Diverticulitis I

Question 1

the prevalence of diverticulosis increase with what factor?

Answer 1

age

Question 2

what area of the colon is predominately involved in diverticulosis?

Answer 2

sigmoid colon

Question 3

patients with diverticulosis usually present

Answer 3

asymptomatically in 70 to 80 percent , exam may be completely normal and the condition is discovered incidentally on colonoscopy or other imaging

Question 4

complication of diverticulosis

Answer 4

diverticulitis (inflammation) and bleeding

Question 5

if they are symptomatic diverticulosis is associated with what symptoms?

Answer 5

occasional abdominal cramping, constipation, diarrhea, bloating

Question 6

what labs and or imaging should be ordered in patients with diverticulosis?

Answer 6

no labs or images are needed, move onto treatment

Question 7

diverticulosis treatment

Answer 7

high fiber diet and adequate hydration

Question 8

seed and nut association with diverticulosis

Answer 8

avoidance of seeds/nuts is not recommended

Question 9

which type of diverticulitis is most common

Answer 9

uncomplicated

Question 10

describe the symptoms of a patient with acute diverticulitis

Answer 10

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

Question 11

what types of irritative urinary symptoms may be present in acute diverticulitis?

Answer 11

pneumaturia (passing gas through urine, bubbles in urine)

fecaluria (feces through urine, if colovesical fistula present)

Question 12

describe the signs of a patient with acute diverticulitis

Answer 12

low grade fever with LLQ tenderness and possible mass possible peritoneal signs

Question 13

bowel signs with acute diverticulitis

Answer 13

normal or abnormal

Question 14

CBC in acute diverticulitis

Answer 14

mild to moderate leukocytosis that may be absent in elderly (less likely to mount immune response)

Question 15

test of choice for acute diverticulitis, what are we looking for?

Answer 15

A/P CT scan with contrast

looking for bowel thickening and fat stranding and presence of colonic diverticula

Question 16

which test are contraindicated due to risk of perforation in acute diverticulitis

Answer 16

Sigmoidoscopy/Colonoscopy and Barium Enema

Question 17

acute diverticulitis treatment uncomplicated

Answer 17

send home with oral antibiotics
begin CL/LR diet
F/U w/in 2 days

repeated imaging not needed if showing clinical improvement

Question 18

acute diverticulitis treatment complicated

Answer 18

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

Question 19

acute diverticulitis treatment uncomplicated antibiotic choice

Answer 19

Gram negative/anaerobic coverage x 10 days

ex Metronidazole 500 mg PO TID + Ciprofloxacin 500 mg PO BID

Question 20

when is surgical repair indicated for acute diverticulitis?

Answer 20

peroration with peritonitis
condition deteriorates/ fails to improve within 72 hours of treatment
complicated

Question 21

after the acute episode of diverticulitis resolves what type of diet is recommended to patients

Answer 21

a high fiber diet

Question 22

6 to 8 weeks after an acute episode of diverticulitis what should be performed in patients

Answer 22

a colonoscopy in appropriate candidates to evaluate extent of the disease and to exclude a concomitant colon cancer or IBD

Question 23

which type of bleeding does diverticular bleeding cause?

Answer 23

overt lower GI bleeding that usually resolves spontaneously

Question 24

main symptom of diverticular bleeding

Answer 24

Painless hematochezia

Question 25

BMP lab finding in those with diverticular bleeding

Answer 25

BUN should NOT be elevated in patients with colonic diverticular bleeding

Question 26

how do we locate the source of bleeding in patients with diverticular bleeding?

Answer 26

Scope: Flex Sig/Colonoscopy or possible tagged red blood cell scan or angiography

Question 27

how is diverticular bleeding managed?

Answer 27

measures taken to maintain blood volume (transfuse as needed)
treatment of the bleeding site though endoscopic therapy, angiographic therapy, or possible surgical intervention

Question 28

Sac-like protrusions of the colonic wall is referred to as

Answer 28

Diverticulum (single) or diverticula (multiple)

Question 29

Diverticulosis is described as what?

Answer 29

just the presence of diverticula

Question 30

Diverticulitis is described as what?

Answer 30

the presence AND the inflammation of a diverticulum