Diverticular Disease Flashcards
What are characteristics of diverticolosis?
Increases w/ age
Involves the sigmoid colon
Asx, discovered incidentally
What are clinical manifestations of diverticulosis?
Abd cramping, constipation, bloating, diarrhea
How do you manage diverticulosis?
High fiber diet
Hydration
What is the MC type of diverticulitis?
Simple!
What is complicated diverticulitis composed of?
Abscess
Fistula
Obstruction
Perforation
What are the clinical manifestations of diverticulitis?
LLQ progressive achy pain Fever, chills \+/- N/V \+/- change in bowel habits \+/- urinary sx
What labs are used to dx diverticulitis?
CBC: leukocytosis BMP/CMP \+/- amylase/lipase UA/urine culture Urine HCG
If diarrhea or occult blood –> stool studies
What imaging is used to dx diverticulitis? What is the test of choice?
CT: AP w/ contrast (TOC!)
Abd/chest xray
U/S
What procedures are contraindicated in diverticulitis?
Flex Sig/ Colonoscopy (risk of perforation)
Barium enema (barium can leak & exacerbate sx)
How do you treat uncomplicated diverticulitis?
Oral abx
F/u within 2 days
How do you treat complicated diverticulitis?
IV abx
NPO, IVF
GI consult, surgery
What abx regimen is given for uncomplicated diverticulitis?
Gram negative / anaerobic x 7-10 days
Ex. Metronidazole + cipro
OR metro + bactrim
OR augmentin
OR moxifloxacin
What is the criteria for inpatient management of diverticulitis?
Complicated diverticulitis Leukocytosis Fever > 102.5 Severe or increasing pain Peritoneal signs Comorbidities/compromised Failure of other tx Elderly Noncompliance, lack of support
Once acute diverticulitis episode resolves, what dietary supplement is recommended?
High fiber diet!
What is the f/u for diverticulitis? What do you want to exclude?
Colonoscopy 6-8 wks after resolution to:
exclude colon CA or IBD
What is a common cause of overt lower GI bleeding?
Diverticular bleeding
How does diverticular bleeding usually resolve?
Spontaneously!
What are clinical manifestations of diverticular bleeding?
Painless hematochezia
+/- bloating, cramping, urgency
+/- abnormal vital signs
What labs are used to dx diverticular bleeding?
CBC
BMP
What procedures are used to dx diverticular bleeding?
EGD/NG lavage
Once resuscitation complete, locate source of bleed via:
Flex sig/ Colonoscopy
+/- RBC scan/ angiography
How do you treat diverticular bleeding?
Maintain blood volume
Treat bleeding site via:
endoscopic therapy
angiographic therapy
+/- surgery
