Diverticulosis/Diverticulitis Flashcards
What are the large bowel disorders?
Diverticular Disease Irritable Bowel Syndrome Constipation Colon Polyps Colorectal Cancer Toxic Megacolon
What is colonic diverticulosis?
Described as out-pouching of diverticula in colon
What are the age characteristics of diverticulosis?
Colonic diverticulosis increases with age
>50% over age 80 years
What are the general characteristics of diverticulosis?
Most are asymptomatic
1. Discovered incidentally on colonoscopy or barium enema
- Vary in number & size from a few mm to several cm
define diverticulosis
- Diverticula present
2. Asymptomatic
Define diverticulitis?
- Inflamed diverticula
2. May cause potentially fatal obstruction, infection or hemorrhage
What are the most common sites for diverticula?
- Sigmoid colon
2. Descending colon
What may be involved in complicated diverticulitis?
- Abscess
- Obstruction
- Perforation
- Fistula
What is the etiology of diverticulosis?
Unknown
What are contributing factors for diverticulosis?
- Diminished colon motility & increased intraluminal pressure
- Low fiber diet
- Connective tissue disorders
A. Scleroderma
B. Marfan Syndrome
What is the pathophys of diverticulosis?
- Diverticula result from high intraluminal pressure on area of weakness in GI wall where blood vessels enter
- Diet may be contributing factor
- Insufficient fiber reduces fecal residue -> narrows bowel lumen -> leads to high intra-luminal pressure during defecation
What are the sxs of diverticulosis?
- Most asymptomatic
- Some pts may have nonspecific complaints:
A. Chronic constipation
B. Abd pain
C. Fluctuating bowel habits - Exam usually unremarkable
What imaging is used for uncomplicated diverticulosis?
No imaging needed for uncomplicated disease
True/false: colonoscopy is helpful in dx diverticulosis?
Colonoscopy less sensitive in detecting diverticula
What imaging may be used for complicated diverticulosis?
Diverticula best seen on barium enema or CT abd & pelvis w/contrast
What is the treatment for diverticulosis?
- High fiber diet or fiber supplements reduce likelihood of complications
- Avoid nuts/seeds
What is diverticulitis?
Defined as inflammation of diverticula caused by obstructing matter
Who is at risk for developing diverticulitis?
Patients with diverticulosis are at risk of developing diverticulitis
What is the pathophys of diverticulitis?
- Undigested food & bacteria accumulate in diverticular sac
2. Hard mass cuts off blood supply to thin walls of sac -> increased risk of infection
What can untreated diverticulitis lead to?
increased risk of perforation
What are the sxs of diverticulitis?
1. Abd pain A. Sudden onset B. Usually LLQ (site of tics) 2. +/- fever 3. Diarrhea OR constipation 4. N / V 5. +/- distention 6. Palpable tenderness A. +/- mass in affected area B. Guarding C. +/- rebound tenderness 7. DRE may be tender
What is the ddx for diverticulitis?
- Perforated colon CA
- Crohn’s Disease
- Appendicitis
- Ischemic colitis
- C. Difficile colitis
- GYN disorders
A. Ectopic pregnancy
B. Ovarian cyst
C. Ovarian torsion
What dx studies are used for diverticulitis?
- Guaiac (+) stool common
- Mild-mod leukocytosis
- CT Abd/pelvis w/ contrast
Who is a CT Abd/pelvis w/ contrast recommended for? Why?
- Recommended in pts who do not respond to empiric therapy after 2-4 days
- Evaluates extent of disease and R/O underlying colon CA
Why should barium enema and colonoscopy be avoided in acute diverticulitis?
Barium enema & colonoscopy should be avoided during acute phase due to risk of perforation & peritonitis
What are the results of a CT abd/pelvis with contrast in a pt with diverticulitis?
- Colonic diverticuli & wall thickening: indicative of inflammation
- Peri-colic fat infiltration
- Abscess formation
- Extraluminal air
When is a colonoscopy or barium enema recommended for a pt w/ diverticulitis? Why?
- ColonoscopyorBE done ≈ 6 weeks later
A.R/O IBD orcolonCA
B. Evaluate extent of tics/obstruction risk
What is the rx for mild diverticulitis?
- Clear liquid / BRAT / Low residue diet
- Add antibx if persistent
A. Broad spectrum antibiotics x 7-10 days
B. Fluoroquinolones/Ciprofloxin (Cipro) 500 mg po bid
+
Metronidazole (Flagyl) 500 mg po tid
What is the rx for moderate diverticulitis?
- Hospitalization & NPO
- IV antibiotics x 5-7 days [gram (+), gram (-) & anaerobic coverage]
A. Cefotaxime (Claforan) or piperacillin (Zosyn)
OR
B. Metronidazole (Flagyl) + ceftriaxone (Rocephin) - Bowel rest (NPO)
- Analgesia
- NG tube if ileus develops
What is the tx for severe diverticulitis or refractory to treatment?
- Surgery
- Two stage procedure:
A. Diseased colon resected, proximal colon brought out to form temp colostomy; distal stump closed
B. 3-6 months later, after inflammation subsides, colon can be reconnected electively
What are the indications for diverticulitis surgery?
- Peritonitis
- Large abscess
- Fistulas
- Obstruction
