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Diverticulitis

Diverticulitis. Fariba Jafari. Definition. Outpouchings of the colon Located at sites where blood vessels enter the colonic wall Inflamed as a result of obstruction by feces or hardened mucus or of mucosal erosion  localized perforation= diverticulitis. Associated Risk Factors.

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Diverticulitis

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  1. Diverticulitis Fariba Jafari

  2. Definition • Outpouchings of the colon • Located at sites where blood vessels enter the colonic wall • Inflamed as a result of obstruction by feces or hardened mucus or of mucosal erosion localized perforation= diverticulitis

  3. Associated Risk Factors • Decreased physical activity • Intake of non-steroidal anti-inflammatory drugs (NSAID) • Smoking • Constipation from any cause • Incidence increases with age. • Diet has been associated with the emergence of this disease.

  4. Low-residue diet constipation  lead to increased intraluminal pressure in the large bowel • High pressure zones or areas of segmentation may develop (sigmoid colon), and diverticula begin to protrude at these locations • Microperforation of thin walled diverticulum widespread contamination with fecal organisms may ensue

  5. Saint’s triad • Cholelithiasis, diverticulitis, and hiatal hernia frequently occur together.

  6. Characteristic Findings • Abdominal pain • LLQ tenderness • Irregular bowel habits • Fever

  7. Physical Examination • Uncomplicated: LLQ tenderness, possible mass, bleeding (uncommon), localized inflammation, • Complicated: mass, evidence of fistula, ambdominal distention, abdominal tenderness, marked in cases of free perforation, hypotension; bleeding

  8. 2 courses • Mild: outpatient basis. Liquid diet, oral antibiotics • If not: hospitalize patient. NPO. IV antibiotics. CT with contrast.

  9. What now? • Symptoms resolve: colonoscopy or contrast study • Recur: surgical treatment Surgical • 20% of patients with diverticulitis require surgical treatment.

  10. Obstruction • Perform diagnostic imaging • Small bowel: high-grade, low-grade • Large bowel: cecal distention

  11. Abscess • Perform diagnostic imaging • Small abscess • Large abscess

  12. Fistula • Signaled by fecaluria and pneumaturia • Diagnostic imagingbladder air • Treat medically • Resect colon and fistula in one-stage procedure

  13. Free Perforation • SURGICAL TREATMENT!! • Hinchey Stage III & IV • To the WEB

  14. Bleeding (lower GI) • Massive • Transfusions • Angiography • If + superselective embolization • If - observe patient, RBC scanning. • Moderate • Observe patient • Colonoscopy

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