diverticulitis
diverticulitis
introduction
diverticula are herniations of the mucosa and submucosa or the entire wall thickness through the muscularis and in Western cultures, 95-95% involve the sigmoid colon, while in those living in Africa and Asia, prevalence is only 0.2% of the population and it mainly affects the right side!
adolescent cases are rare and generally associated with genetic disorders involving
connective tissues in particular, such as:
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Ehlers-Danlos syndrome
Marfan's syndrome
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prevalence is increasing in the Western cultures and now are found in over 25% of patients undergoing colonoscopy, with prevalence increasing with age with prevalence being ~5% in those adults under 40 years, ~30% by age 60 years and 65% by age 85 years.
thought to be caused by low-fiber diet which is the highest risk factor for diverticular disease. The resultant low-bulk stool leads to increased segmentation of the colon during propulsion, causing increased intraluminal pressure and formation of diverticula.
affluent, mainly indoor societies in which passing flatus is regarded as being anti-social, may be an important contributor due to the gas pressures resulting from flatus retention and colonic contractions - perhaps it is better out than in!
risk increases with steroids and aging presumably due in part to impaired collagen maintenance.
complications of diverticular disease include:
initial Mx in ED
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nil orally or minimal ice chips to rest gut
iv fluids
bloods for FBE, U&E, consider CRP (and LFT's and lipase if R abdominal pain, consider blood cultures if temp > 38.5degC)
urinalysis
iv analgesia
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strict fluid balance chart
consider NGT if frequent vomiting
consider IDC if clinical dehydration, or impaired renal function
ECG if over 50 years age or risk of IHD
plain AXR is unlikely to be helpful unless one suspects other diagnoses such as bowel obstruction or sigmoid volvulus
contact surg team to decide on further Mx and possible CT abdomen
patients with known diverticular disease and mild symptoms may be considered for discharge on broad spectrum antibiotics without imaging
pelvic USS may be preferred over CT scan for women of child bearing age
CT abdomen with iv and oral contrast is now the gold standard for non-invasive diagnosis of diverticulitis
the two most common CT findings in uncomplicated diverticulitis are:
an identifiable inflamed diverticulum may also be visible
CT may fail to demonstrate early, mild cases of diverticulitis.
CT findings in complicated diverticulitis may include:
CT with rectal contrast is usually required to visualise fistulae, however, this is rarely performed
antibiotic Mx of diverticulitis
mild diverticulitis suitable for outpatient Mx
augmentin duo forte i bd for 5-7 days
if penicillin HS, then cephalexin 500mg qid plus metronidazole 400mg bd for 5-7 days
moderate diverticulitis warranting admission and iv Rx
severe diverticulitis
abscess on CT scan
diverticulitis.txt · Last modified: 2018/06/05 22:07 (external edit)