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Flashcards in Diverticular Disease Deck (33)
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1

When do you see more diverticulosis?

Increases with age (over 60 see more)

2

Predominant sight of diverticulosis

Sigmoid colon (smallest diameter and largest intraluminal pressure)

3

Most common presentation of diverticulosis

Asymptomatic and discovered incidentally

4

Why does diverticulosis occur?

Develops at weak point in the colonic wall where vasa recta penetrate
Increased pressure predisposes mucosa and submucosa to herniate
Also a low fiber diet--constipation--intraluminal pressure--herniation (progression maybe)

5

Other sxs of diverticulosis

Occasional abdominal cramping, constipation, diarrhea, bloating
Normal exam

6

Diagnostics for diverticulosis

No labs or imaging needed b/c usually found incidentally

7

Tx for asymptomatic diverticulosis

High fiber diet (20-35 g/day)-increase stool bulk
Adequate hydration
Don't recommend avoidance of seeds/nuts

8

Why does diverticulitis occur?

Inspissated debris obstructs neck of diverticulum or increased luminal pressure result sin erosion of diverticular wall leading to inflammation and necrosis and then a perf (free air and peritonitis)

9

Most common type of diverticulitis

Uncomplicated

10

Types of complicated diverticulitis

Abscess, fistula, obstruction or perforation

11

Presentation of acute diverticulitis

Progressive, steady aching pain usually LLQ
Fever/chills
Maybe n/v, change in bowel habits, irritative urinary sxs
Low fever, maybe peritoneal signs

12

What can be seen with a colovesical fistula with diverticulitis?

Pneumaturia or fecaluria

13

Exam for diverticulitis

LLQ abd tenderness
Rectal exam may have mass or tenderness (stool guaiac)
Pelvic exam for women

14

Labs for diverticulitis

CBC-moderate leukocytosis (maybe not in elderly)
BMP/CMP (maybe amylase or lipase)
UA/culture and urine HCG
Stool studies if diarrhea

15

Test of choice for acute diverticulitis

CT scan of A/P with contrast (see localized bowel wall thickening and fat stranding, presence of colonic diverticula)

16

Other options for imaging for acute diverticulitis

Abd/CXR (for obstruction or perf)
U/s

17

Diagnostics contraindicated in diverticulitis

Flex sig/colonoscopy (risk of perf)
Barium enema (can leak through perf and exacerbate peritonitis)

18

General tx for uncomplicated diverticulitis

Usually give oral abx
Clear liquid/low residue diet
Close f/u in 2 days

19

General tx for complicated diverticulitis

Admit
NPO, IVF, IV abx

20

Outpatient tx of uncomplicated diverticulitis

Gram negative/anaerobic coverage x 7-10 days
CL/low residue diet and advance as tolerated to high fiber diet (resolve acute episode)
Maybe repeat imaging
F/u in 2 days!!!

21

When is inpatient management done for diverticulitis?

Complicated on CT
Significant leuokcytosis
>102.5 F
Severe of increasing abd pain
Peritoneal signs
Comorbidities/immunocompromised
Can't tolerate PO
Noncompliance/unreliability/lack of support
Failed outpt tx
Elderly

22

Inpatient tx of diverticulitis

NPO or CL depending on severity
IVF, analgesic
IV abx (transition to oral for a 10-14 day course)

23

When is repeat imaging done with an inpatient diverticulitis?

Failure to improve within 2-3 days of IV abx therapy

24

When to refer to surgery with acute diverticulitis?

Perforation with peritonitis
Condition deteriorates/fails to improve within 72 hrs of medical therapy
Complicated

25

Long term management of diverticulitis

High fiber diet when acute episode resolves
Colonoscopy 6-8 wks after resolution for some ppl (evaluate extent of disease or exclude concomitant colon cancer of IBD)

26

Common cause of overt lower GI bleeding in adults

Diverticular bleeding

27

Tx for diverticular bleeding?

Usually resolves spontaneously

28

Why does diverticular bleeding occur?

Penetrating artery draped over dome of diverticulum is easily exposed to injury and susceptible to bleeding

29

Where is diverticular bleeding seen the most?

Right colon (b/c diverticulum are wider and have more exposure of vasa recta)

30

Presentation of diverticular bleeding

Painless hematochezia
Maybe bloating, cramping, fecal urgency, abd vital signs pending severity
Usually normal exam but maybe TTP