2: Diverticular Disease Flashcards
What is a diverticulum
Outpouching of the bowel wall
What is diverticulosis
Presence of diverticula
What is diverticular disease
Symptomatic diverticula
What is diverticulitis
Inflammation of diverticula
What is a diverticular bleed
When diverticulum erodes a large blood vessel causing a bleed
How does the incidence of diverticular disease change with age
Increases with age
In which gender is diverticular disease more common.
Males
In which countries is diverticular disease more common
Developed countries
What are 4 RF for diverticular disease
Low Fibre Diet
Smoking
FH
Obesity
How will diverticulosis present
Asymptomatic.
Found incidentally on colonoscopy or CT
What are 5 symptoms of diverticular disease
- Colicky LIF pain
- Pain relieved by defecation
- Change bowel habit
- Flatulence
- Nausea
What will diverticulitis present
Acute abdominal pain - sharp and localised to LIF. Worse on movement. Systemic upset including loss of appetite, nausea and pyrexia.
What is a sign of perforated diverticlum
Generalised peritonitis
How can diverticulitis be classified
Simple
Complicated
What is complicated diverticulitis
Diverticulitis with presence of one of:
- perforation
- fistula
- stricture
What is the most common site of diverticula
sigmoid colon
Explain pathophysiology of diverticulosis
- Bowel wall gradually weakness with age
- Increase in intra-luminal pressure will cause weaker areas to out pouch - predominantly where vessels enter bowel wall
- bacteria can grow in out pouch to cause inflammation - which may result in perforation
What is the most common site for diverticular to form
sigmoid colon
what blood tests should individuals with diverticular disease have
FBC
CRP/ESR
What additional 2 blood tests are done in diverticulitis
VBG
Group and Save
What imaging should be done in diverticular disease
Colonoscopy
When should colonoscopy never be performed and why
Diverticulitis - as increases risk of perforation
What imaging is performed in diverticulitis
CT abdomen-pelvis
What classification system is used to determine the severity of diverticulitis on CT
Hinchey Classification
What is stage I on Hinchey classification
Para-colic abscess
What is stage 2 Hinchey classification
Pelvic abscess
What is stage 3 Hinchey classification
Purulent peritonitis
What is stage 4 Hinchey classification
Faecal peritonitis
How is diverticular disease managed
NSAIDs
Oral Fluids
Increase dietary fibre
How is diverticulitis managed
Medical:
IV Fluids
Bowel rest
Antibiotics
What is the surgical management of diverticulitis
Hartmann’s procedure
What is Hartmann procedure indicated for
Diverticular perforation causing faecal peritonitis (Hinchey 4) or sepsis
What does Hartman procedure involve
Sigmoid colectomy - with formation of end-colostomy bag and rectal stump. May be re-anastamosed at later point
What is the main complication of diverticulitis
Recurrence
What are 3 complications of diverituclar disease
- Para-colic abscess
- Stricture resulting in bowel obstruction
- Fistula: colovesical or colovaginal
How are para-colic abscesses manage
- Antibiotics
- Bowel rest
- CT-guided drainage
What is a colovesical fistula
Abnormal connection between bladder and bowel
How will colovesical fistula present
Pneumoturia
Faeces in urine
Recurrent UTI
How will colovaginal fistulas present
Increase vaginal discharge
Recurrent UTIs
