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27 Cards in this Set

  • Front
  • Back
blood supply of the right colon
superior mesenteric artery and its branches (ileocolic, right colic, and middle colic arteries)
left colon
the inferior mesenteric artery
forms an anastomosis between the SMA and IMA
The marginal artery of Drummond
what vessels are directly associated with diverticular bleeding
The vasa recta are the terminal arterial branches to the colon and run directly to the bowel wall.
The most common area of the colon to develop age dependent diverticulosis is the
sigmoid colon
False diverticuli are defined as
herniations or outpouching that involves
only the mucosa and muscularis mucosa through the colonic wall.
• True diverticuli encompasses all three layers of the colonic wall.
• True diverticuli encompasses all three layers of the colonic wall.
• Decreased dietary fiber produces smaller stools.
The colon needs to
contract more forcefully around smaller stools, which leads to higher intraluminal pressures and requires higher colonic wall tension for propulsion.
diverticular disease is the most common cause of
hematochezia, or bright red or maroon blood perrectum.
Persistent localized inflammation after diverticular rupture results in a
phlegmon, a thickened, firm segment of bowel wall, which may ultimately manifest as acute or subacute large bowel obstruction.
most common complication of diverticulitis
Abscess- and its presence is usually signaled by high-grade fever with chills and fatigue
most common types of fistulas associated with diverticular disease are
colovesical fistulas (65 percent) and colovaginal fistulas (25 percent).
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
more common in women with hysterectomies
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
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
stage 3
diverticulitis with generalised purulent peritonitis
stage 4
diverticulitis with generalised faecal peritonitis
margins of resection
proximal rectum splaying of tenia and healthy proximal colon
Right-sided diverticulitis accounts for approximately 1.5% of all cases of diverticulitis. It is much more common in
Asia (up to 75% of cases).
Hartmann Procedure
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.
Primary anastomosis with diverting ileostomy
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.
Single-stage management:
This is the simplest procedure, and consists of resection of the inflammatory region and anastomosis of remaining sigmoid and rectum without any diverting ostomies.
most vulnerable sites for injury of the ureter are at the
pelvic brim, lateral to the uterus, over the iliac vessels, near the apex of the obturator fossa, and at their insertion on the trigone.
complications
ureteral injury, anastomotic leakage, post-operative intra- abdominal abscess, and perioperative bleeding involving the mesentery, adhesions
main determining factor in recurrence appears to be the
location of anastomosis
colorectal anastomoses have a lower recurrence compared
distal sigmoid colon, having a 4-times increased risk of recurrence
Which of the following items elicited in the patient’s history would make you suspect complicated diverticulitis?
Three urinary tract infections in the last 2 months
Complicated diverticulitis includes perforation, abscess, obstruction or fistula
Which of the following physical examination findings is most consistent with and specific to diverticulitis
Left lower quadrant tenderness with guarding is the best answer.