diverticulitis Flashcards
what is diverticula
small outpouchings on colon walls, small intestine, esophagus
weak spots
found by accident
leads to colectomy
what are the risk factors for diverticulitis
high fat diet, red meat, low fiber
acute cause
inf of diverticula reflect inflammatory alone or micro perforation or macro perforation dt
Food impactions, partial obstruction of colon, peritonitis abscess
S&S
local inflam/infection: abd pain mild-mod aching in LLQ
change in bowel habits
n/v
free perforation: intense general pain, peritoneal signs
low grade fever
llq tenderness
palpable mass
labs
cbc, ua, ast/alt, alkaline phosphatase, bilirubin, amylase, lipase, stool cultures if diarrhea
imaging
mild: resumed diverticulitis, empiric therapy w/o imaging
complete colonic evaluation: colonscopy, barium enema
CT scan of colonic diverticula
bowel thickening, increased fat density
ct scan abscess
fluid collection
ct scan perforation and peritonitis
free air
complications
fistula (bladder, ureter, vagina, uterus, bowel, abd wall), structuring of colon w/ partial or complete obstruction
mild symptoms med tx
out pt: clear liq
broad-spectrum abx: augmentin, Flagyl + Cipro, Bactrim
if symptoms improve in 3 days: advance diet AAT
if symptoms worsen + fever + pain: admit
severe med tx, elderly, immunocompromised or comorbidities
hosp: npo, ivf, iv abx (anaerobes and gram neg coverage) 2nd gen cephalosporin, NG tube
symptomatic improvement 2-3 days, cont ib abx for 5-7 days then change to oral
sx tx
severe dz: no improve >72 hrs: sx consult and repeat ct
localized abd abscess: 4 cm in size or larger: urgent percutaneous cath drain (IR placement) goal: control inf
chronic dz w/ fistula or obstruction: elective sx resection
emergent sx: general peritonitis large undrainable abscess, clinical deterioration despite med tx and percutaneous drainage
