SlideShare a Scribd company logo
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
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%)
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
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
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

More Related Content

Similar to 33 Diverticuliti S

29 Acalculus Cholocystitis
29 Acalculus Cholocystitis29 Acalculus Cholocystitis
29 Acalculus Cholocystitis
kdiwavvou
 
32 Irs
32 Irs32 Irs
32 Irs
kdiwavvou
 
Gastrointestinal Nursing
Gastrointestinal NursingGastrointestinal Nursing
Gastrointestinal Nursing
MarkFredderickAbejo
 
30 Biliar Y Coli C
30 Biliar Y  Coli C30 Biliar Y  Coli C
30 Biliar Y Coli C
kdiwavvou
 
Casts and tractions
Casts and tractionsCasts and tractions
Casts and tractions
Joanna Marie Victoria Abanes
 
Meniere’s disease
Meniere’s diseaseMeniere’s disease
Meniere’s disease
Balasubramanian Thiagarajan
 
Congenital laryngeal disorders
Congenital laryngeal disordersCongenital laryngeal disorders
Congenital laryngeal disorders
kcmct20
 
Congenital laryngeal disorders
Congenital laryngeal disordersCongenital laryngeal disorders
Congenital laryngeal disorders
kcmct20
 
Intestinal obstruction
Intestinal obstructionIntestinal obstruction
Intestinal obstruction
Shahrukh Ahmed
 
Periodontal pockets
Periodontal pocketsPeriodontal pockets
Periodontal pockets
Faryal Mangrio
 
periodontal abscess.pptx
periodontal abscess.pptxperiodontal abscess.pptx
periodontal abscess.pptx
nashwahelaly1
 
IBD
IBDIBD
GIT IBD 4th 2012 abstract template.
GIT IBD 4th 2012 abstract template.GIT IBD 4th 2012 abstract template.
GIT IBD 4th 2012 abstract template.
Shaikhani.
 
perioDONTAL pocket
perioDONTAL pocketperioDONTAL pocket
perioDONTAL pocket
Fatima Gilani
 
Corrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin MenonCorrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin Menon
Dr.Ashwin Menon
 
IBD.pptx
IBD.pptxIBD.pptx
Amoebiasis
AmoebiasisAmoebiasis
Amoebiasis
Abigail Abalos
 
Corneal ulcers
Corneal ulcersCorneal ulcers
Corneal ulcers
riddhi27
 
cornealulcers diagnosis treatment and other factors
cornealulcers diagnosis treatment and other factorscornealulcers diagnosis treatment and other factors
cornealulcers diagnosis treatment and other factors
Murali Krishna
 
Inflammation
InflammationInflammation
Inflammation
MUBOSScz
 

Similar to 33 Diverticuliti S (20)

29 Acalculus Cholocystitis
29 Acalculus Cholocystitis29 Acalculus Cholocystitis
29 Acalculus Cholocystitis
 
32 Irs
32 Irs32 Irs
32 Irs
 
Gastrointestinal Nursing
Gastrointestinal NursingGastrointestinal Nursing
Gastrointestinal Nursing
 
30 Biliar Y Coli C
30 Biliar Y  Coli C30 Biliar Y  Coli C
30 Biliar Y Coli C
 
Casts and tractions
Casts and tractionsCasts and tractions
Casts and tractions
 
Meniere’s disease
Meniere’s diseaseMeniere’s disease
Meniere’s disease
 
Congenital laryngeal disorders
Congenital laryngeal disordersCongenital laryngeal disorders
Congenital laryngeal disorders
 
Congenital laryngeal disorders
Congenital laryngeal disordersCongenital laryngeal disorders
Congenital laryngeal disorders
 
Intestinal obstruction
Intestinal obstructionIntestinal obstruction
Intestinal obstruction
 
Periodontal pockets
Periodontal pocketsPeriodontal pockets
Periodontal pockets
 
periodontal abscess.pptx
periodontal abscess.pptxperiodontal abscess.pptx
periodontal abscess.pptx
 
IBD
IBDIBD
IBD
 
GIT IBD 4th 2012 abstract template.
GIT IBD 4th 2012 abstract template.GIT IBD 4th 2012 abstract template.
GIT IBD 4th 2012 abstract template.
 
perioDONTAL pocket
perioDONTAL pocketperioDONTAL pocket
perioDONTAL pocket
 
Corrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin MenonCorrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin Menon
 
IBD.pptx
IBD.pptxIBD.pptx
IBD.pptx
 
Amoebiasis
AmoebiasisAmoebiasis
Amoebiasis
 
Corneal ulcers
Corneal ulcersCorneal ulcers
Corneal ulcers
 
cornealulcers diagnosis treatment and other factors
cornealulcers diagnosis treatment and other factorscornealulcers diagnosis treatment and other factors
cornealulcers diagnosis treatment and other factors
 
Inflammation
InflammationInflammation
Inflammation
 

More from kdiwavvou

56 Establishing A Bedside Diagnosis Of Hypovolemia
56    Establishing A Bedside Diagnosis Of Hypovolemia56    Establishing A Bedside Diagnosis Of Hypovolemia
56 Establishing A Bedside Diagnosis Of Hypovolemia
kdiwavvou
 
55 Aldosterone Inhibitors Diuretic S
55    Aldosterone Inhibitors  Diuretic S55    Aldosterone Inhibitors  Diuretic S
55 Aldosterone Inhibitors Diuretic S
kdiwavvou
 
52 Respir Atory Patt Er Ns
52 Respir Atory   Patt Er Ns52 Respir Atory   Patt Er Ns
52 Respir Atory Patt Er Ns
kdiwavvou
 
50 Myeloproliferative Disease
50 Myeloproliferative Disease50 Myeloproliferative Disease
50 Myeloproliferative Disease
kdiwavvou
 
46 Electrolyte Replacement
46 Electrolyte Replacement46 Electrolyte Replacement
46 Electrolyte Replacement
kdiwavvou
 
46 Electrolytes
46 Electrolytes46 Electrolytes
46 Electrolytes
kdiwavvou
 
35 G I Functional Dearangements
35  G I Functional Dearangements35  G I Functional Dearangements
35 G I Functional Dearangements
kdiwavvou
 
42 Lipids Diagram
42 Lipids Diagram42 Lipids Diagram
42 Lipids Diagram
kdiwavvou
 
42 2 Dyslipidemia
42 2 Dyslipidemia42 2 Dyslipidemia
42 2 Dyslipidemia
kdiwavvou
 
44 Ecg Final
44 Ecg Final44 Ecg Final
44 Ecg Final
kdiwavvou
 
44 Ecg Final
44 Ecg Final44 Ecg Final
44 Ecg Final
kdiwavvou
 
44 E C G
44 E C G44 E C G
44 E C G
kdiwavvou
 
38 Hypertension
38 Hypertension38 Hypertension
38 Hypertension
kdiwavvou
 
37 Vitamins
37 Vitamins37 Vitamins
37 Vitamins
kdiwavvou
 
36 A N T I H Y P E R T E N S I V E D R U G S
36  A N T I H Y P E R T E N S I V E  D R U G S36  A N T I H Y P E R T E N S I V E  D R U G S
36 A N T I H Y P E R T E N S I V E D R U G Skdiwavvou
 
36 Antipyretensive Drugs
36 Antipyretensive Drugs36 Antipyretensive Drugs
36 Antipyretensive Drugskdiwavvou
 
36 Antihypertensive Drugs
36 Antihypertensive Drugs36 Antihypertensive Drugs
36 Antihypertensive Drugskdiwavvou
 
Gi Functional Dearangements
Gi Functional DearangementsGi Functional Dearangements
Gi Functional Dearangements
kdiwavvou
 

More from kdiwavvou (20)

56 Establishing A Bedside Diagnosis Of Hypovolemia
56    Establishing A Bedside Diagnosis Of Hypovolemia56    Establishing A Bedside Diagnosis Of Hypovolemia
56 Establishing A Bedside Diagnosis Of Hypovolemia
 
55 Aldosterone Inhibitors Diuretic S
55    Aldosterone Inhibitors  Diuretic S55    Aldosterone Inhibitors  Diuretic S
55 Aldosterone Inhibitors Diuretic S
 
52 Respir Atory Patt Er Ns
52 Respir Atory   Patt Er Ns52 Respir Atory   Patt Er Ns
52 Respir Atory Patt Er Ns
 
50 Myeloproliferative Disease
50 Myeloproliferative Disease50 Myeloproliferative Disease
50 Myeloproliferative Disease
 
46 Electrolyte Replacement
46 Electrolyte Replacement46 Electrolyte Replacement
46 Electrolyte Replacement
 
46 Electrolytes
46 Electrolytes46 Electrolytes
46 Electrolytes
 
35 G I Functional Dearangements
35  G I Functional Dearangements35  G I Functional Dearangements
35 G I Functional Dearangements
 
42 Lipids Diagram
42 Lipids Diagram42 Lipids Diagram
42 Lipids Diagram
 
42 2 Dyslipidemia
42 2 Dyslipidemia42 2 Dyslipidemia
42 2 Dyslipidemia
 
44 Ecg Final
44 Ecg Final44 Ecg Final
44 Ecg Final
 
44 Ecg Final
44 Ecg Final44 Ecg Final
44 Ecg Final
 
44 E C G
44 E C G44 E C G
44 E C G
 
38 Hypertension
38 Hypertension38 Hypertension
38 Hypertension
 
37 Vitamins
37 Vitamins37 Vitamins
37 Vitamins
 
36 A N T I H Y P E R T E N S I V E D R U G S
36  A N T I H Y P E R T E N S I V E  D R U G S36  A N T I H Y P E R T E N S I V E  D R U G S
36 A N T I H Y P E R T E N S I V E D R U G S
 
36 Antipyretensive Drugs
36 Antipyretensive Drugs36 Antipyretensive Drugs
36 Antipyretensive Drugs
 
32 I R S
32   I R S32   I R S
32 I R S
 
36 Antihypertensive Drugs
36 Antihypertensive Drugs36 Antihypertensive Drugs
36 Antihypertensive Drugs
 
Gi Functional Dearangements
Gi Functional DearangementsGi Functional Dearangements
Gi Functional Dearangements
 
34 Ileus
34 Ileus34 Ileus
34 Ileus
 

Recently uploaded

Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
Josep Vidal-Alaball
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Hiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital Powai News [Read Now].pdfHiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital Powai News [Read Now].pdf
Dr. Sujit Chatterjee CEO Hiranandani Hospital
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
AksshayaRajanbabu
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
rishi2789
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
PsychoTech Services
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
DIVYANSHU740006
 
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
Health Advances
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
rishi2789
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
FFragrant
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1
KafrELShiekh University
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
Gokuldas Hospital
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
Jim Jacob Roy
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
taiba qazi
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
Torstein Dalen-Lorentsen
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
Dr. Ahana Haroon
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
Earlene McNair
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
rishi2789
 
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptxOutbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
Pratik328635
 

Recently uploaded (20)

Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
Hiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital Powai News [Read Now].pdfHiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital Powai News [Read Now].pdf
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
 
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 
OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
 
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptxOutbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
 

33 Diverticuliti S

  • 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.
  • 3.
  • 4.
  • 5. 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%)
  • 6. 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
  • 7. 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
  • 8. 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