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27 Cards in this Set
- Front
- Back
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Where in the world is diverticular disease common?
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Western and industrialized societies; the disease is essentially nonexistent in India and Pakistan (developing nations)
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What age group comprises the majority of diverticulitis patients?
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80% of patients with diverticulitis are 50 or older
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What is diverticulosis or diverticular disease?
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The presence of uninflamed diverticula; diverticula is a blind pouch/outpouching of the alimentary tract
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What is diverticulitis?
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Inflammation of the diverticulum
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What is associated with an increased risk of diverticular disease?
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Diets that are low in dietary fiber and high in refined carbohydrates
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What is the result of a low intake of dietary fiber?
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Increases the intracolonic pressure
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What is the result of increased intracolonic pressure?
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Diverticulum develop and may protrude at areas of weakness, especially areas with vasculature
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The presentation of diverticulitis is similar to a clinical presentation of what other disease?
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Appendicitis
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What kind of bacteria can be cultured from diverticulum?
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Anaerobes and gram-negative aerobes
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How is fecal matter related to diverticulitis?
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Fecal matter can obstruct the diverticula, leading to bacterial overgrowth and local tissue ischemia
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What is the classic clinical presentation of diverticulitis?
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Patient reports of obstipation, abdominal pain that localizes to the LLQ, low-grade fever and have leukocytosis
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What are the differentials of diverticulitis?
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Appendicitis, pelvic inflammatory disease, ectopic pregnancy
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How do patients with free perforation present?
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Marked abdominal tenderness with guarding and involuntary rigidity; perotinitis is an indication for emergency surgical exploration
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How is the severity of diverticulitis graded?
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Hinchey's criteria
Stage 1 - small abscess Stage 2 - larger abscess Stage 3 - perforated diverticulitis Stage 4 - free rupture |
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What is the recommended workup of suspected diverticulitis?
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Computed tomography (CT) is recommended as the initial radiologic examination; high sensitivity and specificity
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When is colonoscopy/sigmoidoscopy avoided?
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When acute diverticulitis is suspected because of risk of perforation or exacerbation of the disease; these tests can be performed when the acute process has resolved (about 6 weeks after)
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What is the outpatient therapy for diverticulitis?
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Oral broad-spectrum antimicrobial therapy including coverage against anaerobic microorganisms
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When is hospitalization indicated?
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If the patient is unable to tolerate oral intake, pain severe enough to require narcotic analgesia or if symptoms fail to improve despite adequate outpatient therapy
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How do you treat an abscess formation?
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Percutaneous drainage
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What are the benefits of laparoscopic procedures for colon resections in diverticulitis?
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When compared to open resections, patients who undergo laparoscopic resections have shorter hospital stays, less pain in the immediate postoperative period, and a reduced overall risk of complications
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When is laparoscopic surgery recommended for patients with diverticulitis?
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Stage 1 or stage 2; NOT stage 3 and 4; most likely to become the standard surgical approach for uncomplicated diverticulitis as more surgeons are trained
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How common are recurrences of patients with diverticulitis?
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The majority of patients with a single episode of diverticulitis will not have another.
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What is recommended for patients with diverticulosis?
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Fiber-rich diet with possibly oral antibiotics to reduce intracolonic pressure and reduce the risk of recurrence
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A previously healthy 45-year-old man presents with severe lower abdominal pain on the left side, which started 36 hours earlier. He has noticed mild, periodic discomfort in this region before but has not sought medical treatment. He reports nausea, anorexia, and vomiting associated with any oral intake. On physical examination, his temperature is 38.5* C and his heart rate is 110 beats per minute. He has abdominal tenderness on the left side without peritoneal signs. How should his case be managed?
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Since this patient is unable to hydrate himself orally, he should be hospitalized.
*IV fluids and broad-spectrum antibiotics. *CT scan of the abdomen *Colonoscopy after the inflammatory symptoms have completely resolved |
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What are the complications of diverticulitis?
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Peritonitis, Abscess formation, fistula formation, and rectal bleeding
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What are recommendations for the patients to prevent the progression of diverticular disease?
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Eat more fiber, drink plenty of fluids, respond to bowel urges and exercise regularly; all which act to decrease intracolonic pressure
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What is a myth regarding the cause of diverticulitis?
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Seeds and nuts were thought to play a role in causing diverticulitis but recent research has found that these foods have no role in causing diverticulitis
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