Diverticulitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Diverticulitis diagnosis depends on taking a proper history and doing physical examination. The known diagnostic criteria for diverticulitis includes abdominal tenderness especially in the left lower quadrant, leukocytosis and CT scan findings helps in disease confirmation. Fever is common in diverticulitis patients. Abdominal examination will reveal tenderness, decreased bowel sounds and palpable mass may be felt. In some patients, genitourinary signs of cystitis would occur due to bladder irritation.

Physical Examination

Diagnostic criteria

Patients with acute diverticulitis usually present with the following:

• Abdominal pain and left quadrant tenderness
• Leukocytosis in the lab findings.
• CT scan confirms the disease. It usually shows dilated loops, extra-colonic air in case of fistula, abscess and air fluid level.

Appearance of the patient

• Patients with diverticulitis appearance is toxic due to pain and infection.

Vital signs

• Tachycardia
• Fever

Abdomen

Abdominal examination in the diverticulitis cases shows the following:

• Abdominal tenderness in the left lower quadrant. It is rare to occur in the right side but it could happen.
• Guarding or rebound tenderness may be present.
• Palpable mass may be felt.
• Bowel sounds:
  • Most often decreased
  • Normal in the mild cases
  • Increased in cases of intestinal obstruction
• Mass may be palpable in rectal examination

Genitourinary

As a result of the colonic inflammation, bladder inflammation may occur in small percentage of the patients. Clinical manifestations of cystitis will appear.