Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Diverticulitis

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In one line

·A diverticulum is a tiny pouch that pushes out through a weak spot in the colon wall, and diverticulitis is when that pouch gets blocked, swells up, and tears or gets infected.

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Normal physiology

·The colon is a long, muscular tube that pushes leftover food and stool toward the rectum. Its wall has layers: a thin inner lining (mucosa), a middle muscle layer, and an outer covering (serosa). Blood vessels poke through the muscle layer to feed the inner lining. Over time, pressure inside the colon can push the inner lining out through these weak spots where blood vessels enter, forming tiny pouches called diverticula. Most diverticula sit in the sigmoid colon, the S-shaped part on your lower left side, because that section squeezes hardest and has the most pressure.

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What goes wrong

·A diverticulum's narrow opening gets plugged—usually by a hard piece of stool or thickened stool. Pressure builds inside the pouch, blood flow to its thin wall slows down, and the wall weakens. Germs that normally live in the colon multiply inside the trapped pouch, the wall tears or cracks, and infection starts. That's the single upstream break that causes every sign and symptom downstream.

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Hallmark signs

·Pain in the lower left belly that gets worse over hours to days
·Fever (temperature above 100.4°F or 38°C)
·Tenderness when you press on the lower left belly (left lower quadrant)
·High white blood cell count (leukocytosis) on a blood test
·Change in bowel habits—either diarrhea or constipation
·Nausea or vomiting
·Blood in the stool (hematochezia)
·Severe belly pain that spreads all over or feels rigid

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Red flags · escalate now

·Severe belly pain that spreads everywhere or belly feels hard and board-like (suggests perforation)
·High fever (above 102°F or 39°C) or shaking chills (suggests severe infection or abscess)
·Unable to keep down food or water, or signs of dehydration (dry mouth, dizziness, little urine)
·Large amount of blood in the stool or black tarry stools (suggests significant bleeding)
·Confusion, very low blood pressure, or rapid heart rate (suggests sepsis—infection spreading through the bloodstream)

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Workup

·Complete blood count (CBC) with differential
·C-reactive protein (CRP)
·CT scan of the abdomen and pelvis with IV contrast
·Basic metabolic panel (BMP)
·Lactate level (venous or arterial)
·Urinalysis

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Treatment

·CT scan of the abdomen and pelvis with IV contrast
·IV antibiotics covering gut bacteria (e.g. ciprofloxacin + metronidazole, OR piperacillin-tazobactam, OR ceftriaxone + metronidazole) for complicated or severe diverticulitis; oral antibiotics (e.g. amoxicillin-clavulanate or ciprofloxacin + metronidazole) for mild, uncomplicated cases if chosen
·Bowel rest (nothing by mouth) and IV fluids during the acute phase
·Percutaneous (through-the-skin) drainage of an abscess if it is 3–4 cm or larger on CT
·Emergency surgery (sigmoid colectomy, often with temporary colostomy) if there is a large perforation with stool spilling into the belly, peritonitis (inflamed belly lining), sepsis, or the patient gets worse despite antibiotics and drainage
·Elective sigmoid colectomy 6–8 weeks after recovery, offered to patients with recurrent attacks (two or more episodes), a complication like stricture (narrowing) or fistula (abnormal connection to bladder, vagina, or skin), or one severe complicated episode
·High-fiber diet after recovery (25–35 grams per day) to prevent future episodes

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NCLEX trap

·Most cases heal without surgery. Simple diverticulitis (Hinchey 1 or 2 — swelling in the colon wall or a small pocket of pus nearby) usually gets better with rest, fluids, and antibiotics at home or in the hospital. Surgery is only needed right away for a big tear, a growing abscess (pus collection), septic shock (the infection is overwhelming the body), or a blockage that won't open. Studies show about 85% heal without an operation.
·Diverticulosis means you have small pouches (diverticula) bulging out from the colon wall — over half of people over 60 have them and never know it. Diverticulitis means one of those pouches got blocked, swollen, and infected. You can live your whole life with pouches and never get an infection. Only 4% of people with pouches ever get diverticulitis.
·New research (AVOD, DIABOLO trials) shows young, healthy patients with simple, mild diverticulitis (no fever over 100.4°F, able to drink and follow up, CT shows only colon wall swelling) may skip antibiotics and still heal fine. But anyone with high fever, pus on CT, immune trouble (diabetes, steroids, HIV), or signs of sepsis needs IV antibiotics fast. American Gastroenterological Association and American College of Gastroenterology say antibiotics are optional for uncomplicated cases but mandatory for complicated ones.
·In Western countries (US, Europe) it usually hits the sigmoid colon on the lower left. But in Asian populations (especially younger adults) it often strikes the cecum and right colon instead. Location depends on where the pouches form, which changes with diet, age, and ancestry. Always check both sides on CT.
·A small amount of fluid (stranding or pericolic fluid) means the body is walling off the infection — that is a good sign the immune system is working. Surgery is reserved for free air (a perforation into the open belly), an abscess over 3–4 cm that won't drain, or failure to improve after 3–4 days of antibiotics. Fluid alone is Hinchey 1 or 2 and usually heals with medicine.
·Pain everywhere (diffuse peritonitis — the whole belly is rigid and tender) means the pouch tore open and spilled stool and bacteria into the entire abdominal cavity. That is Hinchey stage 4 — life-threatening. The patient will have fever, fast heart rate, low blood pressure, and may go into septic shock. This needs emergency surgery (resection and often a temporary colostomy). Simple diverticulitis hurts in one spot, usually lower left.

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