Diverticulitis
Intro
Diverticulitis is inflammation of the colonic diverticulum, which may involve perforation or microperforation. In Western societies, most diverticula (85%) are found in the sigmoid and descending colons; diverticula in the ascending colon are more common in Asian populations. There are two types of diverticulitis: uncomplicated and complicated. Localized inflammation accompanies uncomplicated diverticulitis. Complicated diverticulitis is accompanied by inflammation that is associated with an abscess, phlegmon, fistula, obstruction, bleeding, or perforation.
Etiology and Risk Factors
SIgns and Symptoms
Referral Pattern
Individuals usually present with acute, constant abdominal pain in the left lower quadrant. Individuals with diverticulitis typically present with a fever. Tachycardia and hypotension may occur and should raise suspicion for complicated diverticulitis. Upon the examination, tenderness only in the left lower quadrant significantly increased the likelihood of acute diverticulitis as well as a palpable mass and abdominal distention.
Diagnostic Testing
Diverticulitis is inflammation of the colonic diverticulum, which may involve perforation or microperforation. In Western societies, most diverticula (85%) are found in the sigmoid and descending colons; diverticula in the ascending colon are more common in Asian populations. There are two types of diverticulitis: uncomplicated and complicated. Localized inflammation accompanies uncomplicated diverticulitis. Complicated diverticulitis is accompanied by inflammation that is associated with an abscess, phlegmon, fistula, obstruction, bleeding, or perforation.
Etiology and Risk Factors
- Alterations in colonic wall resistance, colonic motility, and dietary issues such as lack of fiber
- Aspirin and NSAID drugs increase your risk
- Increasing age, obesity, and lack of exercise increase your risk
SIgns and Symptoms
- Left lower abdominal pain and tenderness (most common complaint)
- Left pelvic pain
- Bloody stools
- Anorexia
- Constipation
- Nausea
- Vomiting
- Diarrhea
- Dysuria
Referral Pattern
Individuals usually present with acute, constant abdominal pain in the left lower quadrant. Individuals with diverticulitis typically present with a fever. Tachycardia and hypotension may occur and should raise suspicion for complicated diverticulitis. Upon the examination, tenderness only in the left lower quadrant significantly increased the likelihood of acute diverticulitis as well as a palpable mass and abdominal distention.
Diagnostic Testing
- An abdominal CT scan is the test of choice in patients with suspected diverticulitis
References:
Ferzoco LB, Raptopoulos V, Silen W. Acute diverticulitis. N Engl J Med. 1998;338 (21):1521-1526.
Goodman, MBA, PT, C. C., & Snyder, MN, RN, OCN, T. E. (2007). Differential Diagnosis PHYSICAL THERAPISTS Screening for Referral (4thth ed.). St. Louis, MO: Saunders Elsevier
Wilkins, T., Embry, K., & George, R. (2013, May 1). Diagnosis and Management of Acute Diverticulitis. American Family Physician Journal, 87(9), 612-620.
Image provided by: http://www.webmd.com/digestive-disorders/ss/slideshow-diverticulitis-overview