OnlineMedEd: Gastroenterology - "Diverticula"

Question 1

List some risk factors for the development of diverticula.

Answer 1

• Advancing age
• Low-fiber, meat-heavy diet
• Constipation

Question 2

What is the usual presentation of someone with diverticula?

Answer 2

• 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.

Question 3

Describe the presentation of bleeding diverticula.

Answer 3

• 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).

Question 4

How does diverticular abscess present?

Answer 4

• 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.

Question 5

Go through the treatment recommendations for diverticulitis.

Answer 5

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

Question 6

Go through the workup of LLQ pain.

Answer 6

• 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)