Diverticular Diseases (Diverticular Bleeding, Diverticulosis and Diverticulitis) Flashcards
What is diverticulosis?
little out-pouchings (could be one or many) of the wall of the bowel.
Where is the most common place for diverticulosis (out-pouchings) to occur?
sigmoid colon
Is it common to see diverticulosis in young individuals?
NO. Rather more than half of all people over the age of 80 have diverticulosis.
Is diverticulosis normally asymptomatic?
YES
What happens if a diverticuli becomes plugged?
it can become inflamed (due to bacteria trapped within it), leading to diverticulITIS.
What is complicated diverticulitis?
when these diverticuli progress to the point of perforation, leading to life or death situation.
What can happen as a result of complicated diverticulitis (perforation of bowel)?
peritonitis (peritoneum becomes infected), abscess outside of the bowel, sepsis, fistulas.
What is a fistula?
when the body tries to heal something, but it forms it’s own inappropriate passageway/tube.
How does diverticulosis typically present?
painless lower GI bleeding (but MOST are completely asymptomatic)!
*bleeding is usually minor, but can be massive.
Is diverticulosis one of the top 5 causes of massive lower GI bleed?
YES
What is a hemoccult?
simple stool sample smear that is sent to the lab for testing.
What pt data should you expect to find on H&P for diverticulosis?
- Age greater than 40 (but especially elderly)
- low fiber diet (due to heavy, massive stools that increase intraluminal pressure).
- obesity
- constipation
What key findings should you expect to find on H&P for diverticulOSIS?
none other than a possible positive hemoccult.
What diagnostic tests do we have for diverticulOSIS?
- labs= none
- imaging= none (although diverticuli are sometimes found incidentally on abdominal CT scan or barium enema performed for other reasons).
- endoscopy= COLONOSCOPY (or ANGIOGRAPHY preceded sometimes with radionuclide scan, if BLEEDING is PROFUSE).
- KNOW PICTURES of diverticulosis.
What is the typical presentation of a pt with diverticulITIS?
- LLQ focal abdominal tenderness (usually crampy, though diverticulitis of the right colon can mimic appendicitis). Remember LLQ bc the sigmoid colon is the most common place.
- fever
- constipation (secondary to ileus from sympathetic overstimulation) or diarrhea (due to inflammatory mediators causing edema and accumulation of fluid).
- bloating and flatulence (due to retention of gases).
- +/- nausea and vomiting (in complicated diverticulitis).
- +/- generalized abdominal pain (in complicated diverticulitis).
What are the key histories/pt data to see on H&P in a pt with diverticulITIS?
- PMHx of diagnosed diverticulosis (or history of bleeding).
What other findings will you find on a pt presenting with COMPLICATED diverticulITIS?
- rebound tenderness and guarding (if complicated).
- +/- tender palpable mass
- tympani on auscultation
- decreased or absent bowel sounds
** Will elderly pts (65 and older) on steroids have few if any complaints or pain-related findings on PE for complicated diverticulITIS? (TEST QUESTION)
YES
What are the diagnostic tests for diverticulITIS?
- Labs= CBC (white count), blood culture (only if complicated), and hemoccult (typically NEGATIVE, but will become positive in complicated diverticulitis).
- Imaging= abdominal CT (see pericolic fat stranding, diverticuli, bowel wall thickening, and if complicated +/- abscesses, peritonitis, or fistulas).
- Endoscopy= NOT DURING AN ACUTE EVENT!!!
In what areas of the bowel will you see diverticuli?
- areas where it is weakest; areas where the blood vessels permeate the entire wall thickness. This is why we often see bleeding.
So what 2 things do we need to make a diagnosis of divertiulITIS?
- ABDOMINAL CT (see picture)
2. COLONOSCOPY (AFTER inflammation has subsided).
** How do we treat diverticulOSIS?
- go home and eat high fiber diet
** How do we treat diverticulITIS?
- metronidazole with ciprofloxacin
** How do we treat COMPLICATED diverticulITIS?
admitted to hospital and IV antibiotics
