Diverticulitis:

• Mean age of diagnosis 63 years old, but 16% of cases occur <age 45
• Most common symptom is abdominal pain: 95% LLQ pain, 5% is RLQ pain (more common in Asian patients)
  • 10-15% of diverticulitis patients have dysuria, urgency, or frequency
• In an otherwise healthy patients under the age of 70, uncomplicated diverticulitis without sepsis, significant leukocytosis, diffuse peritoneal signs, or fever >102.5 can be treated outpatient as long as the patient has access to close follow-up (3 days)
  • If symptoms and infectious markers have not improved in 3 days, abscess should be suspected and patient should be admitted and reimaged
• Outpatient treatment of diverticulitis:
  • Antibiotics: Cipro and flagyl first line
  • No evidence for dietary restrictions, but most providers recommend clear liquid diet until symptoms improve
  • Colonoscopy 6-8w after symptoms resolved to screen for colorectal cancer
  • Prevention of recurrences:
    • High-fiber diet
    • No evidence for avoidance of nuts, seeds, or corn as was previously thought
• Complications of acute diverticulitis: abscess, perforation, obstruction, and fistula (usually colovesicular)

Pyogenic Liver Abscess:

• usually polymicrobial
  • EColi most common in Western world
  • Klebsiella most common in Asia (beware of hypermucoid variant)
  • Strep milleri group is common (anginosus, constellatus, intermedius)
  • Staph and strep pyogenes can occur after procedures such as embolization
• Most common symptoms is fever 90%
  • Abdominal pain 50-75%
  • N/v, anorexia, weight loss, malaise
• LFTs are no necessary elevated
• Mainstays of treatment are percutaneous drainage vs. surgical drainage and prolonged course of antibiotics (4-6 weeks)