This document defines and discusses diverticulosis, diverticulitis, segmental colitis associated with diverticula (SCAD), and symptomatic uncomplicated diverticular disease (SUDD). It covers the background, definitions, presentations, diagnoses, differential diagnoses, and treatments of these conditions. Diverticulosis is the presence of diverticula (sac-like protrusions of the colonic wall), while diverticulitis is inflammation of the diverticula that can be acute or chronic. SCAD involves chronic inflammation between diverticula, and SUDD includes abdominal pain associated with diverticulosis.
In this ppt I have discussed the different causes for obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose obstructive jaundice.
In this ppt I have discussed the different causes for obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose obstructive jaundice.
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
Approach to a patient with Chronic DiarrhoeaAhsan Sajjad
Approach to a patient with chronic diarrhea,diagnosis and managment. different causes are also discussed in this presentation and respective treatment is stated.
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
Approach to a patient with Chronic DiarrhoeaAhsan Sajjad
Approach to a patient with chronic diarrhea,diagnosis and managment. different causes are also discussed in this presentation and respective treatment is stated.
Dysphagia is an important problem in surgical patients. I have discussed Introduction, Zenker's diverticulum, GERD, Achalasia Cardia and Carcinoma Esophagus. If you watch all these videos together, i assure you that you will become confident in managing a case of dysphagia.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
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• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
NEONATAL BILIOUS VOMITING- PART 1 & 2
Dear Viewers,
Greetings from “Surgical Educator”
Today I have uploaded two videos on “Neonatal bilious Vomiting- Part 1 & 2. In this episode, I talked about various congenital causes for bowel obstruction in neonatal babies that also cause bilious vomiting. Since there are many causes, I have created two videos to cover everything. In Part1, I talked about duodenal atresia, annular pancreas, malrotation, jejunal & ileal atresia and necrotising enterocolitis. In Part2, I talked about Hirschsprung’s disease, meconium ileus, meconium plug, small left colon syndrome and meconium peritonitis. I request you to watch both videos together and I hope you will enjoy them. You can watch all my surgical teaching video casts in the following links:
Surgicaleducator.blogspot.com
Youtube.com/c/surgicaleducator
Thank you for your support.
9. Diverticulosis Diverticulitis
SUDD
Dietary modifications
- Clear liquids
- High fiber
Antibiotic
- Broad-spectrum (gram(-) and anaerobes)
Spasmolytics
Anticholinergics
Diverticular bleed
Resuscitation
- Fluids
- Blood products
Endoscopic therapy
- Epinephrine injection
- Endoscopic tamponade
- Banding
Angiographic therapy
- Pharmacologic occlusion
- Mechanical occlusion
Surgery
Dietary modifications
- Clear liquids
- High fiber
- Bowel rest (inpatient, severe cases)
Antibiotic therapy
- May not be necessary
- Target gram (-) rods and anaerobes
- 7-14 days based on symptoms
- Outpatient:
ciprofloxacin 500 mg PO BID +
metronidazole 500 mg PO TID
OR
amox-clav 875/125 mg BID
- Inpatient:
ceftolazone 1 g + tazobactam 0.5 g +
metronidazole 500 mg IV every 8 hours
Anti-inflammatory agents
- Mesalamine
Drainage
- Abscess
Surgery
TREATMENT
10. Diverticulosis Diverticulitis
SCAD
Dietary modifications
- Clear liquids
- High fiber
Antibiotic therapy
1. Ciprofloxacin 500 mg BID + metronidazole 10
mg/kg daily x 10-14 days
2. Mesalamine 800 mg TID x 7-10 days
3. Mesalamine 1600 mg TID
4. Prednisone 40 mg daily x 7 days, then taper
over 6 weeks
5. Recurrent symptoms: long-term ciprofloxacin
6. Steroid-refractory/dependent: segmental
resection
Asymptomatic
High fiber
Low-fat
Physical activity
Dietary modifications
- Clear liquids
- High fiber
- Bowel rest (inpatient, severe cases)
Antibiotic therapy
- May not be necessary
- Target gram (-) rods and anaerobes
- 7-14 days based on symptoms
- Outpatient:
ciprofloxacin 500 mg PO BID +
metronidazole 500 mg PO TID
OR
amox-clav 875/125 mg BID
- Inpatient:
ceftolazone 1 g + tazobactam 0.5 g +
metronidazole 500 mg IV every 8 hours
Anti-inflammatory agents
- Mesalamine
Drainage
- Abscess
Surgery
TREATMENT
11. Pemberton JH, Young-Fadok T. Colonic diverticulosis and diverticular
disease: Epidemiology, risk factors, and pathogenesis. In: UpToDate, Post
TW (Ed), UpToDate, Waltham, MA. (Accessed on 19 April 2016).
Tursi A. Diverticular disease: A therapeutic overview. World J Gastrointest
Pharmacol Ther. 2010 Feb 6;1(1):27-35. doi:10.4292/wjgpt.v1.i1.27
Salzman, H, Lillie D. Diverticular Disease: Diagnosis and Treatment. Am
Fam Physician. 2005 Oct 1;72(7):1229-1234
Young-Fadok T, Pemberton JH. Colonic diverticular bleeding. In: UpToDate,
Post TW (Ed), UpToDate, Waltham, MA. (Accessed on 19 April 2016.)
Young-Fadok T, Pemberton JH. Segmental colitis associated with
diverticulosis. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.
(Accessed on 19 April 2016.)
Pemberton JH, Young-Fadok T. Clinical manifestations and diagnosis of
acute diverticulitis in adults. In: UpToDate, Post TW (Ed),
UpToDate, Waltham, MA. (Accessed on 19 April 2016.)
Pemberton JH, Young-Fadok T. Nonoperative management of acute
uncomplicated diverticulitis. In: UpToDate, Post TW (Ed),
UpToDate, Waltham, MA. (Accessed on 19 April 2016.)
REFERENCES
Editor's Notes
Blood from left colon usually bright red (hematochezia)
Blood from right colon usually dark and tarry, may be mixed with stool
Acute uncomplicated diverticulitis criteria for outpatient treatment
Pt will return if symptoms worsen
Compliance to medication regimen
Non-severe abd pain
Fever not more severe than low grade
Tolerate oral intake
No severe comorbidities
Good support system
Inpatient treatment recommended for severe episode, comorbidity, elderly, Immunosuppression
Acute uncomplicated diverticulitis criteria for outpatient treatment
Pt will return if symptoms worsen
Compliance to medication regimen
Non-severe abd pain
Fever not more severe than low grade
Tolerate oral intake
No severe comorbidities
Good support system