GI-Diverticular Disease

Question 1

Diverticulosis

Answer 1

Path: increased intraluminal pressures, false pouches

Pt: > 50 yrs old, decreased fiber, vegetables
Increased red meat
Asx screening

Dx: Colonoscopy

Tx: No tx
High fiber

F/u: + Fruits/Vegetables, Fiber Diet

Question 2

Diverticular Spasm

Answer 2

Path: Contractions of diverticula

Pt: Post-prandial LLQ Abd pain relieved w BM (sounds like irritable bowel syndrome)

Dx: Clx v IBD

Tx: High-Fiber Diet

Question 3

Diverticular Hemorrhage

Answer 3

Path: Arteriole ruptures in dome

Pt; Painless hematochezia, can be fatal or self-limiting

Dx: colonoscopy (for diverticulosis)
Angiogram (for embolization)

Tx: Embolize (severe)
Self-limiting (often)

Question 4

Diverticulitis

Answer 4

Path: Fecalith blocks diverticula and infection grows, microperforation to abscess

Pt: Left sided appendicitis
Constant LLQ pain
Fever/leukocytosis
Local peritoneal signs

Dx: KUB to r/o frank Perf.
CT w IV and PO contrast

Tx: Mild: Liquid diet....po abx
Severe: NPO.....IV abx
Abscess: NPO......IV abx + drainage 
Perf: Exlap w IV abx
Refractory: Hemicolectomy