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Cecum Diverticulum


Presentation

  • Clinical case presentations , highlighted in special boxes, demonstrate how embryology concepts relate to clinical practice and are ideal for preparing for the USMLE Step 1.[books.google.com]
  • Atypical presentations include a right upper quadrant pain from a long appendix or a right loin pain from a retrocaecal appendix. Patients presenting with peritonitis from perforated appendicitis have generalised abdominal pain.[surgwiki.com]
  • It cannot have escaped observation, that diveeticulum the foregoing course of argument the conclusion is divertuiculum from experience of the present order of things to the reasonableness or probability of dxiverticulum other system--of a future state[dykavugo.awardspace.com]
  • Figure 2 Figure 2: Open solitary diverticulum of the cecum presenting fecaliths. Ileocolectomy with primary end-to-end ileocolic anastomosis was performed.[ispub.com]
  • […] female who presented with free air in the abdomen after pelvic laproscopy.[sages.org]
Abdominal Pain
  • pain, feeling like your bowel is not complete, fatigue, weakness, unexplaned weight loss.[prezi.com]
  • pain Can result in perforation Enteroliths ( 10%) Neoplasia ( 3%) Most often carcinoid (M F) Imaging Findings Abdominal Film , non-specific: Enteroliths, small bowel obstruction, perforation Abdominal CT Diverticulum off distal ileum, small bowel obstruction[learningradiology.com]
  • CT and sonographic evaluation of acute right lower quadrant abdominal pain. Am J Roentgenol 1998;170:361-71. 16. Rao PM, Rhea JT, Novelline RA, et al.[journals.lww.com]
  • Additionally, early laparoscopy in patients presenting acute abdominal pain may be a useful tool allowing the correct diagnosis and appropriate therapy ( 10 ).[ispub.com]
  • Assessment of abdominal pain in children can be very difficult. Abdominal pain in pregnancy also causes problems because of distortion of the normal anatomy and stretching of structures by the gravid uterus.[patient.info]
Colic
  • Microscopic haematuria is usually present in ureteric colic. It can also occur in abdominal aortic aneurysm. [ 3 ] Perform a pregnancy test if an ectopic pregnancy or a miscarriage is suspected.[patient.info]
  • […] muscle , femoral nerve , lateral femoral cutaneous nerve and variably, the appendix medial: ileocaecal valve and terminal ileum superior: ascending colon inferior: the lateral third of the inguinal ligament anterior and posterior caecal arteries from the colic[radiopaedia.org]
  • Adrenal crisis Biliary colic Ruptured spleen Kidney stone Tx Pain relief Epidemiology Common Sx Determinig the cause can be diffcult, because many diseases can cause the Sx See also Pain Abdominal guarding Visceral pain[autoprac.com]
  • MDCT findings includes a distended cecum with circumferential wall thickening, peri-colonic infiltration, and peri-colic fluid (Fig. 5) .6,16,17 Pneumatosis can also be present. 6 Treatment includes bowel rest and antibiotics.[jaocr.org]
  • Right ureteric colic may cause confusion but the radiation of pain and haematuria should give the diagnosis.[surgwiki.com]
Recurrent Abdominal Pain
  • Familial Mediterranean fever : this may cause recurrent abdominal pain , mostly in the first decade of life. Investigations These should be tailored to the patient's symptoms and the examination findings.[patient.info]
  • And those with recurrent abdominal pain may receive many CTs over the course of their life. Diverticulitis is seen mainly in the older population, although with CT scanning, we do see it in younger patients as well.[ahcmedia.com]
  • Diverticulitis due to Fish Bone, A colonoscopy was performed This is a 85 year-old lady, had suffered from recurrent abdominal pain, since three years, in the left iliac fossa, the physical examination found, a marked tenderness in the left iliac fossa[gastrointestinalatlas.com]
Right Lower Quadrant Tenderness
  • Left lower quadrant tenderness is the most common physical finding, as most diverticula occur in the sigmoid colon. [15] Right lower quadrant tenderness, mimicking acute appendicitis, can occur in right-sided diverticulitis.[emedicine.medscape.com]
  • In a patient with obstruction, there may be marked abdominal distention, usually of slow onset; abdominal tenderness may or may not be present, but if tears develop in the cecal taeniae, right lower quadrant tenderness is typically seen.[acssurgery.wordpress.com]
Cecal Disease
  • Keywords Acute diverticulitis; Colonic diverticulitis; Cecal disease; Ascending colon; Caucasian Introduction It is unusual to diagnose a patient with acute right-sided colonic diverticulitis (RCD) in the Western world.[omicsonline.org]

Workup

  • Integrating MR imaging into the clinical workup of pregnant patients suspected of having appendicitis is associated with a lower negative laparotomy rate: single-institution study. Radiology 2013;267:137-44. Dewhurst C, Beddy P, Pedrosa I.[jaocr.org]
  • The historical concept that RCD in the Western world was a more aggressive disease than LCD was merely a reflection of the unfamiliarity with this disease, an inadequate diagnostic workup and decision making in the operating room.[omicsonline.org]
  • […] sensitivity in diagnosing bowel ischemia is reported at 82%, which approaches that of angiography, the current gold standard for diagnosis. 38 Due to the invasive nature of angiography, however, CT has become the imaging modality of choice in the initial workup[jaocr.org]

Treatment

  • The preferable treatment is simple resection.[ncbi.nlm.nih.gov]
  • Treatment For Disease The primary treatment for colon cancer is to surgically remove that part of the colon. Chemotherapy is also a choice if the cancer has spread to the nearby lymph nodes. Diverticulosis Pouches formed in the wall of the colon.[prezi.com]
  • The preferable treatment is simple resection. 1969;4:639-45. 6. Miangolarra CJ. Diverticulitis of the right colon: an important surgical problem. Ann Surg 1961;153:861-70. 7. Pemberton J J, Black BM, Maino CR.[documents.tips]
  • […] ischemia) Differential Diagnosis Appendicitis, colonic diverticulitis, acute mesenteric lymphadenitis Single small intestinal diverticulum Communicating enteric duplication Pseudosacculations (Crohn’s Disease) Cavitating malignancies (lymphoma, GIST) Treatment[learningradiology.com]
  • Treatment of chronic diverticulitis involves treatment of disease that is recurrent or treatment of the complications of an acute attack.[fascrs.org]

Prognosis

  • Long Term Prognosis -Perforation(hole in intestine) -Infection of the abdominal cavity -Bleeding/Blockage in the intestine -Pocket of infection Treatment It depends on the severity of your symptoms.[prezi.com]
  • Prognosis after second attack Second attack  Risk of recurrent attacks is high ( 50%)  Some studies suggest a higher rate (60%) of complications (abscess, fistulas, etc) in a second attack and a higher mortality rate (2x compared to initial attack)[slideshare.net]
  • Prognosis The outcome after surgery is usually excellent. The source of bleeding, pain, or obstruction is removed so the symptoms also disappear. A Meckel's diverticulum will not return.[medical-dictionary.thefreedictionary.com]
  • It also prevents recurrence of diverticulitis episodes in patients with complicated diverticulitis. 11 Prognosis Diverticulitis will recur in 20% to 30% of patients. 2,7 Roughly one-third of patients treated nonoperatively will have a recurrent episode[uspharmacist.com]
  • The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients. Eur Radiol . 2003 Dec. 13 (12):2587-95. [Medline] . Schoetz DJ Jr. Uncomplicated diverticulitis.[emedicine.medscape.com]

Etiology

  • […] and Pathophysiology The exact etiology of diverticular disease is not known.[ahcmedia.com]
  • CT angiography (CTA) may be helpful in identifying the underlying etiology so the correct treatment can be implemented.[jaocr.org]
  • Acute abdomen Acute abdomen is sudden, severe abdominal pain of unclear etiology, Traumatic: Blunt or perforating trauma to the stomach, bowel, spleen, liver, or kidney Inflammatory: Infections, including: Acute appendicitis, most commonly Acute cholecystitis[autoprac.com]
  • RCD is considered to have another etiology than left-sided colonic diverticulitis (LCD) because the type and location of the diverticula differ between Asians and Caucasians [ 7 , 8 ].[omicsonline.org]
  • Right-sided diverticulitis is usually diagnosed in patients with an average age of 40 years, which is older than the typical age of patients who present with appendicitis and younger than those diagnosed with the more common left-sided diverticulitis. 7 Etiology[mdmag.com]

Epidemiology

  • First of all, we need to remind ourselves of the epidemiological perspective.[iffgd.org]
  • Epidemiology Before the 20th century, diverticular disease was rare Prevalence has increased over time  1907 First reported resection of complicated diverticulitis by Mayo  1925 5-10%  1969 35-50% 4. Epidemiology Increases with age  Age 40 5.[slideshare.net]
  • Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis. . Accessed July 24, 2018. Tursi A, et al.[mayoclinic.org]
  • In this article arrow-down Epidemiology arrow-down History arrow-down Examination arrow-down Differential diagnosis arrow-down Investigations arrow-down Management arrow-down Conclusion Pain in the right iliac fossa (RIF) immediately raises the suspicion[patient.info]
  • […] the SMA (superior mesenteric artery) Abdominal aortic aneurysm Hemoperitoneum Sickle cell anemia Other: Diabetic ketoacidosis Ectopic pregnancy Ovarian torsion Acute uteric colic Adrenal crisis Biliary colic Ruptured spleen Kidney stone Tx Pain relief Epidemiology[autoprac.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Law of Laplace: P kT / R Pressure K x Tension / Radius Sigmoid colon has small diameter resulting in highest pressure zone 21.[slideshare.net]
  • Review article: The pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Alimentary Pharmacology and Therapeutics. 2015;42:664. Pemberton JH, et al.[mayoclinic.org]
  • Most of several available texts of gastroenterology, medicine, and pathophysiology do not mention nuts or seeds in their descriptions of the pathogenesis, prevention, or treatment of diverticulosis and diverticulitis.[iffgd.org]
  • The pathophysiology of acquired small bowel diverticulosis is thought to be due to abnormalities of smooth muscle and myenteric plexus.[e-ultrasonography.org]
  • Omental infarction Omental infarction has a pathophysiology and clinical presentation similar to that of epiploic appendagitis, with the infarcted fatty tissue being a right-sided segment of the omentum.[radiologyassistant.nl]

Prevention

  • The decision whether or not to exclude seeds or nuts as primary or secondary prevention of diverticulitis will boil down to common sense and personal choice. Primary prevention would be difficult.[iffgd.org]
  • Low-fiber foods can help prevent bloating and gas as your body heals.[livestrong.com]
  • Diet high in fiber increases stool bulk and prevents constipation, and theoretically may help prevent further diverticular formation or worsening of the diverticular condition.[medical-dictionary.thefreedictionary.com]
  • […] measures include altering risk factors such as obesity, inactivity, and smoking. [2] Mesalazine and rifaximin appear useful for preventing attacks in those with diverticulosis. [2] Avoiding nuts and seeds as a preventive measure is no longer recommended[en.wikipedia.org]
  • A high-fiber diet can alleviate symptoms of diverticular disease (diverticulosis and diverticulitis) and prevent recurrence of acute diverticulitis.[uspharmacist.com]

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