Diverticulitis resident survival guide: Difference between revisions

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===Therapeutic Approach===
===Therapeutic Approach===
Shown below is an algorithm depicting the therapeutic approach to
Shown below is an algorithm depicting the therapeutic 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>


====European Association for Endoscopic Surgery clinical Classification<ref name="pmid10094765">{{cite journal| author=Köhler L, Sauerland S, Neugebauer E| title=Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. | journal=Surg Endosc | year= 1999 | volume= 13 | issue= 4 | pages= 430-6 | pmid=10094765 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10094765  }} </ref>====


{| Class="wikitable"
{| Class="wikitable"
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* Obstruction
* Obstruction
* Purulent and fecal peritonitis
* Purulent and fecal peritonitis
|-
|}
====Buckley Classification====
{| Class="wikitable"
|-
|
| '''CT Findings'''
|-
|Mild <br>
|Bowel wall thickening
|-
|Moderate<br>
|
*Bowel wall thickening > 3mm
*Phelgmon or small abscess
|-
| Severe <br>
|
* Bowel wall thickening > 5mm<br>
* Perforation with subdiaphragmatic free air <br>
* Abscess > 5mm<br>
|-
|}
====Hinchey's Classification <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>====
{| Class="wikitable"
|-
| '''Stages'''
| '''CT Findings'''
|-
|Stage 1<br>
|
*small confined precolic or mesenteric abscess
|-
|Stage 2<br>
|
*Large abscess confined to the pelvis
|-
| Stage 3<br>
|
* Perforated diverticulitis br>
* Peridiverticular abscess has ruptured <br>
* Purulent diverticulitis  <br>
|-
|Stage 4
|
*Free rupture of diverticula into the peritoneal cavity
|-
|-
|}
|}

Revision as of 17:28, 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 diverticulitis according to the American Society of Colon and Rectal Surgeons[1] and the American Journal of Gastroenterology[2]


European Association for Endoscopic Surgery clinical Classification[7]

Grades Clinical Description
Grade I
  • symptomatic
  • uncomplicated disease
  • Fever
  • Abdominal pain
Grade II
  • recurrent
  • symptomatic disease
Recurrence of above
Grade III
  • complicated disease
  • Abscess
  • Hemorrhage
  • Fistula
  • Phelgmom
  • Perforation
  • Obstruction
  • Purulent and fecal peritonitis

Buckley Classification

CT Findings
Mild
Bowel wall thickening
Moderate
  • Bowel wall thickening > 3mm
  • Phelgmon or small abscess
Severe
  • Bowel wall thickening > 5mm
  • Perforation with subdiaphragmatic free air
  • Abscess > 5mm

Hinchey's Classification [3]

Stages CT Findings
Stage 1
  • small confined precolic or mesenteric abscess
Stage 2
  • Large abscess confined to the pelvis
Stage 3
  • Perforated diverticulitis br>
  • Peridiverticular abscess has ruptured
  • Purulent diverticulitis
Stage 4
  • Free rupture of diverticula into the peritoneal cavity

Do´s

Don'ts

References

  1. ↑ 1.0 1.1 1.2 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.
  2. ↑ 2.0 2.1 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. ↑ 3.0 3.1 3.2 Jacobs DO (2007). "Clinical practice. Diverticulitis". N Engl J Med. 357 (20): 2057–66. doi:10.1056/NEJMcp073228. PMID 18003962.
  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.
  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.
  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.
  7. ↑ Köhler L, Sauerland S, Neugebauer E (1999). "Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery". Surg Endosc. 13 (4): 430–6. PMID 10094765.


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