-IBIS-1.5.0-
tx
digestive system
diverticulitis
diagnoses

definition and etiology

definitions:
• diverticulosis: small sac-like mucosal herniations in the muscular wall of the colon
• diverticulitis: infection or inflammation of one or several diverticula, potentially causing fatal obstruction or perforation, or the development of fistulae

etiology:
The most common involved area is the sigmoid colon. Diverticula are seen in 20-50% of the population over 50 years old in Western civilizations. The suspected development factor is increased intraluminal pressure (e.g. from chronic constipation) that causes the colonic outpouchings to form at the weak areas where arteries penetrate the muscularis. Diverticulitis follows bacterial or fecal contamination of the colonic tissues in or around the diverticular sac, perhaps involving perforation and serosal or peritoneal inflammation.

signs and symptoms

signs and symptoms: diverticulosis
• usually asymptomatic
• bleeding from the diverticula will sometimes occur

signs and symptoms: diverticulitis
• pain with local tenderness, almost always in LLQ, but sometimes in RLQ or suprapubic area; the pain may be intense.
• constipation
• mass palpable in LLQ
• fever
• guarding; rebound tenderness is possible
• rectal bleeding
• pain worse with urination: indicates bowel has adhered to bladder

lab findings:
• proctoscopic exam
• barium enema: may be dangerous to perform in the acute stage, but may paradoxically relieve pain
• increased WBCs and ESR
• occult blood in stool
• hypochromic microcytic anemia in some patients
• cytologic examination of stool negative for malignant cells

course and prognosis

Only about 1% of patients with diverticulosis will develop diverticulitis.

In patients who increase their roughage, diverticula will often remain asymptomatic. Diverticulitis may lead to just a small intramural abscess or, more seriously, leakage into the free peritoneal cavity causing generalized peritonitis. In a case without perforation, surgery is usually not needed. In severe attacks with perforation, bleeding or repeated attacks, surgery is the conventional treatment.
Other conventional treatments include bulking agents, spasmolytic agents and high-fiber diet.

Severe diverticulitis may require IV fluids, appropriate antimicrobials and nonopiate analgesics.

differential diagnosis

• colonic carcinoma: must rule out before a diagnosis of diverticulitis can be made
• appendicitis
• Crohn's disease
• ischemic colitis
• ulcerative colitis
• other gastrointestinal inflammatory conditions


footnotes