Diverticular disease Flashcards
A 57-year-old woman with a history of hypertension and hypercholesterolaemia presents to the accident and emergency department with a 24-hour history of gradually worsening left-lower quadrant abdominal pain associated with nausea and vomiting.
Impression/DDx/Goals
Impression
Given age, concerned about diverticular disease given location of abdominal pain and associated sx. Need to rule out RED flags such as hernia, sigmoid volvulus, SBO, IBD, malignancy. Other common DDx to consider includes gastroenteritis.
Goals:
- take complete history and examination, identify likely causative aetiology
- initiate appropriate management
Diverticular disease - History
History:
- Sx: pain (SOCRATES), bowel changes, urinary changes,
- RED FLAGS: haematochezia, melena, long prodrome, family history of malignancy, systemic illness/decompensation (fever)
- risk factors: over 50, low fibre diet
- Gynaecological history
- PMHx, PSHx, family history
- Medications, allergies
- SNAP
Diverticular disease - Examination
Exam:
- EOBOG
- Vitals/baselines
- Abdominal examination
- Urinalysis, stool sample
Diverticular disease - Investigations
Investigations:
- bedside: Vital signs
- bloods: FBC, UEC, LFT, CRP/ESR
- imaging: abdominal ultrasound, Contrast CT Abdo, upright CXR
Diverticular disease - Management
Management:
Outpatient treatment setting unless red flags or systemic illness, in which case presentation to hospital.
Non-pharm
- dietary mods: increasing dietary fibre (fruit, vegetables, metamucil/supplementation)
- increased fluid consumption
- no need to avoid nuts/seeds
Pharm
- antibiotics generally not indicated in non-severe flare of diverticular disease
- if complicated, or recurrent, or right sided, or immunocompromised consider antibiotics (augmentin, bacterim.
If severe:
A to E approach, focussed on stabilisation and either medical/surgical treatment.
- medical: gent, metro, amp
- surgical: colectomy, laparotomy
