{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 15, Ep 2 of 2: Diverticular Disease","html":"","width":"100%","height":180,"duration":796,"description":"Diverticular disease as its own entity, following a management algorithm that shifted meaningfully in the last decade while the boards catch up. Uncomplicated diverticulitis is now an inflammatory process treated with selective rather than reflex antibiotics, and prophylactic resection by episode count is dead. Complicated disease grades on Hinchey and splits at the four-centimeter abscess threshold.\n \nTopics covered\n\nDiverticulosis anatomy and false diverticula\nAcute diverticulitis and CT grading\nHinchey classification of complicated disease\nSelective antibiotics in uncomplicated disease\nComplicated disease and abscess thresholds\nRecurrence and elective surgery indications\nSegmental colitis (SCAD) as IBD mimic\nModifiable risk factors and post-episode workup\n\n \nKey decisions\n\nWell-appearing immunocompetent outpatient with uncomplicated left-sided diverticulitis gets supportive care with selective, not reflex, antibiotics; ciprofloxacin plus metronidazole is the wrong move.\nAntibiotics remain standard for the immunocompromised, frail, septic, admitted, or any complicated CT feature, because these hosts cannot mount the response that drives spontaneous resolution.\nPericolic abscess under four centimeters resolves with antibiotics alone; four centimeters or larger gets percutaneous drainage plus IV antibiotics, not urgent sigmoidectomy.\nElective resection is reserved for debilitating recurrences, prior complicated attacks, or immunocompromise, never a fixed episode count in immunocompetent patients.\nColonoscopy six to eight weeks after a first episode is mandatory to exclude a perforating sigmoid cancer masquerading on CT.\nSegmental colitis spares the rectum and proximal colon, rests on segmental distribution not histology, and responds to mesalamine, not an IBD diagnosis.\n\n \nFor the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.\nQuestions or feedback: hello@boardpearls.com.","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}