Diverticulitis Flashcards
sx of diverticulitis
Fever, nausea, vomiting
Constant llq pain x days with radiation to back /groin, mass
Alternating constipation and diarrhea
Obstruction, hematochezia (rare)
Urinary sx (dysuria, polyuria)
Signs of diverticulitis
Fever; ↑ hr, ↓ bp
Llq pain / tenderness, rebound, guarding, mass
Signs and sx of fistula
Fecaluria, pneumaturia, pyuria,
Complications of diverticulitis
Abscess
Fistula
Obstruction
Perforation
Investigations for dx of diverticulitis
,
-WBC, cr, urinalysis, CRP (>150 → complications)
- xray abdomen → free air, ileus, partial obstruction
- ct abdomen with IV contrast
- u/s and MRI are alternatives if ct not available
Predictors of complicated diverticulitis
Signs and symptoms >5 days
Vomiting
Systemic comorbidity
↑ crp > 140mg/l
Ct with pericolic extraluminal air, long segment, collection
NPR 96% for complicated → abdo guarding, increased crp, increasedwbc
Management of uncomplicated diverticulitis
Outpatient management with
Bowel rest + clear liquid diet x 2-3 day
Followed by high fibre diet (35g/d)
Abx if comorbidity, frail, refractory sx, crp > 140 ) WBC > 15, fluid collection /segment > 85 mm on ct
Abx → cipro + flagyl or amoxclav x 4-7d (10 - 14 d if immunocompromised)
C-scope after resolution (6-8w)
Management of complicated diverticulitis
- NPO, iv fluids, NG+ suction
- Abx cipro +flagyl x 7 -10 days
- percutaneous drainage if abscess > 3 Cm and patient stable
- surgery if unstable with peritonitis, abscess > or equal to 4 mm, fistula, ruptured abscess, complex, pt preference
- c-scope after resolution ( 6-8 wk)
When is elective surgery considered for diverticulitis
After recovery if persistent >3mo, recurrent (3 or more in 2 years ) or complicated
Factors that increase risk
Young age, obesity, abscess.
13-30% risk after 1 attack
30 - 50% after 2 attacks
Prevention of recurrence of diverticulitis
-smoking cessation
- ↓ meat
- ↑ physical activity
- ↓ weight
- NSAID 2 or less /week
