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24 Cards in this Set
- Front
- Back
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1. 62-year-old man resents the sign compatible with recurrent sigmoid diverticulitis. Most likely diagnosis?
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a. Acute sigmoid diverticulitis within abcess
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2. Confirmation of about diagnosis?
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a. A CT demonstrating sigmoid diverticula, colonic wall thickening, and mesenteric fat stranding
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3. Associated complications with diverticulitis?
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a. Perforation
b. Abscess formation c. Bowel obstruction d. Development of fistulas |
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4. Value of CT scan for diverticulitis?
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a. Very helpful especially for identifying abcess.
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5. Treatment of small mesenteric abscesses associated with diverticulitis?
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a. Usually resolve with antibiotic therapy alone
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6. Treatment of large abscesses associated with diverticulitis?
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a. May require CT guided drainage in addition to antibiotic therapy.
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7. Treatment of multiple abscesses and abscesses in inaccessible locations with diverticulitis?
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a. May require operative drainage.
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8. Note: If patient fails to improve clinically after 72 hours of diverticulitis with nonoperative treatment, surgical intervention is usually warranted.
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8. Note: If patient fails to improve clinically after 72 hours of diverticulitis with nonoperative treatment, surgical intervention is usually warranted.
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9. Diverticulosis?
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a. Outpouchings of the colon that do not contain all layers of the colon wall.
b. Most commonly in the sigmoid in Western societies |
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10. In whom is right-sided or cecal diverticulosis more common?
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a. Asian populations
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a. Asian populations
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a. Inflammation of the diverticulum caused by obstruction of the neck of the diverticulum and micro perforation.
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12. Radiologic exam of choice for diverticulitis?
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a. CT
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13. Why is a barium enema generally deferred for diverticulitis?
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a. Because of concerns for intraperitoneal leakage of barium.
b. Colonoscopy should be used caution. |
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14. When should patients be hospitalized for diverticulitis (mild cases can be treated on an outpatient basis)?
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a. Patients with signs of systemic toxicity (fever, tachycardia, and peritonitis) should be hospitalized for hydration, treatment with IV antibiotics, bowel rest, and close observation.
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15. Treatment of immunocompromised patient’s diverticulitis?
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a. Patients who are immunocompromised tend to be unresponsive to medical treatment alone and usually require surgical intervention.
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16. When should patients be advised to undergo elective resection?
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a. Patients who have had 4 or more episodes of
b. Or have significantly compromised quality of life due to diverticulitis. |
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17. What is recommended for the diverticulitis patient is hemodynamically unstable or fecal peritonitis is present?
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1. Surgical resection
2. Colostomy 3. Closure of the rectal stump (Hartmann procedure). |
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18. Where may diverticular fistulas occur?
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a. Between the sigmoid colon in the bladder, vagina, spleen, or another segment of bowel.
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19. We can be used to visualize the fistula?
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a. Barium enema
b. CT scan c. Sigmoidoscopy d. Cystoscopy or vaginal speculum exam may help identify a colovesical or colovaginal fistula respectively. |
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20. Treatment of diverticular fistulas?!?
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a. Resection of the sigmoid colon
b. Excision of the fistulous tract c. Repair or resection of the other involved organ |
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21. In a patient presenting with pneumaturia and recurrent UTIs, what test would most likely lead to diagnosis?
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a. Colonoscopy (not CT).
b. The CT scan can be used to confirm the diagnosis of a colovesical fistula and to localize the fistulous tract. |
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22. Most common cause of gastrointestinal fistulas?
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a. Diverticulitis. Usually a colovesical (colon-to-bladder) fistula.
b. Air or stool in the urine or frequent urinary tract infections are typical. |
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23. When the benefits of surgery with colectomy outweigh the risks for diverticulitis?
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a. After the 4th episode of diverticulitis.
b. However, any decision for surgery must also take into account eh pt’s life expectancy and overall fitness to undergo operative intervention. |
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24. Complete
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24. Complete
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