Gastro

Question 1

Age range for diverticulitis?

Answer 1

50-70% are over 80 yrs

80% are over 50 yrs

Question 2

Types of diverticular disease?

Answer 2

Diverticulosis and diverticular disease
- uninflamed diverticula

Diverticulitis

• inflammation of diverticulum/diverticula
• gross/microscopic perforation

Question 3

Cause of diverticular disease?

Answer 3

Low fiber, high refined carb diets

Lead to:

• less bulky stools
• retain less water
• alter gastro transit time

Result is increased intracolonic pressure - evacuation of colonic contents more difficult

Also associated

• lazy
• constipation
• obesity
• smoking
• NSAIDS

Question 4

WTF is a colonic diverticula?

Answer 4

A out-pouching of the colon that has a narrow neck that is easily obstructed w fecal matter leading to:

• bacterial overgrowth
• vascular compromise
• perforation

Question 5

Commonly cultured organisms from diverticula?

Answer 5

Gram neg anerobes
- e-coli

Facultative gram pos
- streptococci

Question 6

Complicated diverticulitis?

Answer 6

Presence of

• Abscess or phlegmon
• Fistula
• Stricter disease
• Bowel obstruction
• Peritonitis

Question 7

Why does diverticulitis cause peritonitis?

Answer 7

Rupture of peridiverticula abscess from free rupture of uninflamed diverticulum

Question 8

Besides peritonitis with diverticulitis we also worry about?

Answer 8

Small bowel obstruction

- large peridiverticular abscess

Question 9

Classic presentation of diverticulitis?

Answer 9

LLQ pain
Abdominal or perirectal fullness (mass effect)
\+ guaiac test
Low grade fever 
Leukocytosis

Question 10

How is the severity of diverticulitis graded?

Answer 10

Hinchey classification
Stages:
1. Small confined pericolic mesenteric abscess
2. Larger abscess (confined to pelvis)
3. Perforated diverticulitis, peridiverticular abscess has ruptured, caused purulent peritonitis
4. Rupture of uninflamed and unobstructed diverticulum into free peritoneal cavity w fecal contamination (free rupture)

Question 11

Preferred imaging for diverticular disease?

Answer 11

CT

• sensitivity 93%
• specificity 100%

Indicates -itis
Bowel wall thickness >4mm or peridiverticular abscess

Question 12

Pt has diverticulitis, when should you do an endoscopy?

Answer 12

Generally wait 6 weeks

Question 13

Tx for diverticulitis?

Answer 13

7-10 days of ciprofloxacin and metronidazole

Surgical consult if unresponsive , recurrent, abscess, rupture

Question 14

Dietary recommendations for pts w diverticulitis?

Answer 14

No real conclusive evidence but:

- bland, low fiber diet during recovery