Diverticulosis is the presence of diverticuli, which may become inflammed (diverticulitis).
See also:
     Abdominal pain Ddx
     Diverticulosis
Pathophysiology
     Inflammation of a diverticulum caused by trapping of particulate matter and/or rupture of the lumen.
     Can involve infection of and microperforation of a colonic diverticulum.
     May lead to perforation and subsequent abscess formation
Hx
     Alternating diarrhea and constipation
     Low-fiber, high-fat diet
     History of constipation is a risk factor: increased luminal pressure over time causes diverticuli to develop
Sx
     Abdominal pain
     Fever
     Chills
     Nausea
     Vomiting     
     Change in bowel habits (constipation or diarrhea) are common
     Hematochezia, heme-positive stool are sometimes seen
     Perforation/rupture of a peridiverticular abscess may present with peritoneal signs
PE
     LLQ pain and tenderness is typical
Workup
     CBC, electrolytes
     CXR
     AXR
     CT-abdomen
     Rectal exam
Labs
    May see leukocytosis
Dx
     May be clinical
     CT is diagnostic study of choice (demonstrates pericolic inflammation and bowel wall thickening and complications such as peridiverticular abscess)
     Hb and Hct key to diagnosing hemorrhage
Tx
     Signs of perforation (free air), a complicated abscess or phlegmon, fistula, or obstruction require surgical consultation
     Mild disease may be treated safely as outpatient with liquid diet & meds for 48 h, so long as there is no vomiting or evidence of complication 
          First-line: Ciprofloxacin (500 mg PO bid) + Metronidazole (500 mg PO tid)
               Or Metronidazole plus ceftriaxone (IV only)
               Or Metronidazole plus Bactrim (PO)
          Alternatively: Augmentin 875/125 mg bid is acceptable
          If patient intolerant of metronidazole and beta-lactams, consider clindamycin or moxifloxacin.
     Signs of toxicity warrant inpatient management: bowel rest (NPO), pain management, IV fluids, IV antibiotics
          Must cover bowel flora including E. coli and anaerobes (Bacteroides fragilis).
     Generally, 7-14 days of antibiotics are recommended for uncomplicated diverticulitis. Extended exposure to antibiotics is not recommended as it can cause antibiotic-associated diarrhea and Clostridium difficile colitis.
     A colonoscopy in 2-6 weeks (after recovery) should be done to explore the full extent of his diverticulosis and rule out colon polyps or cancer. There is no role for waiting a year for colonoscopy.
     A high fiber diet will help decrease constipation and intraluminal pressure and may decrease the chance of recurrent diverticulitis.
     Counsel patient that approximately 1/3 of patients have recurrent abdominal cramps and 1/3 will have another frank episode of diverticulitis in the future. Some patients with recurrent episodes may require surgery to resect the diseased portion of the bowel.

Diverticulosis and Diverticulitis patient article: http://patients.gi.org/topics/diverticulosis-and-diverticulitis/

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The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.