Info
🌱 來自: Huppert’s Notes
Diverticular Disease🚧 施工中
Diverticular Disease
Diverticulosis
• Pathophysiology: Multiple outpouchings of colonic mucosa/submucosa through areas of focal weakness in the setting of increased intraluminal pressure, particularly in the sigmoid colon.
• Clinical features: Asymptomatic or LLQ pain, bloating. More common in elderly patients and those who consume a low-fiber diet
• Diagnosis: CT, colonoscopy
• Treatment: High-fiber diet
Diverticular bleed
• Pathophysiology: Painless hematochezia due to the exposure of the vasa recta over time as the diverticulum herniates
• Treatment: Usually self-limited. If bleeding does not stop, perform colonoscopy to evaluate for the site of active bleeding or visible vessel. Consider angiography with embolization if the bleeding site cannot be identified on colonoscopy. Surgery is a last resort.
Diverticulitis
• Pathophysiology: Inflammation/focal necrosis due to erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles.
• Clinical features: LLQ pain, fever, leukocytosis
• Diagnosis: No imaging needed, can consider CT abd/pelvis if there is concern for complications such as abscess, obstruction, fistula, or perforation
• Treatment: Ciprofloxacin and metronidazole for 7–10 days. Recommend colonoscopy 6–8 weeks later to rule out colon cancer if the patient has not had a colonoscopy in the past year. Do NOT need to avoid nuts, seeds, and popcorn (this myth has been debunked). Elective surgery controversial.