E2: Diverticulular Disease

Question 1

What is the difference between diverticulosis and diverticulitis?

Answer 1

-Diverticulosis is the presence of diverticula and diverticulitis is the inflammation of a diverticulum

Question 2

Where does diverticulosis predominately affect?

Answer 2

The sigmoid colon

Question 3

What is the pathophysiology behind diverticulitis?

Answer 3

• Develops at weak points in colonic wall where the vasa recta penetrate
• increased luminal pressure predisposes mucosa and submucosal to herniate

Question 4

What is the clinical presentation of diverticulosis?

Answer 4

• Most often asymptomatic
• occasionally abdominal cramping, constipation, diarrhea, and bloating
• may have a normal PE

Question 5

What is the management for asymptomatic diverticulosis?

Answer 5

• high fiber diet (20-35 grams/day
• adequate hydration
• avoidance of seeds and nuts is not recommended

Question 6

What is the pathophysiology behind acute diverticulitis?

Answer 6

-inspissated debris obstructs the neck of the diverticulum or increased luminal pressure results in erosion of diverticular wall, leading to inflammation and focal necrosis, which may lead to perforation

Question 7

What can happen in complicated diverticulitis?

Answer 7

Abscess, fistula, obstruction, and perforation

Question 8

What is the clinical manifestation of acute diverticulitis?

Answer 8

-progressive steady aching pain, typically in the LLQ
-fever/chills
-+/- nausea/vomiting
+/- change in bowel habits or irritative urinary symptoms

Question 9

What is the test of choice to diagnose acute diverticulitis?

Answer 9

-CT abdomen/pelvis with contrast

Question 10

What tests are contraindicated in diverticulitis?

Answer 10

• flex sig or colonoscopy due to risk of perforation

- barium enema as barium could potentially leak through perforation and exacerbate peritonitis

Question 11

What is the treatment for uncomplicated diverticulitis?

Answer 11

• home with oral antibiotics
• clear liquid and low residue diet
• close follow up in 2 days

Question 12

What is the treatment for complicated diverticulitis?

Answer 12

• Admit
• NPO/IVF
• IV antibiotics
• Consult GI and surgery

Question 13

What are the antibiotics used for uncomplicated diverticulitis?

Answer 13

• gram negative/anaerobic coverage for 7-10 days
• metronidazole 500mg PO TID and Cipro 500mg PO BID
• Metronidazole 500mg PO TID and Bactrim 800/160 mg PO BID
• Augmentin 875/125 PO TID
• Moxifloxacin 400mg daily

Question 14

When should you consult surgery for diverticulitis?

Answer 14

• perforation with peritonitis
• condition deteriorates and fails to improve within 72 hours of medical therapy
• complicated diverticulitis

Question 15

What is the long term therapy of diverticulitis?

Answer 15

• once acute episode resolves, high fiber diet is recommended
• colonoscopy should be performed, typically 6-8 weeks after, to evaluate extend of diverticular disease and exclude concomitant colon cancer or IBD

Question 16

Diverticular bleeding is a common cause of *** GI bleeding in adults?

Answer 16

Overt lower

Question 17

What is the clinical presentation of diverticular bleeding?

Answer 17

• Painless hematochezia
• bloating, cramping, and fecal urgency
• abnormal vital signs depending on severity
• abdominal exam is typically normal, but blood on rectal exam