Diverticulitis: Difference between revisions

Latest revision as of 01:29, 22 December 2021

Clinical Manifestations

Complicated diverticulitis includes diverticulitis associated with uncontained, free perforation with systemic inflammatory response, fistula, abscess, stricture, or obstruction
Uncomplicated diverticulitis is diverticulitis not meeting the above definition, and includes microperforation with small amounts of contained, extraluminal gas without systemic inflammatory response

Diagnosis

Usually diagnosed by CT and rule out complications when severe

Management

For uncomplicated diverticulitis:
- Observation alone with ibuprofen or acetaminophen, preferred
- Some consider ten days of amoxicillin-clavulanic acid, or a combination of fluoroquinolone and metronidazole
  - Indicated for patients with immunocompromise, comorbidities, or frailty, with refractory symptoms or vomiting, with CRP >140 mg/L or WBC >15
  - Indicated if intraabdominal fluid collection present
For complicated diverticulitis:
- Antibiotic treatment as above
Dietary modification: a clear liquid diet during acute phase of uncomplicated diverticulitis, advanced as symptoms improve
Some patients may benefit from colonoscopy following an episode of diverticulitis (either complicated, or first-episode uncomplicated)
- Typically done 6 to 8 weeks after onset and following resolution of symptoms

Prevention

Eat high-quality diet that is high in fibre from fruits, vegetables, whole grains, and legumes, and low in red meat and added sugar; or a vegetarian diet
- No need to avoid nuts, seeds, or corn
Maintain normal BMI
Be physically active
Smoking cessation
Treat alcohol use disorder
Avoid regular NSAID use
However, 50% of risk is genetic

@@ Line 3: / Line 3: @@
 *'''Complicated diverticulitis''' includes diverticulitis associated with uncontained, free perforation with systemic inflammatory response, fistula, abscess, stricture, or obstruction
 *'''Uncomplicated diverticulitis''' is diverticulitis not meeting the above definition, and includes microperforation with small amounts of contained, extraluminal gas without systemic inflammatory response
+== Diagnosis ==
+* Usually diagnosed by CT and rule out complications when severe
 ==Management==
 *For uncomplicated diverticulitis:
-**Observation alone, or
+**Observation alone with [[ibuprofen]] or [[acetaminophen]], preferred
-**Ten days of [[amoxicillin-clavulanic acid]] (preferred), or a combination of [[fluoroquinolone]] and [[metronidazole]]
+**Some consider ten days of [[amoxicillin-clavulanic acid]], or a combination of [[fluoroquinolone]] and [[metronidazole]]
+***Indicated for patients with immunocompromise, comorbidities, or frailty, with refractory symptoms or vomiting, with CRP >140 mg/L or WBC >15
+***Indicated if intraabdominal fluid collection present
+*For complicated diverticulitis:
+**Antibiotic treatment as above
+*Dietary modification: a clear liquid diet during acute phase of uncomplicated diverticulitis, advanced as symptoms improve
+*Some patients may benefit from colonoscopy following an episode of diverticulitis (either complicated, or first-episode uncomplicated)
+**Typically done 6 to 8 weeks after onset and following resolution of symptoms
+== Prevention ==
+* Eat high-quality diet that is high in fibre from fruits, vegetables, whole grains, and legumes, and low in red meat and added sugar; or a vegetarian diet
+** No need to avoid nuts, seeds, or corn
+* Maintain normal BMI
+* Be physically active
+* Smoking cessation
+* Treat alcohol use disorder
+* Avoid regular NSAID use
+* However, 50% of risk is genetic
-== Further Reading ==
+==Further Reading==
-* The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. ''Dis Colon Rectum''. 2020;63:728–747. doi: [https://doi.org/10.1097/DCR.0000000000001679 10.1097/DCR.0000000000001679]
+*AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review. ''Gastroenterol''. 2021:160(3)906-911.E1. doi: [https://doi.org/10.1053/j.gastro.2020.09.059 10.1053/j.gastro.2020.09.059]
+*The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. ''Dis Colon Rectum''. 2020;63:728–747. doi: [https://doi.org/10.1097/DCR.0000000000001679 10.1097/DCR.0000000000001679]
 [[Category:Gastrointestinal infections]]