Diverticular Disease

Definitions + Epidemiology

100

This is the most common site of diverticula, which is involved in 90% of patients with diverticulosis

Sigmoid colon

200

Contrary to popular belief, consumption of three specific foods do NOT increase the incidence of diverticulitis or diverticular bleeding. Name one of the three

Nuts, corn, or popcorn

300

This is the prevalence of diverticula (NOT diverticulitis) in elderly patients over 85

80%

400

Name the components of the Saint triad (3 conditions that frequently co-occur)

Diverticulosis, cholelithiasis, and hiatal hernia

500

Describe all 4 stages of the Hinchey classification of diverticulitis

Anatomy + Pathophys

100

Diverticula are actually pseudodiverticula because they involve herniation of only the mucosa and submucosa through the muscularis at particular sites between the mesenteric taenia and one of the antimesenteric taenia. Name the structure(s) that occur at these sites of colonic wall weakening

Blood vessels

200

If microperforation of a thin-walled diverticulum occurs causing localized inflammation, this layer of the bowel wall remains relatively normal

Mucosa

300

The Western diet is associated with development of diverticulosis because it is high in something and low in something else. Name these two.

High in refined carbs, low in fiber

400

 

500

Describe the 4 grades of cecal diverticulitis

Grade 1 refers to inflamed diverticulitis, Grade 2 to inflamed cecal mass, Grade 3 to localized abscess and fistula, Grade 4 to diffuse peritonitis or free perforation 

Clinical Presentation/DDX

100

Name one of the classic symptoms of uncomplicated acute diverticulitis

LLQ abdominal pain, low-grade fever, irregular bowel habits, possible urinary symptoms if affected colon ajacent to bladder

200

Name three conditions that define complicated diverticulitis (article lists 5)

Obstruction, abscess formation, fistula formation, free perforation, significant bleeding

300

Name the Hinchey stage(s) associated with free perforations in diverticulitis, and name the disease that can cause free perforations is it important to distinguish perforated diverticulitis from

Hinchey stages III (purulent peritonitis) and IV (fecal peritonitis), distinguish from perforated colon CA

400

In the US, this percentage of lower GI bleeding is caused by diverticulosis

33%

500

Name 5 of the 6 differential diagnoses of uncomplicated diverticulitis mentioned in the article

Gynecologic/urinary disorders

Perforated colon CA

Crohn disease

Ischemic Colitis

Epiploic appendagitis

Appendicitis

Diagnostic Studies

100

This is the best diagnostic test for suspected diverticulitis

CT with PO AND PR contrast

200

This is the time period after acute diverticulitis has subsided that colonoscopy should be performed

6-8 weeks

300

Name the type imaging study (be specific) and describe how it can contrast (hint hint) diverticula from malignancies

Double contrast barium enema, malignancy suggested by an abrupt transition to an abnormal mucosa over a relatively short segment; diverticulitis is usually characterized by a gradual transition into diseased colon over a longer segment, 

400

Name 4 of the 5 classic findings of colovesical fistula seen on CT (images here don't necessarily have all 6)

Sigmoid diverticula

Thickening of bladder and colon

Opacification of fistula tract

Air in bladder

Abscess

500

Name A - D in this angiogram (C is an anatomic location in the bowel) 

A: angio catheter selecting SMA

B: SMA

C: right/ascending colon (with contrast extravasation from diverticular bleed)

D: Right colic artery

Special Types of Diverticulitis

100

According to the article, the high rate of early operation for diverticulitis in young patients (<40) is likely due to it being misdiagnosed as this disease

Acute appendicitis

200

Describe the mechanism that leads to the development of giant diverticula

"Ball-valve" mechanism where intermittent occlusion of neck of diverticulum by fecal material traps air in the diverticulum

300

This subgroup of immunocompromised patients should NOT undergo prophylactic colectomy for asymptomatic diverticulosis (be specific)

Renal transplant

400

This type of atypical diverticulitis is shown in the imaging

Diverticulitis with retroperitoneal abscess

500

Name the 4 necessary conditions described in the article for diverticulectomy in patients with cecal diverticulitis

1. Carcinoma can be ruled out

2. Resection margins free from inflammation

3. Ileocecal valve and blood supply of bowel not compromised

4. Perforation, gangrene, and abscess are present