Flashcards in Colon - Diverticulitis Deck (18):
Plan for patient with diverticulitis?
IV antibiotics, CT scan to exclude paracolic abscess or fistula
Herniation of the mucosa and submucosa through a weakness of the muscle
Diverticulosis versus diverticulitis?
Un-Inflamed diverticula versus inflamed particular
Symptoms of diverticulosis?
Usually asymptomatic but may resemble IBS or may have a cute symptoms
Complications of diverticulosis?
Diverticular hemorrhage presents as?
Painless bright red blood
Treatment of diverticulosis?
In some patients colonic segment resection
Stages of diverticulitis?
Stage 1: small, confined paracolic abscess
Stage 2: distant abscess (retroperitoneal or pelvic)
Stage 3: peritonitis from rupture of abscess (Noncommunicating with Bowl lumen)
Stage 4. Peritonitis caused by free communicating perforation
Mechanism of acute diverticulitis?
Fecaliths obstruct diverticula neck, leading to inflammation, diminished venous outflow, bacterial overgrowth
Pathognomonic finding for colovesicular fistula?
Pneumaturia or fecaluria
Differential for diverticulitis?
GI: Painful diverticular disease without diverticulitis, appendicitis, Crohn's disease, colon carcinoma, ischemic colitis, IBS
Gyn: ruptured ovarian cyst, endometriosis, ectopic pregnancy, PID
If suspect acute diverticulitis, use this test? avoid these tests?
CT scan with contrast
1. Contrast enema (fear of perforation and spillage of contrast into Abdominal cavity)
2. Endoscopy (wait for six weeks after resolution of the attack
When to admit patients for diverticulitis?
Need for narcotics to control pain, comorbid illnesses, inability to tolerate oral liquids, abscess or peritonitis
Indications for emergent surgical intervention?
1. Generalized peritonitis
2. Uncontrolled sepsis
Treatment for diverticulitis as outpatients?
1. Bactrim/Cipro/Levo + flagyl
Treatment in hospitalized patients?
Suspect Abscess when? Treatment?
Tender mass, persistent fever, leukocytosis, despite adequate therapy
Nothing (if small) or CT guided percutaneous drainage