Diverticulitis Flashcards
Diverticula
(definition, location)
herniations involving mucosal and smooth muscle where vasa recta penetrate the colon wall
may occur anywhere along the GI tract, but sigmoid is the MC because experiences highest pressures
Diverticulosis
Presence of diverticula
Asymptomatic
Very common, MC in developed countries
Smoking inc’s risk of complications
Diverticulitis
Pathophys and potential complications
Inflammation of the diverticula
May be from obstruction, leading to further distention and bacterial overgrowth
May result from vascular compromise
Increased intraluminal presure may lead to focal necrosis–> perforation –> can be contained by mesentery (mild disease) or abscess formation and peritonitis (more severe)
Diverticulitis Sxs
- abdominal pain most commonly in LLQ (sigmoid) but depends on where inflamed diverticuli are
- N/V/D/C, bloating flatulence
Diverticulitis Labs
Leukocytosis
Elevated CRP suggests perforation
Consider other labs to r/o other conditions
Clinical Diagnosis of Diverticulitis
If have all three, can dx without imaging:
- tenderness confined to the LLQ
- absence of vomiting
- CRP elevation
Diverticulitis Imaging
CT most appropriate
use PO, IV, and PR contrast
Do NOT do endoscopy–high risk of perforation
Classification of Diveticulitis
Hinchey’s classification
I is mild- IV more severe
help determine tx and urgency
Tx of acute, mild disease
(Hinchey stage I)
outpatient, non-operative
clear liquid diet 2-3 days
broad-spectrum antibiotics
ciprofloxicin or TMP/SMX and metronidazole
Colonscopic evaluation after resolution to exclude other dx or comorbidities
Tx of moderate diverticulitis
non-operative, inpatient
Pts who are more ill, have systemic signs of infection or have peritonitis, or can’t tolerate PO
NPO, IV fluids, broad spectrum IV abx, IV analgesics
tx of operative pts
repeat CT for pts who don’t improve or get worse
CT guided percutaneous drainage for peridiverticular abscesses
Surgical resection of disease portion of colon, creating a colostomy (which is later reversed) in ptsat Hinchey stage III or IV, have obstruction, or sepsis
Long Term Dietary Modifications that help prevent progression of diverticulosis
High fiber diet because don’t have to strain as much to have BM
