Overview
This lecture covers diverticulosis/diverticulitis and benign prostatic hyperplasia (BPH), including their risk factors, diagnosis, management, and complications.
Diverticulosis & Diverticulitis
- Diverticulosis is the presence of outpouchings (diverticula) in the colon wall, often asymptomatic.
- Incidence increases with age; more common in men under 60, women over 60.
- Risk factors: age, obesity, smoking, low fiber diet, genetics, certain medications, red meat, and high-fat diets.
- Diverticulitis occurs when diverticula become inflamed, most often in the sigmoid colon (left lower quadrant).
- Low fiber increases stool transit time and water absorption, leading to constipation and higher intraluminal pressure.
- Symptoms include left lower quadrant pain, fever, bloating, constipation, diarrhea, and possible blood or mucus in the stool.
- Older adults may present atypically: confusion, falls, anorexia, or minimal pain/fever.
- Diverticulitis may look like carcinoma due to focal thickening and stricture formation. Scricture is the abnormal narrowing of a passage.
- Diagnosis: CT scan is preferred; avoid barium enema.
- Uncomplicated cases are managed with oral antibiotics and clear liquid diet; complicated cases may require hospitalization, IV fluids, and surgery.
- Complications include abscess, perforation, fistula, stricture, obstruction, and bleeding.
- Post-acute phase: increase dietary fiber, avoid straining/lifting, encourage weight loss, and complete antibiotic course.
Benign Prostatic Hyperplasia (BPH)
- BPH is noncancerous enlargement of the prostate, common in men over 50.
- The prostate assists urine flow and mixes fluids for ejaculation.
- Theories for cause: hormonal imbalance (testosterone/estrogen), increased DHT, dietary factors.
- Symptoms: weak urine stream, hesitancy, incomplete emptying, urgency, frequency, nocturia, incontinence.
- Complications: acute urinary retention, bladder infection/stones, hydronephrosis, kidney injury.
- Diagnosis: based on symptoms, digital rectal exam, PSA test, and urinalysis to rule out infection.
- Management:
- Mild cases: watchful waiting, avoid medications worsening symptoms, limit evening fluids.
- Medications: alpha blockers (e.g., tamsulosin), 5-alpha reductase inhibitors (e.g., finasteride); combination therapy possible.
- Surgical options: TURP, transurethral incision, open prostatectomy, laser surgery.
- Post-surgery: monitor for complications, maintain light activity, and ensure aseptic care.
- Patients may require catheterization and continuous bladder irrigation post-surgery, with risk of TURP syndrome.
Key Terms & Definitions
- Diverticulosis — Condition with outpouchings in colon walls.
- Diverticulitis — Inflammation of diverticula.
- BPH (Benign Prostatic Hyperplasia) — Noncancerous enlargement of the prostate gland.
- TURP (Transurethral Resection of the Prostate) — Surgery removing inner prostate tissue via the urethra.
- PSA (Prostate-Specific Antigen) — Protein used as a marker for prostate conditions.
- Hydronephrosis — Swelling of a kidney due to urine retention.
Action Items / Next Steps
- Increase fiber intake after diverticulitis recovery.
- Adhere strictly to antibiotic regimens.
- Schedule follow-up and colonoscopy after diverticulitis.
- Monitor symptoms in BPH; report worsening or new urinary symptoms to provider.
- Educate on medication use and possible surgical options for BPH.
- Ensure proper post-surgical care and hygiene.