Diverticulosis

Question 1

Def diverticulosis

Answer 1

• sac like protrusion
• mucosa and submucosa herniate through muscle later
• in areas of high pressure (sigmoid)

Question 2

Def diverticular bleed

Answer 2

Painless bleeding of diverticula

Question 3

Diverticulitis

Answer 3

inflammation of diverticulum

Question 4

Diverticulosis mainly found

Answer 4

sigmoid

Question 5

What is strongly correlated with diverticulosis

Answer 5

W. diet

Question 6

RF diverticulosis

Answer 6

Age 
Constipation
Diet- High fat and red meat
Obesity
Genetics (connective tissue disorders)
Physical Inactivity

Question 7

Dx diverticulosis

Answer 7

colonoscopy

Question 8

Clinical Diverticulitis

Answer 8

• Abdominal pain –LLQ: Constant, several days
• Nausea/vomiting
• Fever
• Change in bowel habits
• Constipation to diarrhea or vice versa
• Dysuria
• Guarding, rigidity, rebound LLQ
• Tender palpable mass

Question 9

Dx diverticulitis

Answer 9

• CBC w/diff- leukocytosis with left shift
• BMP
• Urinalysis
• Abdominal CT abdomen/pelvis with IV contrast +/- PO contrast

Question 10

Tx diverticulitis medical

Answer 10

Antibiotics – Coverage Enterobacteriaciae & Gram Neg Anaerobe (B.Frag)

• Cipro & Flagyl (IV or PO) (first line)
• Augmentin PO
• Ertapenem (IV)
• Zosyn (IV)
• 2nd or 3rd Cephalosporin plus Flagyl IV

IVF (admitted)
Analgesia & Antiemetics PRN (IV vs PO)
NPO/Clear diet

Question 11

Tx diverticulitis Surgical

Answer 11

One Stage Procedure

• Colon Resection with primary anastomosis
• Patients that are elective

Two-stage Procedure (two different procedures)

• Colonic Resection with end colostomy (Hartmann’s procedure)
• Primary anastomosis with diverting ileostomy

Question 12

Who gets surgical diverticulitis tx

Answer 12

Emergent Surgery: free perforation, +/- bowel obstruction

Urgent Surgery: failure of medical treatment; colonic obstruction; abscess failing non-operative intervention

Question 13

Diverticulitis Follow-up

Answer 13

Colonoscopy if new diagnosis diverticulitis or haven’t had in past year
- Approx. 6 weeks post-infection to r/o colon cancer and assess diverticular disease
Diet Modifications:
- Consume high fiber diet or long-term fiber supplementation

Question 14

What is most common cause of LGIB

Answer 14

diverticular bleed

Question 15

Where is diverticular bleed most common

Answer 15

R. colon

Question 16

Cause diverticular bleed

Answer 16

vasa recta recurrent injury leading to weakness, and bleeding

Question 17

Clinical diverticular bleed

Answer 17

• Painless hematochezia
• Painless maroon-color blood mixed with stool
• Bloating, cramping, urge to defecate
• Hemodynamically unstable: syncope, lightheadedness, postural dizziness
• Abdomen – benign; soft and non-tender

Question 18

Dx diverticular bleed

Answer 18

CBC
- Hemoglobin/Hct – normal to decreases (MCV normal)
BMP
- Bun/creatinine normal
Colonoscopy
- After initial resuscitation

Question 19

Tx diverticular bleed

Answer 19

Resuscitation if bleeding hasn’t stopped
o Two large bore IV
o IVF NS
o Type and Cross for blood
o Transfuse pRBCS PRN
Colonoscopy (first step)
- Treat active bleeding with submucosal epinephrine or endoscopic tamponade
Angiography (2nd step)
- Alternative to colonoscopy if bleeding cannot be found
Surgical Intervention (Segmental Colectomy)
- Hemodynamically unstable