Diverticulitis Flashcards
Diverticulitis versus Diverticulosis
Diverticulosis is presence of diverticula without inflammation or bleeding
Diverticulitis is when there is inflammation and/or bleeding
Diverticulum
The outpouching of mucosa through the colon wall
Causes of a diverticula
Increased pressure gradient between colonic lumen and the serosa
Areas of relative weakness in the colonic wall
Risk factors for diverticular disease
Age Aspirin and NSAID use Lack of exercise Smoking Consumption of red or processed meats
Presentation of diverticulosis
Usually asymptomatic
Symptomatic may present with
intermittent abdominal pain, bloating, flatulence
Irregular defecation, change in stool
Anorexia, N/V, urinary dysfunction
Diverticulosis Diagnosis and Treatment
Asysmptomatic requires no workup, symptomatic needs CBC if rectal bleeding is occurring, consider CT scan
Usual diagnosis of symptomatic is CT scan and colicky pain in abdomen in absence of inflammatory process
Management is exercise, slow increase in fiber. Antispasmodics may help, not recommended
Diverticulitis
Common complication of diverticulosis
Inflammation of one or more colonic diverticula
Diverticula locations
Most often in the sigmoid or descending colon
Asian countries tend to have them in the ascending colon
Diverticulitis Presentation
Aching abdominal pain, usually LLQ
Fever
Leukocytosis
Hematochezia is uncommon
In females, always assess a pelvic exam to rule out gynecologic etiology
Diverticulitis Diagnosis
CT with contrast
Ultrasound may also help
Diverticulitis Management
Antibiotics not recommended routinely (TMP-SMZ and Metrondiazole most often used)
Bowel rest
Fiber reduction until symptoms resolve, then increase fiber
Anti-inflammatories may help
Diverticulitis Complications
Rupture resulting in peritonitis can occur
Refer severe symptom patients to the hospitals (sign of sepsis, hypovolemia, high fever)
Diverticular Bleed
Common cause of lower GI bleeding
Hematochezia is usually painless
Colonoscopy is needed to find source and CBC for severity of bleed
Must exclude other causes such as malignancy, colitis, etc
