Diverticulitis resident survival guide: Difference between revisions

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Revision as of 16:07, 20 February 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Andrea Tamayo Soto [2]

Definition

Causes

Life Threatening Causes

Common Causes

Management

Diagnostic Approach

Shown below is an algorithm depicting the diagnostic approach to diverticulitis according to the American Society of Colon and Rectal Surgeons^[1] and the American Journal of Gastroenterology^[2]

Characterize the symptoms:^[3] ❑ Abdominal pain ❑ Lower left quadrant ❑ Abdominal or preirectal fullness ❑ Fever ❑ Leukocytosis ❑ Nausea ❑ Vomits ❑ Fecaluria^[1] ❑ Pneumaturia ❑ Pyuria



Obtain a detailed history:^[4] ❑ Age ❑ Previous history of diverticular disease ❑ Previous episodes of diverticulitis ❑ Chronic Abdominal pain ❑ Previous history of abdominal surgery ❑ Dietary regime ❑ History of: ❑ Irritable bowel syndrome ❑ Inflammatory bowel disease ❑ Colitis^[5] ❑ Immunodeficiency^[6]



Examine the patient: ❑ Ectoscopy: ❑ Obesity ❑ Measure the heart rate ❑ Measure the temperature ❑ Abdomen: ❑ Rigidty ❑ Tendernes



Order labs and tests:^[3] ❑ CT ❑ Blood Count: ❑ Leukocytes ❑ Abdominal X-rays with soluble contrast ❑ Urianalysis

Therapeutic Approach

Shown below is an algorithm depicting the therapeutic approach to

Do´s

Don'ts

References

↑ ^1.0 ^1.1 Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD; et al. (2014). "Practice parameters for the treatment of sigmoid diverticulitis". Dis Colon Rectum. 57 (3): 284–94. doi:10.1097/DCR.0000000000000075. PMID 24509449.
↑ Sheth AA, Longo W, Floch MH (2008). "Diverticular disease and diverticulitis". Am J Gastroenterol. 103 (6): 1550–6. doi:10.1111/j.1572-0241.2008.01879.x. PMID 18479497.
↑ ^3.0 ^3.1 Jacobs DO (2007). "Clinical practice. Diverticulitis". N Engl J Med. 357 (20): 2057–66. doi:10.1056/NEJMcp073228. PMID 18003962.
↑ Andeweg CS, Knobben L, Hendriks JC, Bleichrodt RP, van Goor H (2011). "How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system". Ann Surg. 253 (5): 940–6. doi:10.1097/SLA.0b013e3182113614. PMID 21346548.
↑ Lamps LW, Knapple WL (2007). "Diverticular disease-associated segmental colitis". Clin Gastroenterol Hepatol. 5 (1): 27–31. doi:10.1016/j.cgh.2006.10.024. PMID 17234553.
↑ Tyau ES, Prystowsky JB, Joehl RJ, Nahrwold DL (1991). "Acute diverticulitis. A complicated problem in the immunocompromised patient". Arch Surg. 126 (7): 855–8, discussion 858-9. PMID 1854245.

Template:WikiDoc Sources

[pmid24509449-1] 1.0 ^1.1 Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD; et al. (2014). "Practice parameters for the treatment of sigmoid diverticulitis". Dis Colon Rectum. 57 (3): 284–94. doi:10.1097/DCR.0000000000000075. PMID 24509449.

[pmid18479497-2] Sheth AA, Longo W, Floch MH (2008). "Diverticular disease and diverticulitis". Am J Gastroenterol. 103 (6): 1550–6. doi:10.1111/j.1572-0241.2008.01879.x. PMID 18479497.

[pmid18003962-3] 3.0 ^3.1 Jacobs DO (2007). "Clinical practice. Diverticulitis". N Engl J Med. 357 (20): 2057–66. doi:10.1056/NEJMcp073228. PMID 18003962.

[pmid21346548-4] Andeweg CS, Knobben L, Hendriks JC, Bleichrodt RP, van Goor H (2011). "How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system". Ann Surg. 253 (5): 940–6. doi:10.1097/SLA.0b013e3182113614. PMID 21346548.

[pmid17234553-5] Lamps LW, Knapple WL (2007). "Diverticular disease-associated segmental colitis". Clin Gastroenterol Hepatol. 5 (1): 27–31. doi:10.1016/j.cgh.2006.10.024. PMID 17234553.

[pmid1854245-6] Tyau ES, Prystowsky JB, Joehl RJ, Nahrwold DL (1991). "Acute diverticulitis. A complicated problem in the immunocompromised patient". Arch Surg. 126 (7): 855–8, discussion 858-9. PMID 1854245.

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@@ Line 14: / Line 14: @@
 ===Diagnostic Approach===
-Shown below is an algorithm depicting the diagnostic approach to diverticulitis
+Shown below is an algorithm depicting the diagnostic approach to diverticulitis according to the American Society of Colon and Rectal Surgeons<ref name="pmid24509449">{{cite journal| author=Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD et al.| title=Practice parameters for the treatment of sigmoid diverticulitis. | journal=Dis Colon Rectum | year= 2014 | volume= 57 | issue= 3 | pages= 284-94 | pmid=24509449 | doi=10.1097/DCR.0000000000000075 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24509449  }} </ref> and the American Journal of Gastroenterology<ref name="pmid18479497">{{cite journal| author=Sheth AA, Longo W, Floch MH| title=Diverticular disease and diverticulitis. | journal=Am J Gastroenterol | year= 2008 | volume= 103 | issue= 6 | pages= 1550-6 | pmid=18479497 | doi=10.1111/j.1572-0241.2008.01879.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18479497  }} </ref>
 {{Family tree/start}}
-{{familytree  | A01 | A01=  '''Characterize the symptoms:''' <br> <div style="float: left; text-align: left;">
+{{familytree  | A01 | A01=  '''Characterize the symptoms:'''<ref name="pmid18003962">{{cite journal| author=Jacobs DO| title=Clinical practice. Diverticulitis. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 20 | pages= 2057-66 | pmid=18003962 | doi=10.1056/NEJMcp073228 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18003962  }} </ref> <br> <div style="float: left; text-align: left;">
-❑ [[Chest pain]]<br>
+❑ [[Abdominal pain ]]<br>
-:❑ Absence of physical exertion <br>
+:❑ Lower left quadrant  <br>
-:❑ Duration> 20 minutes <br>
+❑ Abdominal or preirectal fullness <br>
-:❑ Radiation to the jaw or left arm
+❑ [[Fever]]<br>
-:❑ No relief with medications<br>
+❑ [[Leukocytosis]] <br>
-:❑ No relief with rest <br>
-:❑ Worse with time <br>
 ❑ [[Nausea]] <br>
-❑ Vomiting <br>
+❑ [[Vomit]]s <br>
-❑ Sweating</div>}}
+❑ [[Vesicointestinal fistula|Fecaluria]]<ref name="pmid24509449">{{cite journal| author=Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD et al.| title=Practice parameters for the treatment of sigmoid diverticulitis. | journal=Dis Colon Rectum | year= 2014 | volume= 57 | issue= 3 | pages= 284-94 | pmid=24509449 | doi=10.1097/DCR.0000000000000075 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24509449  }} </ref> <br>
+❑ [[Pneumaturia]]<br>
+❑ [[Pyuria]]</div>}}
 {{familytree  | |!| | }}
-{{familytree  | B01 | B01=   '''Obtain a detailed history:''' <br><div style="float: left; text-align: left;">
+{{familytree  | B01 | B01=   '''Obtain a detailed history:'''<ref name="pmid21346548">{{cite journal| author=Andeweg CS, Knobben L, Hendriks JC, Bleichrodt RP, van Goor H| title=How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system. | journal=Ann Surg | year= 2011 | volume= 253 | issue= 5 | pages= 940-6 | pmid=21346548 | doi=10.1097/SLA.0b013e3182113614 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21346548  }} </ref> <br><div style="float: left; text-align: left;">
 ❑ Age <br>
-❑ Previous [[MI]] <br>
+❑ Previous history of [[diverticular disease]]  <br>
-❑ Previous [[PCI]] or [[CABG]] <br>
+❑ Previous episodes of [[diverticulitis]] <br>
-❑ Cardiac risk factors: <br>
+❑ Chronic [[Abdominal pain]] <br>
-:❑ [[Hypertension]] <br>
+❑ Previous history of [[abdominal surgery]]<br>
-:❑ [[Diabetes]] <br>
+❑ Dietary regime <br>
-:❑ [[Hypercholesterolemia]] <br>
+❑ History of:
-:❑ Tobacco use </div>}}
+:❑ [[Irritable bowel syndrome]] <br>
+:❑ Inflammatory bowel disease <br>
+:❑ [[Colitis]]<ref name="pmid17234553">{{cite journal| author=Lamps LW, Knapple WL| title=Diverticular disease-associated segmental colitis. | journal=Clin Gastroenterol Hepatol | year= 2007 | volume= 5 | issue= 1 | pages= 27-31 | pmid=17234553 | doi=10.1016/j.cgh.2006.10.024 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17234553  }} </ref> <br>
+❑ [[Immunodeficiency]]<ref name="pmid1854245">{{cite journal| author=Tyau ES, Prystowsky JB, Joehl RJ, Nahrwold DL| title=Acute diverticulitis. A complicated problem in the immunocompromised patient. | journal=Arch Surg | year= 1991 | volume= 126 | issue= 7 | pages= 855-8; discussion 858-9 | pmid=1854245 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1854245  }} </ref></div>}}
 {{familytree  | |!| | }}
 {{familytree  | C01 | C01=  '''Examine the patient:''' <br> <div style="float: left; text-align: left;">
-❑ Measure the [[blood pressure]] <br>
+❑ Ectoscopy: <br>
+:❑ Obesity <br>
 ❑ Measure the [[heart rate]] <br>
-❑ Auscultate the heart searching for murmurs <br>
+❑ Measure the temperature <br>
-❑ Search for signs of [[CHF]]
+❑ Abdomen: <br>
-:❑ Decreased air entry in the lungs
+:❑ Rigidty <br>
-:❑ Edema in the extremities </div>}}
+:❑ Tendernes <br> </div>}}
 {{familytree  | |!| | }}
-{{familytree  | D01 | D01=   '''Order labs and tests:''' <br><div style="float: left; text-align: left;">
+{{familytree  | D01 | D01=   '''Order labs and tests:'''<ref name="pmid18003962">{{cite journal| author=Jacobs DO| title=Clinical practice. Diverticulitis. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 20 | pages= 2057-66 | pmid=18003962 | doi=10.1056/NEJMcp073228 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18003962  }} </ref> <br><div style="float: left; text-align: left;">
-❑ [[EKG]] <br>
+❑ CT <br>
-❑ Biomarkers <br>
+❑ Blood Count:  <br>
-:❑ Troponin I<br>
+:❑ Leukocytes <br>
-:❑ CK-MB <br>
+❑ Abdominal X-rays with soluble contrast <br>
-❑ [[Creatinine]] <br>
+❑ [[Urianalysis]] </div>}}
-❑ [[Glucose]] <br>
-❑ [[Hemoglobin]] </div>}}
 {{Family tree/end}}