Diverticulosis

Revision as of 20:23, 29 September 2019 by ClaireLewis (talk | contribs) (Evaluation)
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Background

  • Outpouchings in colonic wall due to erosion of diverticular wall by inspissated fecal material, which can lead to microperforation
  • Prevalence of diverticulosis 30% by age 60, >70% by age 85
  • 70% of patients with diverticulosis remain asymptomatic
  • Diverticular disease is almost exclusively left-sided colon (USA) or right-sided (Asia)

Clinical Features

Differential Diagnosis

Lower gastrointestinal bleeding


Evaluation

  • CBC
  • Chemistries
    • BUN may be elevated if bleeding occurs from site high in GI tract
  • Coags
  • LFTs
  • Type and screen
  • Fibrinogen
  • ECG (if concern for silent ischemia in patients likely to have CAD)
  • CTA
  • Tagged red blood cell scan

Management

  • Categorize as stable versus unstable using shock index (HR/SBP), SI <1 stable, >1 unstable or suspect active bleeding
  • Unstable patients resuscitate, CT angiogram, if CTA does not identify source of bleeding, upper endoscopy if hemodynamic instability [1]
  • Stable calculate risk score
    • Oakland score
    • Glasgow-Blatchford score
  • IVF
  • Consider transfusing pRBCs/platelets for unstable patients or with very low hemoglobin (<7). with cardiovascular disease use trigger of 8 and target of 10 hemoglobin.
  • Consider NGT - high possibility for surgery to request
  • Emergent sigmoidoscopy/colonoscopy (next 24 hours)
  • Surgery if endoscopy fails or not available

Major Bleed and Supratherapeutic INR


Disposition

  • Depends on severity of bleeding

See Also

External Links

References

  1. Oakland K, Chadwick G, East JE, et al. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut 2019;67:776-789.
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