fariba jafari. definition outpouchings of the colon located at sites where blood vessels enter the...
TRANSCRIPT
Definition• Outpouchings of the
colon• Located at sites
where blood vessels enter the colonic wall
• Inflamed as a result of obstruction by feces or hardened mucus or of mucosal erosion localized perforation= diverticulitis
Associated Risk FactorsDecreased physical activityIntake of non-steroidal anti-inflammatory
drugs (NSAID)SmokingConstipation from any cause• Incidence increases with age.• Diet has been associated with the emergence
of this disease.
• Low-residue diet constipation lead to increased intraluminal pressure in the large bowel
• High pressure zones or areas of segmentation may develop (sigmoid colon), and diverticula begin to protrude at these locations
• Microperforation of thin walled diverticulum widespread contamination with fecal organisms may ensue
Physical ExaminationUncomplicated: LLQ tenderness, possible
mass, bleeding (uncommon), localized inflammation,
Complicated: mass, evidence of fistula, ambdominal distention, abdominal tenderness, marked in cases of free perforation, hypotension; bleeding
2 coursesMild: outpatient basis. Liquid diet, oral
antibioticsIf not: hospitalize patient. NPO. IV
antibiotics. CT with contrast.
What now?Symptoms resolve: colonoscopy or contrast
studyRecur: surgical treatment
• 20% of patients with diverticulitis require surgical treatment.
Surgical
ObstructionPerform
diagnostic imaging
Small bowel: high-grade, low-grade
Large bowel: cecal distention
FistulaSignaled by fecaluria and pneumaturiaDiagnostic imagingbladder airTreat medicallyResect colon and fistula in one-stage
procedure