Diverticular dz

Question 1

difference btwn diverticulosis and diverticulitis?

Answer 1

presence of diverticula vs. inflammation of diverticulum

Question 2

presentation of diverticulosis?

Answer 2

increases w/age

predominantly sigmoid colon

asxs (incidental finding) w/ normal PE

Question 3

pathophys of diverticulosis?

Answer 3

weak points in colonic wall where vasa recta penetrate

low fiber diet –> constipation –> intraluminal pressure –> herniation

Question 4

how much fiber a day should a pt have?

Answer 4

20-35g/day (increases stool bulk reducing work of colon for BM)

Question 5

what is acute diverticulitis?

Answer 5

An acute symptomatic episode corresponding to inflammation of a diverticulum

Question 6

pathophys of acute diverticulitis?

Answer 6

inspissated debris obstructs or INCREASED LUMINAL PRESSURE –> inflamm and focal necrosis –> perforation

Question 7

What can occur w/ complicated acute diverticulitis?

Answer 7

abscess, fistula, obstruction, perforation

Question 8

clinical manifestations of acute diverticulitis?

Answer 8

progressive, steady LLQ
fever and/or chills

also: N/V, change in BM’s, irritative urinary sx (pneumaturia or fecaluria if colovesical fistula)

Question 9

what PE exam is important to perform?

Answer 9

pelvic exam in women

Question 10

Lab work for acute diverticulitis?

Answer 10

CBC (leukocytosis), CMP, UA, stool studies for diarrhea, occult blood in stool

+/- amylase/lipase

Question 11

Imaging for acute diverticulitis?

Answer 11

CT scan of A/P w/contrast = TOC

x-ray, u/s

Question 12

CT findings for acute diverticulitis?

Answer 12

localized bowel wall thickening/fat stranding, presence of colonic diverticula

Question 13

how can you assess for obstruction or perforation?

Answer 13

abdominal/chest x-ray

Question 14

what tests are contraindicated?

Answer 14

sigmoidoscopy/colonoscopy d/t risk of perforation

barium enema d/t perforation and exacerbate peritonitis

Question 15

tx for uncomplicated acute diverticulitis?

Answer 15

home w/ PO abx
close f/u w/in 2 days

Clear liquid/low residue diet

Question 16

tx for complicated acute diverticulitis?

Answer 16

admit
NPO, IVF
IV abx (transition to PO x10-14d)
consult GI, surgery

*repeat imaging INI w/in 2-3 days

Question 17

abx tx for acute uncomplicated diverticulitis?

Answer 17

gram neg/anaerobe coverage x7-10days

Metronidazole + cipro
Metronidazole + TMP-SMX
Augmentin
Moxifloxacin

Question 18

criteria for inpt management for acute diverticulitis?

Answer 18

CT - complicated 
significant leukocytosis
high fv > 102.5 degF
peritoneal signs
signficant comorbidities/immunocomp.
elderly
cannot tolerate PO

Question 19

when is surgical referral necessary?

Answer 19

Perforation with peritonitis
Condition deteriorates or INI w/in 72hrs
complicated

Question 20

when is high fiber diet recommended for acute diverticulitis?

Answer 20

once acute episode resolves

Question 21

when should colonoscopy be performed?

Answer 21

typically 6-8wks after resolution

exclude a concomitant colon cancer or IBD

Question 22

what is the MCC of overt lower GI bleeding in adults?

Answer 22

diverticular bleed

usu. resolves spontaneously

Question 23

where is the MC location for diverticular bleed?

Answer 23

right colon (as opposed to L in diverticulitis)

Question 24

Clinical manifestation for diverticular bleeding?

Answer 24

** painless hematochezia
blood on rectal exam

+/- bloating, cramping, fecal urgency, abnormal VS

Question 25

Labs for diverticular bleed?

Answer 25

CBC (trend H/H), BMP, EGD, NG lavage (r/o UGI source)

once initial resuscitation complete, locate source of bleed (flex sig/colonsocopy)

Question 26

tx for diverticular bleeding?

Answer 26

resuscitation/hospitalization: maintain blood volume (transfuse prn)

Tx of bleeding site:
Endoscopic therapy
Angiographic therapy
+/- Surgical intervention