33 Diverticuliti S


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33 Diverticuliti S

  1. 1. Diverticulitis Further reading : http://emedicine.medscape.com/article/173388-overview Interesting Links : http://www.diseasesdatabase.com/links1.asp?glngUserCh oice=7903 Inflammation of the COLONIC DIVERTICULA, generally with abscess formation and subsequent perforation See also : Persistent vitelline duct
  2. 2. Diverticulitis 4. Signs 1. See Also 1. Fever 1. Diverticulosis 2. Tenderness over left lower quadrant 3. GUARDING AND REBOUND TENDERNESS MAY BE PRESENT 2. Pathophysiology 1. COMPLICATES 5% OF DIVERTICULOSIS 5. Labs 2. DISTRIBUTION 1. COMPLETE BLOOD COUNT 1. MOST OFTEN AFFECTS SIGMOID COLON 1. Leukocytosis (>68% of cases) 2. Right Diverticular Disease in age <60 and asians 2. URINALYSIS 1. DYSURIA AND URINARY FREQUENCY MAY OCCUR 3. INFLAMMATION OF COLONIC DIVERTICULA 1. Impacted with fecal material (fecalith) 6. Radiology 1. ABDOMINAL FLAT AND UPRIGHT ABDOMEN 2. Colon Perforation 1. Observe for abdominal free air 1. Microperforation 2. Small Bowel Obstruction (Simple Diverticulitis) 1. Peridiverticulitis with localized phlegmon 2. Infection walled off by pericolic fat 2. ABDOMINAL CT WITH CONTRAST 1. Best test to confirm Diverticulitis 2. Macroperforation (Complicated Diverticulitis) 2. Best test to identify complications 1. Pericolic abscess or (perforation) 2. Free perforation with generalized peritonitis 3. Fistulas may form between adjacent 3. Findings suggestive of perforation structures 1. Pericolic fat infiltration 2. Fascial thickening and muscle hypertrophy 3. Arrowhead sign 1. Localized bowel wall thickening 2. Bowel lumen resembles arrow 3. Symptoms shape at diverticulum 1. Mild anorexia 2. Nausea or Vomiting 3. Chills 4. Diarrhea or cobstipation 5. Abdominal Pain: Acute constant pain 3. AVOID COLONOSCOPY IN ACUTE DISEASE 1. Initial: Hypogastric pain 1. Risk of worsening perforation 2. LATER: LEFT LOWER 4. AVOID BARIUM ENEMA IN ACUTE DISEASE QUADRANT ABDOMINAL PAIN 1. Risk of extravasation if perforation (>92%)
  3. 3. 7. Management: General Measures 1. Clear Liquid Diet (NPO in severe disease) 2. Low fiber diet in acute phase 9. Management: Inpatient 3. Avoid Narcotics (INCREASES INTRACOLONIC 1. INDICATIONS FOR HOSPITALIZATION PRESSURE) 1. Age >85 years 1. Except Meperidine (decreases 2. Significant inflammation intraluminal pressure) 3. Unable to take oral fluids 4. ANTICIPATE IMPROVEMENT WITHIN 48-72 HOURS 2. GENERAL MEASURES 8. Management: Outpatient Mangement 1. Nothing by mouth initially of mild disease 1. INDICATIONS FOR OUTPATIENT MANAGEMENT 1. Uncomplicated Diverticulitis 3. ANTIBIOTIC REGIMEN FOR MODERATE 2. Stable clinically DISEASE 3. Tolerating oral fluids 1. Primary agents 1. Unasyn 3 g IV q6 hours 2. Zosyn 3.375 g IV q6 hours 3. Timentin 3.1 g IV q6 hours 2. Alternative agents 2. ANTIBIOTIC REGIMEN 1. Cefoxitin 2 g IV q8 hours 1. Primary protocol (requires 2 agents for 7- 2. Cefotetan 2 g IV q12 hours 10 days) 3. Ciprofloxacin 400 mg IV q12h 1. CIPROFLOXACIN 500 mg PO bid with Flagyl 500 IV q6h or Septra DS PO bid and 2. METRONIDAZOLE (Flagyl) 500 mg PO q6 hours 4. ANTIBIOTIC REGIMEN FOR SEVERE DISEASE (E.G. ICU) 2. Alternative protocol 1. Primary agents 1. AUGMENTIN 500 mg PO 1. Imipenem 500 mg IV q6 hours or tid for 7-10 days 2. Merepenem 1 g IV q8 hours 2. Alternative agents 1. Trovafloxacin 300 mg IV day 1, then 200 mg IV qd or 2. Three agent protocol 1 1. Ampicillin 2 g IV q6 hours and 2. Metronidazole 500 mg IV q6 hours and 3. Aminoglycoside (requires monitoring of levels) 1. Gentamicin or 2. Tobramycin or 3. Amikacin 3. Three agent protocol 2 1. Ampicillin 2 g IV q6 hours and 2. Metronidazole 500 mg IV q6 hours 3. Ciprofloxacin 400 mg IV q12 hours
  4. 4. 10.Course 1. Improves on antibiotics within 48 to 72 hours 11.Follow-up 1. COLONOSCOPY 6 WEEKS AFTER DIVERTICULITIS EPISODE 1. Define extent of Diverticulosis 2. Evaluate for Colon Cancer 3. Barium Enema may be used as alternative option 2. SURGICAL INDICATIONS 1. Recurrent Diverticulitis (more than 1 episode) 12.Complications 1. Colonic perforation 2. Colonic abscess 3. Generalized peritonitis 4. Colonic fistula 13.Prevention 1. High fiber diet (except in acute phase - see above) 2. Maintain adequate hydration 14.Prognosis 1. After first episode, recurs in 20-30% of cases 2. After second episode, recurs in 50% of cases 15. References 1. Gilbert (2002) Sanford Guide to Antimicrobials, p. 14 2. Simmang in Feldman (1998) Gastrointestinal, p. 1793-7 3. Salzman (2005) Am Fam Physician 72:1229
  5. 5. MY NEXTBIO DATA IMPORT COMMUNITY CORPORATE HOME Sign In Register for free Diverticulitis Overview Search Term: Diverticulitis (disease) Overview Print page RESEARCH Inflammation of a DIVERTICULUM or diverticula. Data Correlations View Complete Description PUBLICATIONS Literature Clinical Trials Literature | 5,617 results View All Clinical Trials | 125 trials View All News Obesity increases the risks of diverticulitis and diverticular bleeding. Laparoscopic Versus Open Sigmoid NEXTBIO COMMUNITY Authors: Lisa L Strate, Yan L Liu, Walid Colectomy for Diverticular Disease Users H Aldoori, Sapna Syngal, Edward L conditions: Diverticulitis Giovannucci interventions: laparoscopic sigmoid Groups Gastroenterology 2009 Jan resection Diverticulitis in the United States: 1998-2005: changing patterns of Prevention of Recurrence of Bookmark this page disease and treatment. Diverticulitis Forward this page Authors: David A Etzioni, Thomas M conditions: Diverticulitis E-mail feedback Mack, Robert W Beart, Andreas M Kaiser interventions: SPD476, MMX™ Annals of surgery 2009 Feb mesalazine, 1.2g extended release tablet ; SPD476, MMX™ mesalazine, 1.2g extended release tablet ; SPD476, MMX™ mesalazine, 1.2g extended release tablet ; Associated Researchers Placebo Thought leaders and organizations working on research involving Diverticulitis. Authors View All News | 8 stories View All NDSG Craig L Floch Walter E Longo Martin H Floch Laparoscopic diverticulitis surgery in India Eric J Dozois Mumbai with memorable medical tourism PR-inside.com. - October 13, 2009 Clinical Trials Sponsors View All Uninsured Face Worse Outcomes After Wyeth University Hospitals Diverticulitis news of Cleveland e-Healthcare. Pfizer The SmartPill Corporation Shire Pharmaceutical Community Development NextBio Users Organizations View All No NextBio users were found for “Diverticulitis”. Mayo Clinic College Yale University Complete your user profile with your interests, of Medicine School of Medicine if you want others to find you within the Our Lady of Norwalk Hospital NextBio community. Lourdes Hospital University of NextBio Groups Washington School of Medicine No NextBio groups were found for “Diverticulitis”. Be the first to start a group and share your interests with others within the NextBio community. Resources Contact Us Customer Support © 2009 NextBio | privacy policy | terms of service | site map