Diverticulitis/Diverticulosis Lecture Powerpoint

Question 1

Diverticula

Answer 1

Small pouches created by herniation of the mucosa into the wall of the colon thru intestinal layers and smooth muscles, can be true (contain all layers thru the adventitia) or false (only involving mucosa or submucosa)

Question 2

Diverticulosis vs diverticulitis

Answer 2

Having an uninflamed diverticula vs inflammation of one or more diverticula

Question 3

Where are diverticula most common?

Answer 3

Sigmoid colon (high intraluminal pressure)

Question 4

The more diverticula a patient has the more likely they are to have…

Answer 4

….diverticulitis

Question 5

The younger you are, the ___ likely you are to get diverticulitis, despite you are ____ likely to have diverticulie

Answer 5

more, less

Question 6

Clinical presentation of diverticulitis (4)

Answer 6

• most common is LLQ pain
• change in bowel habits and constipation
• fever
• n/v

Question 7

Diverticulitis complications

Answer 7

• peritonitis due to perforation

- fistula (often colovesicular - fecaluria)

Question 8

Diverticulitis may present asymptomatic in this population

Answer 8

Immunosuppressed

Question 9

Lab tests for suspected diverticulitis (4)

Answer 9

• CBC (will see left shift and maybe anemia)
• electrolytes (if N/V/D)
• urine culture
• pregnancy test

Question 10

Best imaging study for suspected diverticulitis and one that is contraindicated

Answer 10

• CT of abdomen and pelvis

- colonoscopy

Question 11

Mild diverticulitis treatment (2)

Answer 11

• clear liquid diet with advancement as tolerated

- oral broad spectrum (7-10 day course) of ciprofloxacin/metronidazole

Question 12

Metronidazole has an absolute contraindication for…

Answer 12

….acohol

Question 13

Severe diverticulitis treatment (5)

Answer 13

• if comorbidities then admission
• NPO with IVF hydration
• broad spectrum IV antibiotics
• morphine (avoid NSAIDS/steroids as that worsens colonic perforation)
• surgery if free air perforation or fistula

Question 14

Long term management of diverticulitis (3)

Answer 14

• initial low fiber diet for 1 month followed by high fiber diet
• NO recommendation to avoid nuts and seeds
• colonoscopy 4-6 weeks later or CT

Question 15

Diverticular bleed

Answer 15

A common cause of lower GI bleeding typically painless hematochezia with massive bright red bleed, usually self limiting, aspirin and NSAIDS increase risk

Question 16

Small intestinal diverticulosis

Answer 16

Less common than colonic with duodenal being far more common than jejunoileal, often asymptomatic unless complications occur

Question 17

Meckel diverticulum and the rule of 2’s

Answer 17

Congenital abnormality that causes true diverticulum of the small bowel, most commonly incidental finding but can develop complications, surgical resection if complications occur

2% of population, within 2 feet of ileocecal valve, 2 inches in length, types of heterotopic mucosa, and present before the age of 2