Diverticular dz Flashcards
Diverticulosis
leads to
sac like protrusion in colon wlal
diverticular bleed/diverticulitis
Patho
true diverticulum
develops in areas of
most occur in
develop false diverticulum bc only mucosa/sub penetrate MP of colon
herniate entire bowel wall
weakness in colon well, vasa recta penetrates MP
sigmoid colon
Pts havw
contributing fator
diverticula lined w
r side of colone
Inc intraluminal pressre
most common area
excessive segmental colon contracts- inc intraluminal pressure/herniation
diet leading to constip
vasa recta- can compress/erode, leading to weakness of artery (perf/bleeding)
weaker wall, wider diverticula, more VR exposed (more bleeding)
damage mucosa wall, inflammation- focal necrosis w perforation (leads to diverticultis)
sigmoid (intraluminal pressure + in distal colon)
Common pops
complications
diverticular bleeding is MCC cause of
older, western diet
older people
Lower GI bleeding in >60yrs
CM
Dx made w
asx until comp
endoscopy/colonoscopy/CT scan
Diverticular nleeding
on r side
bright red blood indicates
Dx challenging w
painless hematochezia
bloating/ab cramping, maroon colored (proximal colon)
r side bleeding or sigmoid colon
blood in lumen/no bleeding (get colonoscopy)
Diverticulitis
diarrhea may be
Comp
PE
Acute F, anorexia, LLQ pain, const/diarrhea
low volume
localized/generalized peritonitis/pericolic abscess (mass)
LLQ tenderness, guarding, reboudn tenderness
CT scan findings diverticulitis
helpful w
localized bowel wall thickening, pericolic stranding, diverticula
complications- fluid/abscess
Mx- asx
Diet
acute diverticulitis
Outpatient
Inpatient
curative therapy
no mx
high fiber- red episodes
AB (-/an) and liquid diet
O- cipro/metro, amox/clav
I- cef/metro or BL/BLI (amp/sul pip/taxo. tacarcillin/clav)
bowel resection- segmental colectomy if massive/recurrent bleeding/peritonitis/abscess
Prog
asx, comps w age
