Diverticulitis pg 2212

Question 1

most patients with localized inflammation or infection with diverticulitis report mild to moderate pain in which quadrant?

Answer 1

Left Lower Quadrant (bleeding occurs from the right colon in 50-90% of cases)

Question 2

sx of diverticulitis

Answer 2

LLQ pain
Constipation or Loose stools
N/V
fever
possible palpable mass
occult blood
leukocytosis (mild to moderate)

a free perforation will present with dramatic abdominal pain and peritoneal signs.

Question 3

labs for diverticulitis

Answer 3

CBC with diff
Occult blood

Question 4

Can therapy be initiated without a RAD diagnosis of diverticulitis?

Answer 4

mild sx with presumptive diagnosis can receive empirical therapy without imaging. colonoscopy should be initiated after resolution of sx to corroborate diagnosis or exclude other disorder such as neoplasm.

Question 5

treatment for diverticulitis

Answer 5

mild sx- clear liquid diet and broad spectrum antibiotics with anaerobic activity. (e.g. augmentin or bactrim. 7-10 days until afebrile for 3-5 days.

Severe (fever, leukocytosis, peritoneal signs)- NPO, IV, NG tube if ileus is present, IV antibiotics to cover anaerobic and gram negative bacteria.

Question 6

when can normal diet be advanced with diverticulitis patients?

Answer 6

after symptom improvement, usually within 3 days.

Question 7

what do recurrent attacks of diverticulitis warrant?

Answer 7

elective surgery, which carries lower morbidity than emergency surgery.