Which condition?
- Prevalence incr. w/ age
- Sigmoid colon = LLQ pain
- Asymptomatic
- Discovered incidentally
Diverticulosis
S/S of which condition?
- Abdominal cramping
- Constipation
- Diarrhea
- Bloating
Diverticulosis
2 complications of Diverticulosis?
- Diverticulitis
- Bleeding
PE of which condition?
- Completely normal exam
- LLQ pain
Diverticulosis
Tx for diverticulosis?
- Higher fiber diet
- Hydration
What is NOT recommended as part of tx for diverticulosis?
Avoidance of seeds/nuts
(literature does not support avoiding seeds/nuts)
What is used to dx diverticulosis?
Nothing, usually found incidentally
Microperforation
Simple/Uncomplicated Diverticulitis
(Most common - 85%)
Macroperforation
Complicated Diverticulitis
(least common - 15%)
S/S of which condition?
- Progressive, steady aching pain (LLQ)
- Fever / Chills
- N / V / Change in bowel habits
- Irritative urinary sxs (pneumaturia or fecaluria if colovesical fistula)
Diverticulitis
What diagnostic studies are needed for Diverticulitis?
- CBC = Leukocytosis
- BMP/CMP, amylase/lipase
- UA / urine culture
- HCG if childbearing age
- Stool cultures if diarrhea +
- CT w/ contrast
Leukocytosis is seen in which condition?
Diverticulitis w/ CBC.
May be absent in elderly though…
What is the Test of Choice for dx diverticulitis?
CT scan of A/P w. contrast
- localized bowel wall thickening/fat stranding
- colonic diverticula
What 2 studies are contraindicated in patients w/ Diverticulitis??
- Flex Sigmoidoscopy / Colonoscopy –> risk of perforation
- Barium enema –> barium fluid could leak through perforation & worsen the peritonitis
PE of which condition?
- Low grade fever
- BS normal / abnormal
- LLQ tenderness / mass
- Peritoneal signs
- Mass/Tenderness on DRE
- Guaiac
- Pelvic for women
Diverticulitis
Tx for uncomplicated Diverticulitis?
Outpatient tx
- Oral abx: 500mg PO TID x10 days
- Metronidazole + Ciprofloxacin
- Metronidazole + Bactrim
- Clear liquid / low fiber diet (low residue)
- High fiber diet AFTER acute episode resolves
What is follow up for Diverticulitis and what tests are needed?
- 2 days FU (close FU)
- Repeat imaging not needed if pt improving
- 6 - 8 weeks after resolution of acute diverticulitis –> colonoscopy to eval for extent and r/o cancer & IBD
Tx for complicated Diverticulitis?
Inpatient tx:
- Admission, NPO, IV fluids
- IV abx, then PO to complete 10-14 day course
- Analgesics
- Consult GI & surgery
- If pt not improving in 2-3 days of abx –> repeat imaging
3 indications for surgery in pts w/ diverticulitis
- Perforation w/ peritonitis
- Deteriorates / fails to improve within 72 hours of therapy
- Complicated diverticulitis
4 complications of diverticulitis
- Abscess
- Fistula
- Obstruction
- Perforation
FOPA
Which condition?
- Overt lower GI bleed
- Resolves spontaneously
- Where is MC source of bleed????
Diverticular Bleeding
- Right Colon MC source of bleed
Main symptom of Diverticular Bleeding?
- What are 3 others? +/-
PAINLESS hematochezia
- +/- bloating
- +/- cramping
- +/- fecal urgency
What diagnostic studies are used to r/o upper GI source bleed in Diverticular Bleeding?
- EGD lavage (esophagogastroduodenoscopy)
- NG lavage (nasogastric)
What lab should NOT be elevated in pts w/ colonic diverticular bleeding?
BUN
-
GI Diagnostics—143
-
GI Diagnostics—235
-
Diverticulitis Popcorn27
-
Colon57
-
Esophagus 145
-
Esophagus 235
-
Stomach54
-
Crohn's32
-
GI Diagnostic Studies25
-
Pancreas46
-
Pancreas 228
-
Obstruction Popcorn33
-
Rectal Popcorn27
-
Diverticulitis I30
-
Biliary Popcorn26
-
Biliary Popcorn 224
-
IBD popcorn23
-
GI misc COPY45
-
IBS 130
-
IBS 234
-
Liver 146
-
Liver 260
-
Liver 320
-
Liver 441
