Diverticulitis I Flashcards
the prevalence of diverticulosis increase with what factor?
age
what area of the colon is predominately involved in diverticulosis?
sigmoid colon
patients with diverticulosis usually present
asymptomatically in 70 to 80 percent , exam may be completely normal and the condition is discovered incidentally on colonoscopy or other imaging
complication of diverticulosis
diverticulitis (inflammation) and bleeding
if they are symptomatic diverticulosis is associated with what symptoms?
occasional abdominal cramping, constipation, diarrhea, bloating
what labs and or imaging should be ordered in patients with diverticulosis?
no labs or images are needed, move onto treatment
diverticulosis treatment
high fiber diet and adequate hydration
seed and nut association with diverticulosis
avoidance of seeds/nuts is not recommended
which type of diverticulitis is most common
uncomplicated
describe the symptoms of a patient with acute diverticulitis
a progressive and steady achy pain in the left upper quadrant with fever and/or chills. The patient may also have nausea, vomiting, change in bowel habits, or irritative urinary symptoms
what types of irritative urinary symptoms may be present in acute diverticulitis?
pneumaturia (passing gas through urine, bubbles in urine)
fecaluria (feces through urine, if colovesical fistula present)
describe the signs of a patient with acute diverticulitis
low grade fever with LLQ tenderness and possible mass possible peritoneal signs
bowel signs with acute diverticulitis
normal or abnormal
CBC in acute diverticulitis
mild to moderate leukocytosis that may be absent in elderly (less likely to mount immune response)
test of choice for acute diverticulitis, what are we looking for?
A/P CT scan with contrast
looking for bowel thickening and fat stranding and presence of colonic diverticula
which test are contraindicated due to risk of perforation in acute diverticulitis
Sigmoidoscopy/Colonoscopy and Barium Enema
acute diverticulitis treatment uncomplicated
send home with oral antibiotics
begin CL/LR diet
F/U w/in 2 days
repeated imaging not needed if showing clinical improvement
acute diverticulitis treatment complicated
Admit
NPO, IV fluids
IV antibiotics (Transitioned to PO abx to complete a total 10-14 day course)
GI consult, surgery
repeated imaging not needed if showing clinical improvement
acute diverticulitis treatment uncomplicated antibiotic choice
Gram negative/anaerobic coverage x 10 days
ex Metronidazole 500 mg PO TID + Ciprofloxacin 500 mg PO BID
when is surgical repair indicated for acute diverticulitis?
peroration with peritonitis
condition deteriorates/ fails to improve within 72 hours of treatment
complicated
after the acute episode of diverticulitis resolves what type of diet is recommended to patients
a high fiber diet
6 to 8 weeks after an acute episode of diverticulitis what should be performed in patients
a colonoscopy in appropriate candidates to evaluate extent of the disease and to exclude a concomitant colon cancer or IBD
which type of bleeding does diverticular bleeding cause?
overt lower GI bleeding that usually resolves spontaneously
main symptom of diverticular bleeding
Painless hematochezia
BMP lab finding in those with diverticular bleeding
BUN should NOT be elevated in patients with colonic diverticular bleeding
how do we locate the source of bleeding in patients with diverticular bleeding?
Scope: Flex Sig/Colonoscopy or possible tagged red blood cell scan or angiography
how is diverticular bleeding managed?
measures taken to maintain blood volume (transfuse as needed)
treatment of the bleeding site though endoscopic therapy, angiographic therapy, or possible surgical intervention
Sac-like protrusions of the colonic wall is referred to as
Diverticulum (single) or diverticula (multiple)
Diverticulosis is described as what?
just the presence of diverticula
Diverticulitis is described as what?
the presence AND the inflammation of a diverticulum
