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Gastroentrology > 2: Diverticular Disease > Flashcards

2: Diverticular Disease Flashcards

1
Q

What is a diverticulum

A

Outpouching of the bowel wall

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2
Q

What is diverticulosis

A

Presence of diverticula

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3
Q

What is diverticular disease

A

Symptomatic diverticula

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4
Q

What is diverticulitis

A

Inflammation of diverticula

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5
Q

What is a diverticular bleed

A

When diverticulum erodes a large blood vessel causing a bleed

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6
Q

How does the incidence of diverticular disease change with age

A

Increases with age

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7
Q

In which gender is diverticular disease more common.

A

Males

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8
Q

In which countries is diverticular disease more common

A

Developed countries

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9
Q

What are 4 RF for diverticular disease

A

Low Fibre Diet
Smoking
FH
Obesity

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10
Q

How will diverticulosis present

A

Asymptomatic.

Found incidentally on colonoscopy or CT

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11
Q

What are 5 symptoms of diverticular disease

A
  1. Colicky LIF pain
  2. Pain relieved by defecation
  3. Change bowel habit
  4. Flatulence
  5. Nausea
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12
Q

What will diverticulitis present

A

Acute abdominal pain - sharp and localised to LIF. Worse on movement. Systemic upset including loss of appetite, nausea and pyrexia.

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13
Q

What is a sign of perforated diverticlum

A

Generalised peritonitis

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14
Q

How can diverticulitis be classified

A

Simple

Complicated

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15
Q

What is complicated diverticulitis

A

Diverticulitis with presence of one of:

  • perforation
  • fistula
  • stricture
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16
Q

What is the most common site of diverticula

A

sigmoid colon

17
Q

Explain pathophysiology of diverticulosis

A
  • 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
18
Q

What is the most common site for diverticular to form

A

sigmoid colon

19
Q

what blood tests should individuals with diverticular disease have

A

FBC

CRP/ESR

20
Q

What additional 2 blood tests are done in diverticulitis

A

VBG

Group and Save

21
Q

What imaging should be done in diverticular disease

A

Colonoscopy

22
Q

When should colonoscopy never be performed and why

A

Diverticulitis - as increases risk of perforation

23
Q

What imaging is performed in diverticulitis

A

CT abdomen-pelvis

24
Q

What classification system is used to determine the severity of diverticulitis on CT

A

Hinchey Classification

25
Q

What is stage I on Hinchey classification

A

Para-colic abscess

26
Q

What is stage 2 Hinchey classification

A

Pelvic abscess

27
Q

What is stage 3 Hinchey classification

A

Purulent peritonitis

28
Q

What is stage 4 Hinchey classification

A

Faecal peritonitis

29
Q

How is diverticular disease managed

A

NSAIDs
Oral Fluids
Increase dietary fibre

30
Q

How is diverticulitis managed

A

Medical:
IV Fluids
Bowel rest
Antibiotics

31
Q

What is the surgical management of diverticulitis

A

Hartmann’s procedure

32
Q

What is Hartmann procedure indicated for

A

Diverticular perforation causing faecal peritonitis (Hinchey 4) or sepsis

33
Q

What does Hartman procedure involve

A

Sigmoid colectomy - with formation of end-colostomy bag and rectal stump. May be re-anastamosed at later point

34
Q

What is the main complication of diverticulitis

A

Recurrence

35
Q

What are 3 complications of diverituclar disease

A
  1. Para-colic abscess
  2. Stricture resulting in bowel obstruction
  3. Fistula: colovesical or colovaginal
36
Q

How are para-colic abscesses manage

A
  • Antibiotics
  • Bowel rest
  • CT-guided drainage
37
Q

What is a colovesical fistula

A

Abnormal connection between bladder and bowel

38
Q

How will colovesical fistula present

A

Pneumoturia
Faeces in urine
Recurrent UTI

39
Q

How will colovaginal fistulas present

A

Increase vaginal discharge

Recurrent UTIs

Gastroentrology (18 decks)

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