Diverticulitis

Question 1

Diverticulitis is defined as

Answer 1

inflammation of a diverticulum

Question 2

Symptoms of what issue
(1) Perforation of a colonic diverticulum results in an intra-abdominal infection that may vary from microperforation (most common) with localized paracolic inflammation to macroperforation with either abscess or generalized peritonitis. Thus, there is a range from mild to severe disease.
(2) Most patients with localized inflammation or infection report mild to moderate aching abdominal pain, usually in the left lower quadrant.
(a) Diverticular bleeding occurs from the right colon in 50-90% of case.
(3) Constipation or loose stools may be present.
(4) Nausea and vomiting are frequent.
(5) Physical findings include a low-grade fever, left lower quadrant tenderness, and a possible palpable mass.
(6) Stool occult blood is common, but hematochezia is rare.
(7) Leukocytosis is mild to moderate.
(8) Patients with free perforation present with a more dramatic picture of generalized abdominal pain and peritoneal signs.

Answer 2

Diverticulitis

Question 3

Labs for diverticulitis

Answer 3

(1) CBC w/diff
(2) Occult blood

Question 4

In patients with mild symptoms and a presumptive diagnosis of diverticulitis, empiric medical therapy is started without further ____ in the acute phase.

Answer 4

imaging

Question 5

Patients who respond to acute medical management should undergo ____________________ after resolution of clinical symptoms to corroborate the diagnosis or exclude other disorders such as colonic neoplasms.

Answer 5

complete colonic evaluation with colonoscopy

Question 6

True/False
Treatment for Diverticulitis
Most patients can be managed with conservative measures

Answer 6

True

Question 7

Patients with mild symptoms and no peritoneal signs may be managed initially as outpatients on a _______ diet and _______ Dual therapy is required:

Answer 7

clear liquid diet
broad-spectrum oral antibiotics with anaerobic activity.

Question 8

What is the Dual therapy for mild symptoms

Answer 8

Amoxicillin and clavulanate potassium (Augmentin)
OR
Metronidazole (Flagyl)
–PLUS —
either Ciprofloxacin (Cipro)
OR
trimethoprimsulfamethoxazole (Bactrim)

For 7-10 days or until the patient is afebrile for
3-5 days

Question 9

Treatment
-Symptomatic improvement usually occurs within __days, at which time the
diet may be advanced
-Patients with increasing pain, fever, or inability to tolerate oral fluids require
______

Answer 9

3 Days
hospitalization

Question 10

Diverticulitis associated with high fevers, leukocytosis, or peritoneal signs is considered what?

Answer 10

severe

Question 11

Patients with severe diverticulitis (high fevers, leukocytosis, or peritoneal signs) and patients who are elderly or immunosuppressed or who have serious comorbid disease require ______ acutely.

Answer 11

hospitalization

Question 12

Initial Care of diverticulitis

Answer 12

Upon patient presentation and inclination of diverticulitis, treat patient to stabilize and prepare for MEDEVAC

Question 13

Disposition of diverticulitis

Answer 13

MEDIVAC

Question 14

Diverticulitis recurs in ____% of patients treated with medical management

Answer 14

10-30

Question 15

Patients with severe diverticulitis
(a) Patients should be given nothing by mouth and should receive ________.
(b) If _________ is present, a nasogastric tube should be placed.
(c) ________ should be given to cover anaerobic and gram-negative bacteria. Single agent and combination therapy appear to be equally effective.

Answer 15

a) intravenous fluids
b) ileus
c) Intravenous antibiotics