized studies found that the use of antibiotics in such cases _______ (did vs did not) improve recovery time, prevent development of complications or prevent recurrent disease?Did not
*** Despite these results, most patients in the US are treated with _______ and studies are ongoing to further clarify the issue?Antibiotics
List the antibiotics recommended for thos w/ persistent or worsening symptoms?Bactrim or Cipro PLUS Flagyl or Levoquin PLUS Flagyl. OR Augmentin
*** When is hospitalization indicated?1) those who can't tolerate oral liquids and antibiotics (severe illness) 2) in the presence of severe comorbidites disease and if any complications are present
What is the treatment during hospitalization?1) bowel rest 2) IVF 3) IV antibiotics (Zosyn, Invanz, Levaquin PLUS Flagyl
Clinical improvement usually occurs in ___ to ___ days?2; 4
If a localized abscess is present, what may be helpful diagnostically and therapeutically?CT-guided drainage
About ___ to ___ % of patients may require surgical resection?15; 30
Diverticulitis may recur in ___ % to ___% of cases?9; 36
Patients < _____ years of age have a higher risk of recurrence?50
In general, if > _____ episodes of acute diverticulitis occur, patients should be referred for possible definitive surgery therapy?3
***Is there evidence that avoiding nuts, seeds or corn decreases the risk of recurrent diverticulitis?No
***SUMMARY = Define acute diverticulitis?A common complication of diverticulosis and is usually treated with antibiotics and supportive care
*** SUMMARY = Is hospitalization necessary for most patients?No
*** SUMMARY = Hospitalization is necessary for what patients?1) those who can't tolerate oral liquids and antibiotics 2) severe illness 3) in the presence of severe comorbidites diseases and if any complications are present
*** SUMMARY = Is there evidence that avoiding nuts, sees, or corn decrease the risk of recurrent diverticulitis?No