Diverticular Disease Flashcards

1
Q

When do you see more diverticulosis?

A

Increases with age (over 60 see more)

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2
Q

Predominant sight of diverticulosis

A

Sigmoid colon (smallest diameter and largest intraluminal pressure)

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3
Q

Most common presentation of diverticulosis

A

Asymptomatic and discovered incidentally

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4
Q

Why does diverticulosis occur?

A

Develops at weak point in the colonic wall where vasa recta penetrate
Increased pressure predisposes mucosa and submucosa to herniate
Also a low fiber diet–constipation–intraluminal pressure–herniation (progression maybe)

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5
Q

Other sxs of diverticulosis

A

Occasional abdominal cramping, constipation, diarrhea, bloating
Normal exam

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6
Q

Diagnostics for diverticulosis

A

No labs or imaging needed b/c usually found incidentally

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7
Q

Tx for asymptomatic diverticulosis

A

High fiber diet (20-35 g/day)-increase stool bulk
Adequate hydration
Don’t recommend avoidance of seeds/nuts

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8
Q

Why does diverticulitis occur?

A

Inspissated debris obstructs neck of diverticulum or increased luminal pressure result sin erosion of diverticular wall leading to inflammation and necrosis and then a perf (free air and peritonitis)

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9
Q

Most common type of diverticulitis

A

Uncomplicated

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10
Q

Types of complicated diverticulitis

A

Abscess, fistula, obstruction or perforation

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11
Q

Presentation of acute diverticulitis

A

Progressive, steady aching pain usually LLQ
Fever/chills
Maybe n/v, change in bowel habits, irritative urinary sxs
Low fever, maybe peritoneal signs

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12
Q

What can be seen with a colovesical fistula with diverticulitis?

A

Pneumaturia or fecaluria

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13
Q

Exam for diverticulitis

A

LLQ abd tenderness
Rectal exam may have mass or tenderness (stool guaiac)
Pelvic exam for women

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14
Q

Labs for diverticulitis

A

CBC-moderate leukocytosis (maybe not in elderly)
BMP/CMP (maybe amylase or lipase)
UA/culture and urine HCG
Stool studies if diarrhea

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15
Q

Test of choice for acute diverticulitis

A

CT scan of A/P with contrast (see localized bowel wall thickening and fat stranding, presence of colonic diverticula)

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16
Q

Other options for imaging for acute diverticulitis

A

Abd/CXR (for obstruction or perf)

U/s

17
Q

Diagnostics contraindicated in diverticulitis

A
Flex sig/colonoscopy (risk of perf)
Barium enema (can leak through perf and exacerbate peritonitis)
18
Q

General tx for uncomplicated diverticulitis

A

Usually give oral abx
Clear liquid/low residue diet
Close f/u in 2 days

19
Q

General tx for complicated diverticulitis

A

Admit

NPO, IVF, IV abx

20
Q

Outpatient tx of uncomplicated diverticulitis

A

Gram negative/anaerobic coverage x 7-10 days
CL/low residue diet and advance as tolerated to high fiber diet (resolve acute episode)
Maybe repeat imaging
F/u in 2 days!!!

21
Q

When is inpatient management done for diverticulitis?

A
Complicated on CT
Significant leuokcytosis
>102.5 F
Severe of increasing abd pain
Peritoneal signs
Comorbidities/immunocompromised
Can't tolerate PO
Noncompliance/unreliability/lack of support
Failed outpt tx
Elderly
22
Q

Inpatient tx of diverticulitis

A

NPO or CL depending on severity
IVF, analgesic
IV abx (transition to oral for a 10-14 day course)

23
Q

When is repeat imaging done with an inpatient diverticulitis?

A

Failure to improve within 2-3 days of IV abx therapy

24
Q

When to refer to surgery with acute diverticulitis?

A

Perforation with peritonitis
Condition deteriorates/fails to improve within 72 hrs of medical therapy
Complicated

25
Long term management of diverticulitis
High fiber diet when acute episode resolves Colonoscopy 6-8 wks after resolution for some ppl (evaluate extent of disease or exclude concomitant colon cancer of IBD)
26
Common cause of overt lower GI bleeding in adults
Diverticular bleeding
27
Tx for diverticular bleeding?
Usually resolves spontaneously
28
Why does diverticular bleeding occur?
Penetrating artery draped over dome of diverticulum is easily exposed to injury and susceptible to bleeding
29
Where is diverticular bleeding seen the most?
Right colon (b/c diverticulum are wider and have more exposure of vasa recta)
30
Presentation of diverticular bleeding
Painless hematochezia Maybe bloating, cramping, fecal urgency, abd vital signs pending severity Usually normal exam but maybe TTP
31
Diagnostics for diverticular bleed
CBC (trend H/H) | BMP (BUN/Cr should not be elevated in pts with colonic diverticular bleed but upper GI will be)
32
How to locate source of bleeding for diverticular bleed
Flex sig/colonoscopy and maybe tagged RBC scan/angiography (after initial resuscitation)
33
Management of diverticular bleeding
Resuscitation/hospitilization and maintain BV (transfuse) | Tx of bleeding site: endoscopic therapy, angiographic therapy and maybe surgical intervention