Diverticulitis is defined as inflammation of diverticulum leading to pouches within the large bowel wall which can cause inflammation and lower abdominal pain. This is often associated with nausea, vomiting, fever, abdominal pain, guarding and rigidity.
Medications:
For mild cases (mild pain, vitals stable, no signs of peritonitis and patient can take oral fluids)
- Tab. Flagyl (Metronidazole 400 mg) 1 tablet thrice a day for 7 days.
- Tab. Zilee (Levofloxacin 750 mg) 1 tablet once a day for 5 days.
- Ensure Powder (a special liquid food mixture containing carbohydrates, proteins, fats, vitamins and minerals) – 6 scoops in 200 ml water for one meal replacement.
For moderate to severe cases (severe pain, unstable vitals, fever, left lower quadrant tenderness, signs of peritonitis, patient unable to tolerate oral fluids)
- Hospitalize the patient, start intravenous fluids and keep nil by mouth.
- Infusion Metrocip (Metronidazole 500 mg) i.v. every 6 hours.
- Inj. Lupillin (Ampicillin 500 mg) i.v. every 6 hours.
- Inj. Loxazin 500mg (Levofloxacin 500 mg) i.v. every 24 hours.
Supportive treatments:
- Cap. Prowel (Probiotic and prebiotic) 1 capsule twice a day.
- Tab. Cyclopam (Dicyclomine 20 mg, Paracetamol 500 mg) 1 tablet orally 4 times a day as needed for abdominal pain and fever.
General advice:
- Advice liquid diet till acute symptoms improve.
- Introduce solid foods gradually.
- Avoid spicy and oily foods till acute symptoms improve
- Stop smoking and reduce alcohol intake
Investigations:
- Complete blood count – to rule out systemic infection
- Erythrocyte sedimentation rate (ESR) – to evaluate disease activity
- Urine routine – to rule out infection
- Liver function test – to rule out liver impairment
- Serum creatinine – to rule out renal impairment
- Random blood sugars – to rule out diabetes
- CT abdomen – to rule out colitis, perforation etc.
Referral:
Specialist referral to gastroenterologist in case of refractory symptoms or if patients present with complications.