Chronic Diverticulitis: Complications and Pathology

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary goal of treatment in pericolic abscess?

To drain the abscess and resolve acute inflammation (correct)

To prevent fistula formation

To resect the affected segment

To manage intestinal obstruction

What is the most common cause of massive lower gastrointestinal hemorrhage?

Vascular malformations

Colonic cancer

Inflammatory bowel disease

Diverticular disease (correct)

Which investigation has the highest diagnostic yield for detecting vesico-colic fistula?

Barium enema

Colonoscopy

Cystography

Cystoscopy (correct)

What is the indication for a two-stage procedure in the management of fistula?

Extensive inflammatory process Signup and view all the answers

What is the purpose of endoluminal wall stents in the management of intestinal obstruction?

To decompress the obstruction Signup and view all the answers

What is the diameter of the abscess that requires US guided percutaneous drainage?

> 5 cm Signup and view all the answers

What is the symptom of chronic intestinal obstruction?

Progressive constipation Signup and view all the answers

What is the investigation of choice to diagnose colovesical fistula?

CT scan Signup and view all the answers

What is the most common complication of chronic diverticulitis?

Acute inflammation Signup and view all the answers

What is the typical demographic for uncomplicated diverticulosis coli?

Female > 40 years Signup and view all the answers

What is the characteristic symptom of irritable colon syndrome in diverticulosis coli?

All of the above Signup and view all the answers

What is the best diagnostic imaging modality for diverticulosis coli?

Barium enema Signup and view all the answers

What is the pathophysiological mechanism underlying chronic diverticulitis?

Recurrent attacks of acute diverticulitis Signup and view all the answers

What is the commonest location for hemorrhage in diverticulosis coli?

Right colon Signup and view all the answers

What is the characteristic radiological feature of 'pre-diverticular state' on barium enema?

Saw teeth appearance Signup and view all the answers

What is the purpose of sigmoidoscopy in the management of diverticulosis coli?

To exclude a neoplasm Signup and view all the answers

What is the typical location of tenderness in a patient with diverticulitis?

Left lower quadrant Signup and view all the answers

What is the primary goal of the Reilly sigmoid myotomy procedure?

To restore colonic lumen and reduce colonic pressure Signup and view all the answers

What is the recommended dietary modification for patients with diverticulosis?

High residue diet Signup and view all the answers

What is the primary concern when performing a barium enema or sigmoidoscopy in a patient with acute diverticulitis?

Perforation and peritonitis Signup and view all the answers

What is the typical clinical presentation of perforation in diverticulitis?

Severe abdominal pain and toxaemia Signup and view all the answers

What is the primary indication for surgical intervention in diverticulitis?

All of the above Signup and view all the answers

What is the ideal surgical procedure for treating diverticulitis?

One-stage resection of the affected segment with end-to-end anastomosis Signup and view all the answers

What is the diagnostic imaging modality of choice for evaluating perforation in diverticulitis?

Plain X-ray abdomen Signup and view all the answers

Study Notes

Chronic Diverticulitis

Result of recurrent attacks of acute diverticulitis, with a thickened and adherent colon wall.
Complications include acute inflammation, perforation, chronic intestinal obstruction, fistula, and hemorrhage.

Complications

Acute inflammation: most common complication.
Perforation: leads to peritonitis, either localized (abscess) or generalized.
Chronic intestinal obstruction: due to fibrosis and strictures.
Fistula: external (colocutaneous) or internal (colovesical, colovaginal, or coloenteric).
Hemorrhage: due to erosion of vasa recta, more common in the right colon.

Management

Uncomplicated: females > males, >40 years old.
Clinical picture: asymptomatic or irritable colon syndrome with 5 A's (abdominal distension, pain, abnormal stool frequency, form, and passage).
Signs: thickened, tender, palpable colon.
Investigations: barium enema, sigmoidoscopy, and CT scanning.

Treatment

Uncomplicated: high-residue diet, antispasmodic drugs, and bulking agents.
Complicated:
- Diverticulitis: Ochsner-Sherren regimen, antibiotics, and fluids.
- Perforation: surgical intervention, with Hinchey classification guiding treatment.
- Intestinal obstruction: conservative approach with endoluminal wall stents or surgical intervention.
- Fistula: one-stage or two-stage procedure with resection anastomosis and fistulectomy.
- Bleeding: diagnosis is challenging, and treatment involves identifying and treating underlying causes.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Learn about the long-term effects of recurrent acute diverticulitis, including thickened colon walls, complications, and potential outcomes. This quiz covers the pathology and consequences of chronic diverticulitis.