• Divericular disease
      • Herniation of the mucosa and submucosa through the muscular layers of the bowel wall at sites where arterioles penetrate, forming small out- pouchings or diverticula. (MCQ)
      • Diverticula occur on the mesenteric side of the colon. . (MCQ)
      • > 50% over 70 years of age . (MCQ)
      • Men and women equally affected
      • Sigmoid colon most commonly involved with progressively decreasing frequency of involvement as one proceeds proximally. (MCQ)
      • Risk factors. (MCQ)
        • Old age
        • Low-fiber diet
      • Signs and symptoms
        • Diverticulosis
          • 80% of patients asymptomatic.
          • May cause recurrent, intermittent left lower quadrant (LLQ) pain and tenderness that often follows a meal and is relieved by flatus or defecation. . (MCQ)
          • LLQ rope-like mass sometimes palpable on exam. . (MCQ)
          • Massive lower GI bleeding is classic (notably absent in diverticulitis). . (MCQ)
        • Diverticulitis
          • Persistent abdominal pain initially diffuse in nature that often becomes localized to the LLQ with development of peritoneal signs . (MCQ)
          • LLQ and/or pelvic tenderness
          • Ileus
          • Fever, anorexia, nausea, vomiting,
          • change in bowel habits (usually constipation) (MCQ)
          • Elevated WBC
      • Diagnosis
        • Diverticulosis
          • Characteristic history and physical exam confirmed by diverticula iden- tified on barium enema and/or colonoscopy.
        • Diverticulitis
          • Characteristic history and physical exam with elevated WBCs
          • Abdominal x-ray: Ileus, distention, and/or free intraperitoneal air(MCQ)
          • CT scan:
            • Pericolonic inflammation with or without abscess formation (MCQ)
            • barium enema and colonoscopy may induce perforation and are contraindicated in the acute setting but should be obtained in follow-up(MCQ)
      • Treatment
        • Diverticulosis:
          • High-fiber diet, stool softeners. (MCQ)
        • Mild diverticulitis:
          • Outpatient management:
            • Clear liquid diet, PO antibiotics(MCQ)
            • non-opioid analgesics with close follow-up.
            • Follow-up includes colonoscopy and dietary recommendations once acute infection has subsided.
          • If outpatient therapy fails, admit for IV antibiotics and IV hydration with bowel rest.
          • Nasogastric tube (NGT) is placed when there is evi- dence of ileus or small bowel obstruction (SBO), with nausea and vom- iting. (MCQ)
        • Severe diverticulitis with peritonitis and/or perforation:
          • Two-stage procedure with initial surgical drainage and diverting colostomy followed by colonic reanastomosis 2 to 3 months later. (MCQ)
          • Elective resection of affected bowel may be considered in the patient who has recurrent episodes of diverticulitis requiring treatment. (MCQ)
      • Prognosis
        • Seventy percent of patients have no recurrence after one episode of un- complicated diverticulitis.
        • After a second episode, 50% recur.
      • Clinical Pearls :
        • Recommend colonscopy (MCQ)
          • after 7 years of pancolitis
          • after 10 years of left-sided colitis
          • then scope and biopsy every 1 to 2 years
        • The diverticula of common diverticulosis are false diverticula, because only the mucosa and submucosa herniated rather than all the layers of the bowel wall. (MCQ)
        • Pathology of diverticulitis:
          • A peridiverticular inflammation caused by (usually tiny) perforation of the diverticulum secondary to increased pressure or obstruction by inspissated feces.
          • Feces extravasate onto the serosal surface but infection is usually well contained in a patient with normal immune function.

    Diverticulosis is a common gastrointestinal finding on colonoscopy.
    Diverticulosis Causes, Symptoms And Treatment
    his video on diverticulosis was written and narrated by an experienced TV/radio health and wellness reporter, with information drawn from established and well-respected medical resources.

    But you should always consult a qualified medical professional in matters related to diverticulosis or any other health problem you may be experiencing.
    Diverticulosis and Surgical Treatment
    This patient education vdieo is for patients who may need surgery for diverticulosis. Included are the following sections: Anatomy, Symptoms & Causes, Alternative Treatments, Surgical Treatment, Risks & Complications, and After Surgery.

    A colonoscopy displaying multiple diverticulae
    Diverticular disease occurs when pouches (diverticula) in the intestine, usually the large intestine or colon, become inflamed. Most diverticula occur in the sigmoid colon, the curved part of the large intestine closest to the rectum, and they tend to become more numerous as we age.
    Colonic Diverticulosis and Diverticular Hemorrhage
    Colonic diverticulosis predisposes individuals to lower gastrointestinal hemorrhage in up to 5% of cases. These sac-like protrusions are pseudodiverticula and arise due to a combination of anatomic, dietary, motility, and structural influences. In the setting of acute hemorrhage, patient stabilization takes priority, followed closely by maneuvers aimed at localizing and controlling blood loss. Through the use of an arsenal of tools including colonoscopy, angiography, and nuclear scintigraphy, most diverticular bleeds can be localized and subsequently controlled. When persistent and not controlled by colonoscopic or angiographic means, expeditious surgical resection serves as definitive therapy.
    Dr. TV Perú (24-06-2013) – B3 – Asistente del día: Diverticulosis y diverticulitis
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