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27 Cards in this Set
- Front
- Back
blood supply of the right colon
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superior mesenteric artery and its branches (ileocolic, right colic, and middle colic arteries)
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left colon
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the inferior mesenteric artery
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forms an anastomosis between the SMA and IMA
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The marginal artery of Drummond
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what vessels are directly associated with diverticular bleeding
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The vasa recta are the terminal arterial branches to the colon and run directly to the bowel wall.
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The most common area of the colon to develop age dependent diverticulosis is the
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sigmoid colon
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False diverticuli are defined as
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herniations or outpouching that involves
only the mucosa and muscularis mucosa through the colonic wall. |
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• True diverticuli encompasses all three layers of the colonic wall.
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• True diverticuli encompasses all three layers of the colonic wall.
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• Decreased dietary fiber produces smaller stools.
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The colon needs to
contract more forcefully around smaller stools, which leads to higher intraluminal pressures and requires higher colonic wall tension for propulsion. |
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diverticular disease is the most common cause of
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hematochezia, or bright red or maroon blood perrectum.
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Persistent localized inflammation after diverticular rupture results in a
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phlegmon, a thickened, firm segment of bowel wall, which may ultimately manifest as acute or subacute large bowel obstruction.
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most common complication of diverticulitis
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Abscess- and its presence is usually signaled by high-grade fever with chills and fatigue
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most common types of fistulas associated with diverticular disease are
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colovesical fistulas (65 percent) and colovaginal fistulas (25 percent).
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As colovesical fistulas tend to have a slight predominance in men, it is believed that the uterus provides some protection to the bladder. This is supported by the fact that colovaginal fistulas are
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more common in women with hysterectomies
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Hinchey classification of acute diverticulitis-
stage 1 |
stage 1a - phlegm on
stage 1b - diverticulitis with pericolic or mesenteric abscess Modified Hinchey Stage 0 and 1a disease is typically treated with bowel rest with a liquid or low-residue diet and oral antibiotics over 7-10 days in stable patients with no significant comorbidities or immunosuppression |
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Hinchey classification of acute diverticulitis
stage 2 |
diverticulitis with walled off pelvic abscess
small abscesses less than 3-4cm might not be amenable to CT-guided drainage |
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stage 3
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diverticulitis with generalised purulent peritonitis
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stage 4
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diverticulitis with generalised faecal peritonitis
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margins of resection
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proximal rectum splaying of tenia and healthy proximal colon
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Right-sided diverticulitis accounts for approximately 1.5% of all cases of diverticulitis. It is much more common in
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Asia (up to 75% of cases).
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Hartmann Procedure
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This procedure is performed traditionally in the urgent setting of perforation (Hinchey stages 3 and 4), obstruction, or massive bleeding and includes a temporary stoma procedure to eliminate the risk of anastomotic leakage
First the proximal sigmoid colon is divided at a level above the inflamed tissue, and then the rectum is divided through noninflamed tissue, thus removing the inflammatory mass in between. Next the proximal colon is delivered through a previously marked stoma site and a colostomy is created. |
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Primary anastomosis with diverting ileostomy
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the proximal sigmoid and rectum are diverted above and below the inflammatory mass, respectively. At this point these ends are anastomosed and a loop ileostomy is created in the right lower quadrant.
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Single-stage management:
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This is the simplest procedure, and consists of resection of the inflammatory region and anastomosis of remaining sigmoid and rectum without any diverting ostomies.
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most vulnerable sites for injury of the ureter are at the
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pelvic brim, lateral to the uterus, over the iliac vessels, near the apex of the obturator fossa, and at their insertion on the trigone.
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complications
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ureteral injury, anastomotic leakage, post-operative intra- abdominal abscess, and perioperative bleeding involving the mesentery, adhesions
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main determining factor in recurrence appears to be the
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location of anastomosis
colorectal anastomoses have a lower recurrence compared distal sigmoid colon, having a 4-times increased risk of recurrence |
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Which of the following items elicited in the patient’s history would make you suspect complicated diverticulitis?
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Three urinary tract infections in the last 2 months
Complicated diverticulitis includes perforation, abscess, obstruction or fistula |
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Which of the following physical examination findings is most consistent with and specific to diverticulitis
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Left lower quadrant tenderness with guarding is the best answer.
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