S09C85 - Diverticulitis

Question 1

Diverticulosis: pathophys

Answer 1

• increased intraluminal pressures cause weakening of bowel wall
• low fiber, high fat, high carbs diet increase GI transit times
• RF: obesity, smoking, EtOH, caffeine, seeds, nuts
• diverticula occur at vasa recta sites where vasculature penetrate the circular muscle layer of the colon

-diverticulitis = erosion of wall by fecal matter, inflm, microperf, bacterial pathogen (bacteroides, peptostreptococcus, clostridium, fusobacterium, e coli)

Question 2

Diverticulitis: presentation

Answer 2

• LLQ pain
• fever
• leukocytosis
• pain may be intermittent or constant
• assoc with change in BM (diarrhea or constipation)
• n/v 60%

Question 3

Diverticulitis: Dx

Answer 3

• can be diagnosed by history and exam alone
• if no previous dx made or the current episode differs from previous episodes then diagnostic imaging is required
• CT is best imaging 97% Sn, 100% Sp
• all pts should have f/u colonoscopy 6w after resolution

Question 4

Diverticulitis: Tx

Answer 4

Uncomplicated: isolated inflm of diverticula

• bowel rest - liquid diet
• Abx
• f/u scope in 6w

Complicated: inflm plus complications - phelgmon, abscess, stricture, obstruction, fistula, perforation

• often requires admission
• IV Abx
• bowel rest
• Hinchy classification (Stage 4 is perforation=43% mortality)
• hinchey class 2 = percutaneous drainage of abscess
• if obstruction –> NPO, NGT

Abx: flagyl and cipro/levo/clinda/septra/amox-clav/moxi
if inpt: pip-tax or moxi or (flagyl + levo/cipro)

Question 5

Diverticulitis: dispo

Answer 5

-if not sever then d/c home on CF diet, PO Abx, f/u with GP in 2-3d, advance diet as tolerated

Question 6

Meckel’s diverticulitis

Answer 6

Rule of 2s

• 2% of popn
• 2 ft from ileocecal falve
• symptomatic in 2% of pts
• crampy abdo pain with n/v and bleeding

Question 7

Epiploic Appendagitis

Answer 7

=fat-filled sacs near lining of colon, become inflamed as result of torsion or venous thrombosis

• often an afebrile, middle-aged adult with sharp abdo pain assoc with n/v
• benign self-limiting course
• often an incidently finding on CT
• tx: pain mgmt, f/u 1wk

Question 8

Diverticular bleeding

Answer 8

• painless rectal bleeding that is generally self-limited

- accounts for 23% of lower GIB