#Diverticulitis of the large intestine without perforation or abscess and without bleeding
H&P. LLQ pain…
Risk factors:
DDx / Etiology
Labs/Imaging: CT abd, BCx, CBC, CMP, Lipase
Treatment
Inpatient tx
Admit pt to Med-Surg floor.
IVFs, NPO, NGT if needed.
Zosyn (to cover anaerobes + GNR)
Zofran and Phenergan for N/V
Morphine / Dilaudid for pain for severe pain. Norco for moderate pain.
Will need outpatient f/u with GI.
Get colonoscopy 6 weeks after an episode of acute diverticulitis to r/o malignancy even if the patient has a colonoscopy and it’s not been up to ten years.
Monitor WBC
Outpatient tx: Ciprofloxacin + Metronidazole.
Preventing diverticulitis
“Increased intake of dietary fiber and increased exercise have been shown to prevent recurrences of diverticulitis (SOR B). Weight loss has been shown to be effective in persons with a body mass index of 30 kg/m2 or higher but this patient is underweight and should not be counseled to lose weight (SOR B). There is no evidence that avoiding nuts, corn, or popcorn decreases the risk of diverticulitis (SOR B). Risk factors for diverticulitis include the use of NSAIDs, but not acetaminophen.”
“Patients with diverticulosis should increase dietary fiber intake or take fiber supplements to slow progression of the diverticular disease. Avoiding nuts, corn, popcorn, and small seeds has not been shown to prevent complications of diverticular disease. Limiting intake of dairy products, spicy foods, and wheat flour would be appropriate for other gastrointestinal problems such as lactose intolerance, gastroesophageal reflux disease (GERD), and celiac disease.”
“can be confused with urinary tract infections because bladder symptoms can accompany the gastrointestinal symptoms. The sigmoid colon lies close enough to the bladder that the bladder can be irritated by sigmoid diverticulitis. Conversely, urinary infections do not cause painful defecation. Tenderness in the left lower quadrant and above the rectum is typical for sigmoid diverticulitis. ” ABFM critique.
Reference
Wilkins T, Embry K, George R: Diagnosis and management of acute diverticulitis. Am Fam Physician 2013;87(9):612-620.