Diverticular dz Flashcards
(26 cards)
difference btwn diverticulosis and diverticulitis?
presence of diverticula vs. inflammation of diverticulum
presentation of diverticulosis?
increases w/age
predominantly sigmoid colon
asxs (incidental finding) w/ normal PE
pathophys of diverticulosis?
weak points in colonic wall where vasa recta penetrate
low fiber diet –> constipation –> intraluminal pressure –> herniation
how much fiber a day should a pt have?
20-35g/day (increases stool bulk reducing work of colon for BM)
what is acute diverticulitis?
An acute symptomatic episode corresponding to inflammation of a diverticulum
pathophys of acute diverticulitis?
inspissated debris obstructs or INCREASED LUMINAL PRESSURE –> inflamm and focal necrosis –> perforation
What can occur w/ complicated acute diverticulitis?
abscess, fistula, obstruction, perforation
clinical manifestations of acute diverticulitis?
progressive, steady LLQ
fever and/or chills
also: N/V, change in BM’s, irritative urinary sx (pneumaturia or fecaluria if colovesical fistula)
what PE exam is important to perform?
pelvic exam in women
Lab work for acute diverticulitis?
CBC (leukocytosis), CMP, UA, stool studies for diarrhea, occult blood in stool
+/- amylase/lipase
Imaging for acute diverticulitis?
CT scan of A/P w/contrast = TOC
x-ray, u/s
CT findings for acute diverticulitis?
localized bowel wall thickening/fat stranding, presence of colonic diverticula
how can you assess for obstruction or perforation?
abdominal/chest x-ray
what tests are contraindicated?
sigmoidoscopy/colonoscopy d/t risk of perforation
barium enema d/t perforation and exacerbate peritonitis
tx for uncomplicated acute diverticulitis?
home w/ PO abx
close f/u w/in 2 days
Clear liquid/low residue diet
tx for complicated acute diverticulitis?
admit
NPO, IVF
IV abx (transition to PO x10-14d)
consult GI, surgery
*repeat imaging INI w/in 2-3 days
abx tx for acute uncomplicated diverticulitis?
gram neg/anaerobe coverage x7-10days
Metronidazole + cipro
Metronidazole + TMP-SMX
Augmentin
Moxifloxacin
criteria for inpt management for acute diverticulitis?
CT - complicated significant leukocytosis high fv > 102.5 degF peritoneal signs signficant comorbidities/immunocomp. elderly cannot tolerate PO
when is surgical referral necessary?
Perforation with peritonitis
Condition deteriorates or INI w/in 72hrs
complicated
when is high fiber diet recommended for acute diverticulitis?
once acute episode resolves
when should colonoscopy be performed?
typically 6-8wks after resolution
exclude a concomitant colon cancer or IBD
what is the MCC of overt lower GI bleeding in adults?
diverticular bleed
usu. resolves spontaneously
where is the MC location for diverticular bleed?
right colon (as opposed to L in diverticulitis)
Clinical manifestation for diverticular bleeding?
** painless hematochezia
blood on rectal exam
+/- bloating, cramping, fecal urgency, abnormal VS