Diverticulitis Management

Management

Clinical Decision

Decision to treat as outpatient versus inpatient will depend on clinical judgment of the physician, severity of the disease process, tolerance of oral intake, presence of comorbid illnesses, patient support system, and the probability that the condition will respond to outpatient therapy

Patients Receiving Outpatient Therapy

Reliability of patient and caregivers is an important consideration
Patient and caregiver should be advised that the patient should return to the emergency room or call physician if condition worsen

Indications for Hospitalization of Patients with Uncomplicated Diverticulitis

Unable to tolerate oral intake
Failure of outpatient management
Significant peritoneal signs are present
Patient needs narcotic analgesia for severe pain
A chronic underlying medical condition is present eg immunosuppression

Clinical Evaluation

Risk Factors for Progression of Uncomplicated Diverticulitis to Complicated Diverticulitis

Symptoms >5 days prior to presentation
Presence of vomiting
CRP level >140 mg/L
Baseline white blood cell (WBC) count >15 x 10⁹ cells/L
Baseline CT with finding of fluid collection or longer segment of inflammation

Indications of Worsening Disease Requiring Hospitalization

Inability to tolerate oral fluids
Increase in temperature or high fever
Worsening abdominal pain

Follow Up

Re-evaluation of the patient should be done after resolution of an attack of acute diverticulitis

Patient should be instructed to gradually resume a high-fiber diet
- Long-term fiber supplementation may reduce recurrence of attacks
- Bulk-forming laxatives may be given to patients who cannot tolerate high-fiber diet
Advise patients to avoid using NSAIDs or opioids
Appropriate exams 6 weeks after recovery include colonoscopy or a combination of flexible sigmoidoscopy and barium enema
- Establishes extent of disease and rules out polyps or carcinoma
Diverticulitis may result in formation of strictures which may have a carcinoma-like appearance and may need to be biopsied
Surgery may be needed for recurrent attacks of diverticulitis
- Elective surgery is not needed for patients responsive to medical treatment and not routinely recommended for either uncomplicated or complicated diverticulitis in young patients

Long COVID: What we have learned so far

Prof. Ghassan Dbaibo, 27 Apr 2023

The WHO defines long COVID as a condition that occurs 3 months from COVID-19 onset, whose symptoms last ≥2 months and cannot be attributed to an alternative diagnosis. In an interview with MIMS Doctor, Professor Ghassan Dbaibo of the Center for Infectious Diseases, American University of Beirut, Beirut, Lebanon, describes the evolving attitudes towards long COVID among healthcare professionals (HCPs), some unexpected predisposing factors, potential biological mechanisms behind prolonged symptom duration and shares data on vaccination’s protective effects against long COVID.

Optimizing anticoagulation therapy for atrial fibrillation with prior gastrointestinal bleeding

Dr. Pipin Kojodjojo, 24 Jul 2022

Long-term anticoagulation therapy is often recommended for patients with atrial fibrillation (AF) to reduce their risk of stroke, but gastrointestinal bleeding (GIB) is a common complication that presents a significant challenge. Patients with a history of GIB have heightened risks of recurrent bleeding events, hence interruption or discontinuation of anticoagulants is often warranted. When and how to restart anticoagulant therapy following an episode of GIB has been debated. MIMS Doctor interviewed Dr Pipin Kojodjojo, Cardiologist and Cardiac Electrophysiologist at Asian Heart & Vascular Centre, Singapore, to gather his perspectives on how to manage anticoagulant therapy after a GIB episode.

GP symposium 2019: Updates on the Use of Probiotics in Clinical Practice

Dr. Gwee Kok Ann, Dr. Warren Lee, Dr. Mark Tang, Dr. Lim Sanghyun, 24 Apr 2019

Modulation of gut microbiota with probiotics has been studied in a wide range of clinical settings, in the hope of achieving health benefits in the host. Under the auspices of the Asian GI Faculty, four experts discussed the role of probiotics in clinical practice at the recent IMPACT (Improving Medical Practice through Advancement in Clinical Treatment) GP symposium in Singapore sponsored by DCH Auriga.