AM Report 12/12/16: Diverticulitis

Define:
Diverticulosis:
presence of diverticula ~ sac-like protrusion of colonic wall.
Diverticulitis:
inflammation of the diverticula

Epidemiology:
5-10% of patients > 45 years old
80% of patients > 85 years old

Risk Factors (formation of diverticulosis):
Lack of fiber / Western Diet (red meats/fats)
Decreased colonic motility
Decreased colonic wall resistance
Genetic susceptibility
NSAIDs/Aspirin
Age
Obesity
Smoking
Lack of exercise

DDx – Features:
Bowel Obstruction – abdominal pain, nausea/vomiting, abnormal imaging
Colorectal CA – weight loss, anemia, GI bleeding
Gastroenteritis – abdominal pain, nausea/vomiting
IBD – diarrhea, weight loss, rectal bleeding, mucus in stool
IBS – abdominal spasms relieved with defication
Ischemic colitis – abdominal pain out of portion to exam, arterial disease
Nephrolithasis – flank pain, hematuria, stone on imaging
Pancreatits – epigastric pain, nausea/vomiting

Likelihood Ratios for Acute Diverticulitis:
1

LLQ Imaging:

2

Accuracy of CT Finding for Diagnosing Acute Diverticulitis:

3

Treatment:
Inpatient ~ 6%
Any complicated case (abscess, obstruction, perforation, fistula)
Any uncomplicated with 1 (or more)
– Immunosuppression – Comorbidities
– Fever > 39 C – No PO intake
– Significant leukocytosis – Non-compliance
– Severe pain – Failed outpatient
– Old age

Outpatient ~ antibiotics 7-10 days
1) Cipro + Flagyl
2) Bactrim + Flagyl
3) Augmentin
4) Moxifloxacin

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