Session 3 GI : Exam 2 L10 Diverticular Disease

What is diverticulitis?

when diverticula become inflamed and infected.

When symptomatic, what tests would you order and why? LISTEN

1. CBC to check for anemia and leukocytosis. 2. U/A for infection and hematuria, 3. XR for perforations, obstruction, urolithiasis. 4. Abdominal US - for gyn pathology, hydronephrosis. 5. CT scan - diagnose diverticulitis/abscess

Diverticulitis occurs in approximately 1/3rd of patients treated with medical management, Recurrent attacks warrant elective surgical resection and lowers morbidity and mortality risk than does emergency surgery. What are the surgical options for severe or complicated diverticulitis?

1. Hartmann's operation - laparotomy with resection of diseased segment and anastomosis, . 2. CT guided percutaneous drainage. 3. Colectomy - resects diseased sigmoid colon, constructs a colostomy using noninflamed descending colon and suture end of rectum closed

Meckel diverticulum is one of the most common congenital abnormalities and occurs when connection between intestines and umbilical cord doesn't completely close off during fetal development resulting in small outpouching if small intestines. Most cases do not cause any problems, but when they do, what are complications of this congenital disorder?

1. diverticulitis. *often misdiagnosed for appendicitis*. 2. intestinal obstruction or bleeding. *3. painless bleeding from the rectum most common* 4. stools with BRB or black tarry stools.

what is the treatment for diverticulitis?

1. low residue fluids or NPO when severe, 2. maintain hydration. 3. BS IV Antibiotics 7-10 days covering gram neg and anaerobic organisms (Cipro or ampicillin and metronidazole or clindo) 4. severe/complicated cases require surgery

if diverticulitis patient has a perforation or peritonitis, what additional treatment is required?

2nd or 3rd generation of cephalosporins in combo with gentamicin.

What are symptoms of diverticulosis?

70% asymptomatic, 15% bleeding due to erosion or abrasion of artery due to inspissated feces, cause of profuse GI bleed. Recurrent, intermittent LLQ pain, flatulence. 20% progress to diverticulitis.

what is the etiology of diverticular disease.

Constipation and low fiber diet. segemental spasm through weak point.

what are divertiula found?

May occur anywhere in digestive tract. Along mesenteric borders at anatomically weak point where vasa recta penetrate the wall. Sigmoid colon most common side in US. ( Certain populations predom right sided)

what are differential diagnoses for diverticular disease?

appendicitis (older age helps distinguish), pyelonephritis, IBS, IBD, colorectal or ovarian cancer, PID, endometriosis, pseudomembranous colitis (C difficile and abx use), Iscehmic colitis

what is the gold standard for diagnosing diverticular disease in symptomatic patients, but is not done during an acute episode?

colonoscopy

What is the epidemiology of diverticular disease?

common in westernized/industrialized nations due to diet and with increasing age, 65% over 85 yoa. Universal over 90 yoa. Chinese, Japanese, Hawaiin - cecum and ascending colon more common.

definition of diverticular disease is a disorder of the digestive tract consisting of sak-like outpouchings of mucosa and submucosa through muscular layer. What is the pathogenesis?

diverticula are herniations of mucosa due to segmental spasm of muscular coat of bowel through points of entry of blood vessels across muscular wall

since most diverticulosis is asymptomatic, how is it usually diagnosed?

found incidentally by colonoscopy/barium enema

What is the PE of diverticulosis?

generally normal, may have LLQ tenderness, thickened palpable sigmoid and descending colon

What is the treatment for diverticulosis?

high fiber diet, high fluid intake, physical activity, bulking agent

what are complications of diverticula?

LLQ pain, constipation, anorexia, N/V, diverticulitis ( rarely concurrent bleeding).

what are signs of diverticulitis?

LLQ tenderness w/ or w/o guarding (RLQ in certain pop). Low grade fever, leukocytosis, rare: signs of abscess, fistula (bladder, vagina, skin), perforation, obstruction