tailieunhanh - EAES Guidelines for Endoscopic Surgery - part 5

Có sự đồng thuận chung đó là bệnh phụ thuộc vào tiêu chí để quyết định điều trị bao gồm số lượng các cuộc tấn công trước đó, sốt, thiếu máu, tăng bạch cầu, thu hẹp intraluminal, tắc, rò, hình thành áp xe, không khí miễn phí, dịch intraabdominal, và dày của bức tường xác minh bằng CT scan | 148 L. Kohler et al. 6. Criteria for Making the Treatment Decision There is general consensus that disease-dependent criteria for the treatment decision include number of previous attacks fever anemia leukocytosis intraluminal narrowing obstruction fistulas abscess formation free air intraabdominal fluid and thickening of the wall verified by CT scan 10 26 . Patient-dependent criteria include age and concomitant disease functional and emotional status degree of disability cognitive function and subjective well-being of the patient. However these criteria have not been thoroughly studied in previous trials. The number of diverticula their distribution and manometry data should have no influence on decision making. 7. Indications for Conservative Treatment There is a consensus that conservative treatment is indicated in cases with a first attack of uncomplicated diverticulitis 51 The rationale is that approximately 50-70 of patients treated for a first episode of acute diverticulitis will recover and have no further problems. Only approximately 20 of patients with a first attack develop any complications. Those with recurrent attacks are at 60 risk to develop complications 29 . The members agreed that a detailed description of conservative treatment was outside the scope of the consensus conference and stated that conservative treatment strategies should be followed as suggested in a recent review article 30 Appropriate conservative therapy in mild cases consists of oral hydration oral antibiotics . ciprofloxacin and metronidazol 66 and antispasmodics. In moderate or severe cases oral feeding should be stopped to allow bowel rest 11 Hydration and antibiotics should be given intravenously. Analgesics can be given as required including narcotics but morphine should be avoided because of its potential to cause colonic spasm and hypersegmentation 65 Patients with diverticular disease who are not suffering from an acute attack should be instructed to maintain a diet .