One of the most common conditions the Physician Assistant Exam will question you about occurs in the older population and is termed diverticulosis, which is simply an outpouching or formation of pockets of the colonic mucosa through weaknesses in the intestinal wall. This pouching most commonly occurs in the sigmoid colon.
Realize that diverticulosis is a leading cause of hematochezia as well. For the most part, diverticulosis is painless, and the bleeding associated with it is painless bleeding.
For PANCE purposes, be aware of the factors that increase the risk of developing diverticulosis: older age, a Western-based diet (low in fiber content with excessive meat ingestion), and abnormal bowel habits, including straining and constipation.
One complication of diverticulosis is diverticulitis, an infection of the diverticula. Here are some key points:
Symptoms of diverticulitis include acute left lower-quadrant abdominal pain and fever. Labs can show a leukocytosis. The diagnosis can be confirmed by a CT scan.
Mild cases can be managed as an outpatient with a low-residue diet, clear liquids, and an oral antibiotic. Moderate to severe cases are often treated in the hospital. Treatment includes making the patient NPO, giving intravenous fluids, and ordering intravenous antibiotics. The most common antibiotics prescribed are metronidazole (Flagyl) and a fluoroquinolone such as levofloxacin (Levaquin) or ciprofloxacin (Cipro).
Complications of diverticulitis can include perforation, abscess, bleeding, obstruction, and/or fistula formation. Again, diagnosis is via CT scan. A localized abscess is often amenable to CT-guided drainage.
With diverticulitis, the third time’s the charm. After three attacks, discuss the need for possible surgery with the patient. Surgical options can include a hemicolectomy with reanastomosis or a colostomy initially if significant inflammation is involved.
