Beruflich Dokumente
Kultur Dokumente
1971-1973)
Epidemiology
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Factors contributing to
creation of diverticula:
o High-amplitude
contractions
o Constipation
o High-fat content stool
within the sigmoid
lumen in an area of
weakness in the colonic
wall
o Chronic low-grade
inflammation
o Dysbiosis
Hemorrhage most
common cause of
hematochezia in patients age
> 60
Presenting factors of
diverticular bleeding:
o Hypertension
o Atherosclerosis
o NSAID use
Usually self-limited and
stops with bowel rest; risk of
rebleeding is 25%
Localization of bleeding can
be done using:
o Colonoscopy
o Multiplanar CT
angiogram
Best
management if
patient is stable
If this localizes
the bleeding, a
coil can occlude
the bleeding
vessel
o Nuclear medicine
tagged red cell scan
Patient is followed up closely
with repetitive colonoscopy
look for evidence of
colonic ischemia
Alternative methods
(hemodynamically stable):
o Segmental resection of
colon advantageous
to those who require
constant anticoagulant
therapy
o Vasopressin infusion
stops haemorrhage but
is associated with
significant
complications
Surgery used for unstable
patients or those who had a
6-unit bleed within 24 hours
o Segmental resection
used if bleeding is
localized
o Subtotal colectomy
used if bleeding is
not definitively
identified
o Primary anastomosis
used in those
without
comorbidities
Pericolonic abscess
presents with abdominal
distention and localized
peritonitis
Laboratory: leukocytosis
o Performed 6 weeks
after an attack of
diverticular disease
Complicated diverticular
disease associated with
abscess, perforation, or
fistula
o Perforation is staged
using the Hinchey
classification system
Hinch Presentation
ey
Stage
I
Perforated diverticulitis
with confined paracolic
abscess
II
Perforated diverticulitis
with distant abscess
formation
III
Noncommunicating
perforated diverticulitis
with fecal peritonitis
IV
Perforation and free
communication resulting
to fecal peritonitis
Surgical
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Asymptomatic: diet
alterations (30 g fiber/day),
stop smoking
Symptomatic: give
antibiotics and bowel rest
o Antibiotic: TMP/SMX
or Ciprofloxacin and
Metronidazole, with
Ampicillin
o Alternatively: IV
piperacillin or oral
penicillin/clavulanic
acid
o Patients kept at limited
diet until pain resolves
o Use of antiinflammatory
medications
(mesalazine)
Dysbiosis give
probiotics such as
Lactobacillus acidophilus and
Bifidobacterium
Advised for:
o For low risk patients
(ASA P1 and P2) who
do not rapidly improve
on medical therapy
Recurrence of Symptoms
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