OnlineMedEd: Gastroenterology - "Diverticula" Flashcards
1
Q
List some risk factors for the development of diverticula.
A
- Advancing age
- Low-fiber, meat-heavy diet
- Constipation
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.
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).
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.
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
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)