Term
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Definition
| a balloon-like sac/pouch in the wall of the colon. diverticulosis is the presence of these in a pt, diverticulitis is when they become inflamed. |
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Term
| what is a common symptom of pts with diverticulosis? how is this addressed? |
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Definition
| constipation - which is addressed via 5 servings of fiber daily. |
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Term
| what is the incidence of diverticulosis? |
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Definition
| 33-50% for ptx > 50 yrs old, and > 50% for pts > 80 yrs old. it increases w/age |
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Term
| what are pseudodiverticula? |
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Definition
| diverticuli which lack muscle and only involve mucosa/serosa. |
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Term
| what is involved in 95% of diverticulosis pts? |
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Definition
| the sigmoid, often accompanied by excruciating LLQ pain |
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Term
| is diverticulosis often seen in the rectum? |
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Definition
| it is rare to see in the rectum b/c the circumferential longitudinal muscle prevents herniation |
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Term
| what is diverticulosis due to? |
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Definition
| increased intraluminal pressure (often due to lack of fiber) and decreased strength of the bowel wall. there is a questionable relationship between IBS and diverticulosis. |
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Term
| what characterizes uncomplicated diverticulosis? what is the rate of progression to diverticulitis? |
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Definition
| bloatedness, flatulence, abdominal pain and irregular defecation. rate of progression to diverticulitis: 10-25% |
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Term
| how is diverticulosis diagnosed? |
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Definition
| ABD x-ray (not as beneficial), double contrast barium enema, and colonoscopy |
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Term
| what is in the ddx for uncomplicated diverticulosis? |
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Definition
|
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Term
| what is in the tx for uncomplicated diverticulosis? |
|
Definition
| fiber, avoidance of nuts/seeds |
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Term
| what is diverticulitis? what can it result in? |
|
Definition
| complicated diverticulosis - which can result in self-resolution, abscess, peritonitis, and obstruction |
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Term
| how do pts with diverticulitis present? |
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Definition
| n/v, abdominal pain, fever, ileus, leukocytosis, and ESR |
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Term
| what is in the ddx for diverticulitis? |
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Definition
| acute appencdicitic, IBD, ischemic colitis radiation induced colitis, and infectious colitis |
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Term
| how is diverticulitis diagnosed? |
|
Definition
| CT (best), double contrast barium enema/endoscopy - not recommended |
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Term
| what is tx for diverticulitis? |
|
Definition
| fluid status/replacement, NG tube for ileus/obstruction, broad spectrum antibx (triple tx: amp, gent, metro: gold standard). |
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Term
| how often does diverticulitis require sx? what are indications for sx? |
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Definition
| 15-30% of cases. indications for sx: free perforation (air) w/fecal peritonitis, suppurative peritonotis due to ruptured abscess, abd/pelvic abscess, fistula obstruction, recurrent diverticulitis, and inability to r/o CA |
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Term
| how common are diverticular bleeds w/diverticulitis? |
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Definition
| 47% have minor/painless bleeding w/self resolution. 5% have massive rectal bleeds, which opens concern for hypovolemic shock (hyptension, tachycardia, and syncope) |
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Term
| what is in the ddx for diverticular bleeds w/diverticulitis? |
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Definition
| duodenal ulcer, meckel's diverticulum, and vascular ectasias |
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Term
| what are diagnostic studies for pts with diverticular bleeds w/diverticulitis? |
|
Definition
| colonoscopy, angiography, and nuclear scans |
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Term
| how are diverticular bleeds w/diverticulitis treated? |
|
Definition
| minor bleed: <2 units of PRBCs. major bleed: >4 units of PRBCs. (order PRBCs on admission) colonoscopy if bleeding persists, then angiography, then sx. complete colectomy if unable to ID site and bleeding persists. |
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Term
|
Definition
| a GI disorder characterize by altered bowel habits and abdominal pain *in the absence of detectable structural abnormalities*. no clear diagnostic markers exist, and women present w/IBS 2-3x more often. |
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Term
| what is the prevalance of IBS? |
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Definition
| IBS is the most common dx amoung GI practices, among top 10 for PCPs, and the *most common functional bowel disorder (not structural) |
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Term
| what are the clinical features of IBS? |
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Definition
| abdominal pains, altered bowel habits, gas/flatulence, and upper GI symptoms. |
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Term
| what is the pathophysiology of IBS? |
|
Definition
| poorly understood, involves an exaggerated sensory response to visceral stimulation as well as psychosocial/environmental factors (anxiety, depression, somatization, and hx of abuse/stressors) |
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Term
| what psychosocial factors are often specifically involved w/IBS pts? |
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Definition
| depression/anxiety, panic disorders, life stressors, and hx of abuse |
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Term
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Definition
| IBS is a dx of exclusion. organic disease must be eliminated and according to the rome criteria, symptoms have to be present for at least 3 months. |
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Term
| what are the rome criteria for IBS? |
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Definition
| likely IBS if: if abdominal pain is relieved with defecation, associated with change in stool frequency or consistency OR if pts experience change in stool frequency/consistency, difficulty in passing stools, sense of incomplete evacuation or presence of mucus in the stool 2x or >25% of the time for 12 wks. |
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Term
| what foods may incite IBS symptoms? |
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Definition
| fatty foods, raw fruit/veggies, caffeine, lactose, and spicy foods |
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Term
|
Definition
| reassurance/careful explanation of the functional nature of the disorder. elimination of aggravating foods. fiber/low fat diet. anti-cholingergic rx. psychoanalysis/counseling/*cognitive behavior therapy and stress management. |
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Term
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Definition
| a 5HT3 antagonist for diarrhea in women which was taken off the market due to concerns about ischemic colitis/severe constipation. it can now be prescribed w/special certification/registration |
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Term
| what is tegaserod? contraindications? |
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Definition
| a 5HT4 receptor agonist for IBS constipated women that stimulates the peristaltic reflex, alters secretion of the intestine and reduces visceral sensitivity. contraindications: severe renal impairment, mod/severe hepatic impairment, hx of bowel obstruction, symptomatic bowel disease, suspected sphincter of oddi dysfunction, or abnormal adhesions, and known hypersensitivity to the drug. |
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Term
| what is the current DOC for constipation IBS? |
|
Definition
| lubiprostone which activates Cl channels. it is contraindicated in pregnancy and may cause n/v, diarrhea, and HA. |
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