Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

496 Diverticulitis

Colonoscopy

■Not essential but helpful – difficult to perform in setting of acute

diverticulitis – very edematous bowel with narrow lumen.

Diverticular Hemorrhage, see GI Bleeding Section

Laboratory Tests

■Decreased Hg/Hct: can occasionally have exsanguinating bleed from

diverticulosis

■Colonoscopy

➣Helpful when bleeding stops, otherwise need to localize site of

hemorrhage by RBC nuclear scans and/or angiography

differential diagnosis

■Differential diagnosis for diverticulitis:

➣Appendicitis – always in consideration unless previously re-

moved

➣Perforating colonic cancer – very difficult to differentiate early

➣Foreign body perforation – don’t ask, don’t tell, just consider it

➣Ischemic colitis – the great masquerader

➣Adhesions – very common

➣Acute infectious, idiopathic ulcerative colitis or Crohn’s disease

■Differential diagnosis for diverticular hemorrhage:

➣Colonic neoplasms – most have chronic anemia indices

➣Vascular ectasias – usually older patients

➣Colitis, infectious or idiopathic – WBC’s in stool

➣Hemorrhoids – look for them, don’t pass the buck

➣Rectal laceration/ fissure

➣Colonic varices – not only in alcoholics

management

What to Do First

■Resuscitate

■Stools for WBCs, C&S, O&P

■Early testing

➣CT for suspected diverticulitis

➣Sigmoidoscopy then RBC scan if bleeding

General Management

■Get GI and Surgical consultations

■Follow closely – repeat examinations essential, document your find-

ings in chart