Join Brit Long, MD as he discusses the ED evaluation of diverticulitis, focusing on the importance of history, physical exam, and CT imaging. Learn about diagnostic indicators, clinical evaluation, imaging considerations, and guidelines for CT imaging in diagnosing diverticulitis.
Abdominal pain in the left lower quadrant and tenderness indicate diverticulitis, while elevated CRP levels suggest complications.
CT imaging is crucial for diagnosing diverticulitis and assessing complications, but guidelines vary based on clinical factors.
Deep dives
History and Examination Findings in Diverticulitis
Key findings during initial evaluation include abdominal pain in the left lower quadrant, tenderness in the same region, and alterations in bowel habits. Abdominal pain is the most common symptom, particularly on the left side, with a positive likelihood ratio for diverticulitis. Tenderness in the left lower quadrant indicates a higher likelihood of the condition. Changes in bowel habits, including constipation and diarrhea, are prevalent. Systemic symptoms like fever can be present, but signs of peritonitis suggest acute complications.
Diagnostic Factors and Utilization of Labs
Labs like white blood cell count and CRP can aid but not definitively diagnose diverticulitis. Elevated CRP levels signify a higher likelihood and potential complications, with specific thresholds indicating significant risk. Studies have explored various predictors combining history, exam, and labs to decrease reliance on imaging. One study from the Netherlands identified specific indicators like CRP levels, absence of vomiting, and tenderness in the left lower quadrant to enhance diagnostic accuracy.
Imaging Guidelines for Diverticulitis
CT imaging is predominantly recommended for diagnosing and assessing diverticulitis complications. Different guidelines emphasize CT as the initial imaging choice due to its high sensitivity and specificity. Guidelines from various organizations highlight using CT to confirm the diagnosis, evaluate disease severity, and identify complications. However, there is some variability in recommendations, with considerations for diagnostic uncertainty, severity of presentation, and patient characteristics driving the necessity for CT imaging.