Internal Medicine

P1: RLJ/OZN P2: KUF

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

Diverticulitis Drug Allergy 497

specific therapy

■Prevention is the best – rarely in time

➣Need to increase bulk in diet – particularly with bran – should

have 10 grams of nonabsorbable fiber per day (read the cereal

boxes – the best way)

■If acute diverticulitis – need NPO status, fluids and IV antibiotics;

➣usually mixed colonic flora – remember – diverticulitis is a colonic

microperforation

■If diverticular hemorrhage – usually stops spontaneously

➣Some data for using somatostatin analogues (octreotide IV infusion)

■Some patients need intervention – colonoscopic therapy (clips, coag-

ulation possible)

➣Diverticular abscesses usually drained by interventional radio-

logic techniques; occasionally surgical resection

➣Persistent hemorrhage requires surgical resection – need to local-

ize site of bleed – do not assume it is from left sided diverticula

follow-up

■For presumed diverticulitis or diverticular bleeding

➣Elective colonoscopy essential to exclude neoplasm – best done

when acute inflammation subsides – several weeks or when

bleeding subsides (several days)

complications and prognosis

■Most patients do not have recurrent bleeding diverticula or diverticulitis

■Colectomy – rarely needed acutely – usually can stabilize patient

with antibiotics and interventional radiology drainage of abscesses;

surgical procedure can be scheduled electively

■No good controlled trials of high-residue diet after the onset of com-

plications from diverticula – but easy to institute; no rationale for

dietary restrictions on nuts, seeds, grains etc.

■Remember: prevention is best, and easily achievable

Drug Allergy........................................

SHAUN RUDDY, MD

history & physical

History

■Penicillins, sulfonamides, barbiturates, ACE inhibitors are common

offenders, but almost any drug may be responsible