OnlineMedEd: Gastroenterology - "Diverticula" Flashcards

1
Q

List some risk factors for the development of diverticula.

A
  • Advancing age
  • Low-fiber, meat-heavy diet
  • Constipation
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2
Q

What is the usual presentation of someone with diverticula?

A
  • Diverticula are most often asymptomatic, so the most common presentation is discovery on colonoscopy.
  • Some people with diverticula get postprandial pain, thought to be due to colonic contraction against constipation.
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3
Q

Describe the presentation of bleeding diverticula.

A
  • Diverticula can cause bleeding from stretched out arterioles. This can lead to a painless hematochezia.
  • When this happens, you treat it like any other GI bleed: start two large-bore IVs, begin infusions, and do an EGD (to rule out upper sources) and then a colonoscopy (to confirm the diagnosis and embolize).
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4
Q

How does diverticular abscess present?

A
  • It can have three grades of severity: (1) fecolith with contained abscess, (2) fecolith with minor perforation that is contained, or (3) fecolith with perforated abscess, leading to stool and pus in the abdomen.
  • These lead to fever and LLQ abdominal pain. (The pain is usually left-sided because the stool is harder on the left side and more likely to cause abscesses there.)
  • Get an x-ray to rule out perforation and then a CT to confirm.
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5
Q

Go through the treatment recommendations for diverticulitis.

A
  • Mild (localized, non-perforated abscess): liquid diet, oral antibiotics
  • Severe (abscess): NPO, IV antibiotics
  • Perforation: emergent surgery, IV antibiotics
  • Refractory/recurrent: hemicolectomy
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6
Q

Go through the workup of LLQ pain.

A
  • KUB to rule out perforation (free air on x-ray) and obstruction (loops of small bowel with air-fluid levels
  • CT to assess for diverticulitis (fecolith, abscess)
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