Diverticulitis

Question 1

diverticulitis

Answer 1

increases with age
microscopy inflammation of the diverticulum
micro perforation localized paracolic inflammation
macro perforation with abscess or generalized periostitis

uncomplicated: disease 75%
abd pain
fever
leukocytosis
anorexia

Complicated:
abscess
perforation
stricture
fistula

Question 2

two type of diverticuli

Answer 2

true: sack like herniation

pseudo: protrusion in submucosal most affects the colon
the rectum is spared,
Asian population is right colon and rectum

Question 3

diverticulitis findings and diagnosis

Answer 3

signs and symptoms:
hallmark left lower quad pain
N/V
low grade fever
palpable mass
occult blood
hematochezia is rare

CT abd :
colonic diverticula and wall thicking > 4mm
paracolic infiltraion
collection of contrast media
abscess formation or extraluminal air
20% present with abscess

Complication: with chronic or untreated abcess
fisutla formation
bladder , urter , vagina, uterus , bowel and abd wall

Question 4

Diverticulitis treatment plan

Answer 4

Mild cases:
consertive management:
CLD
advance as tolerated to high fiber
selective use with abx
augmentin 87.5/25mg PO BiD
flagyl 500mg tid and cipro 500 mg BID7-10 d

Severe cases:
requireing hospitalizaion
increased pain
fever
inability to tolerate oral fluid
elderly or immunocomprimised

NPO:
ngt for illeus
IVF
ABX:
cover zosyn or ceftoin
continue 5-7 d
transition to po

Question 5

Diverticulitis procedure and surgical management

Answer 5

colonoscopy or ct colonography
after resolution of clinical symptoms
exclude other disorders such as neoplasms
endoscopy and colonography were contraindicated during inital stages

no improvement in 72 hours
consult general surgery or colorectal
repeat abdominal

located abdominal abscess > 4cm
percutaneous catheter drainage vi IR
control infection and inflammatory process

indication for emergent surgical management
generalized peritonitis
large undrainable abscess
clinical perforation