Diverticulitis

 

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Definition/Description

Diverticula are small, bulging pouches that can form in the lining of your digestive system and are prevalent in adults after the age of 40. They are found most often in the lower part of the large intestine (colon). Sometimes, one or more of the pouches may become inflamed or infected. This inflammation or infection is known as diverticulitis.

The most common symptoms of diverticulitis include severe left lower quadrant abdominal pain, marked changes in bowel habits, fever, and nausea. Possible complications include perforation of bowels, abscess formation, fistula formation, obstruction, and bleeding.

Diverticulitis diagnosis is typically confirmed with the presence of constitutional symptoms, bloody stools, elevated white blood cell count, and with use of imaging studies. Depending on the severity of the condition, diverticulitis can be treated with rest, changes in diet or antibiotics, and in severe cases may require surgery.

Prevalence

Diverticula are common in more than half of adults over the age of 60, with 10%-25% developing diverticulitis. (2)
Diverticulitis is more common in males, younger than 50 years old, but is seen more frequently in women in older age groups. Diverticulitis is common and increasing in incidence in westernized countries. The disorder is most common in people over the age of 60, although the average age of incidence has been decreasing. (2)  Younger individuals typically have more aggressive forms of diverticulitis and may require surgery after an initial episode. (2)

Characteristics/Clinical Presentation

• The presentation and signs and symptoms can vary for each individual patient. Although many of the patients have the same effects, they are experienced at different intensities and timing compared to other patients. Some of the most common signs and symptoms that are present with the diverticulitis diagnosis include the following:
  • Sudden abdominal pain usually in LLQ - cramping, bloating, tenderness, but can still occur on the right
  • Palpable mass
  • Irregular bowel movements
  • Bowel sounds absent or decreased
  • Flatulence
  • Fever
  • Nausea/ Vomiting
  • Bloody stools
  • Increase frequency of urination
  
  

Associated Co-morbidities

Diverticulitis is more common as the person ages and if the person is overweight. Increasing the amount of exercise that is done each day has shown less of a risk for being diagnosed with diverticulitis. Patients who smoke and /or drink heavy amounts of alcohol have a higher chance of developing diverticulitis than those who do not. Certain medications, such as NSAIDS, steroids, and opiates put a person more at risk for developing this problem. When looking at diet, if people do not get enough fiber, this could lead to decreased bowel movements. In acute diverticulitis, one can get an abscess or blockage in their colon or small intestine from the scarring that took place during the episode. Fistula, an abnormal connection between two body parts, can also form between the colon and bladder or vagina, leading to a medical emergency. Another medical emergency is if a person gets peritonitis, which occurs when contents of the intestine get into the abdomen from a ruptured inflamed pouch. Quick attention is necessary for the patient to begin fighting a possible infection.

Medications

Physicians will suggest a variety of treatments based on the severity of patient’s diverticulitis.

Uncomplicated diverticulitis with mild signs and symptoms may be treated with:
• Antibiotics, if infection is present
• Clear, liquid diet until bowels heal
• Tylenol or other over the counter pain reliever

Complicated diverticulitis includes individuals who have severe attacks, hospitalizations, or have other comorbidities/health problems. Physician may recommend:
• IV antibiotics
• Drainage of abscess (if one has formed due to complications)

Surgery may be required if patient has a complication (abscess, fistula formation, bowel obstruction), has had multiple episodes of uncomplicated diverticulitis, or may be immune compromised. Surgery may be recommended, but is an individual decision. There are two main types of surgery:
• Primary bowel resection/laparoscopic procedure
• Bowel resection with colostomy

Follow up care may be suggested such as colonoscopy to rule out colon cancer or other digestive issues.

Diagnostic Tests/Lab Tests/Lab Values

Diverticulitis is typically diagnosed during an acute attack due to the complaints of severe abdominal pain. Due to the prevalence of abdominal pain in a number of conditions, the physician may order a number of tests to rule out other causes of abdominal pain and associated symptoms.

A thorough physical examination that includes palpation of the abdomen for tenderness is necessary to rule out other conditions and rule in diverticulitis. Women may also have a pelvic exam to rule out gynecological involvement of abdominal pain. Physicians may suggest the following test to help rule in and out the cause of abdominal pain:
• Blood and urine tests for signs of infection, elevated WBC count
• Pregnancy test, to rule out cause of abdominal pain in women who are of childbearing years
• Liver function tests
• Stool tests
• CT Scan of abdomen and pelvis to identify inflammation of diverticula or complications such as abscess formation or
• Colonoscopy in chronic cases (avoided during acute attacks due to risk of perforation)

Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Differential Diagnosis

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