Acute Diverticulitis Flashcards
Define diverticular disease
Herniation of colonic mucosa through muscular wall of the colon
Symptoms of acute diverticulitis
Altered bowel habit
Bleeding
Abdominal Pain
Complications
Diverticulitis Haemorrhage Development of fistula Perforation and faecal peritonitis Perforation and development of abscess Development of diverticular phelgmon
Diagnosis of diverticulitis
- colonoscopy/CT cologram/barium enema in clinic
- if acutely unwell = abdominal XR to identify perforation
- abdominal CT with oral and IV contrast to detect inflammation and complications such as abscesses
Severity of perforations due to diverticulitis
Hinchey 1 = para colonic abscess 2 = pelvic abscess 3 = purulent peritonitis 4 = faecal peritonitis
Treatment
- increase fibre
- AB if mild attacks
- peri colonic abscesses drain
- recurrent acute episodes = segmental resection
- Hinchey stage 4 perforation = resection and stoma
- less severe peritonitis = laparoscopy washout and drain insertion
Hinchey Stage 4 management
- high risk of post op complications
- require HDU
- Resection and stoma
- less severe peritonitis = laparoscopy washout and drain insertion
Define diverticulitis
Infection of out-pouching intestinal mucosa
- as increased intra-abdominal pressure
Where does diverticulitis occur?
- weaker areas of wall
- where arteries penetrate
- sigmoid colon mostly
RF of diverticulitis
- 50-70 yrs
- age
- low fibre diet
- obesity
- sedentary
- smoking
- NSAIDs
Diverticulitis symptoms - chronic
- intermittent abdominal pain in LLQ
- bloating
- bowel habit changes = diarrhoea or constipation
Diverticulitis Acute onset symptoms
- severe abdominal pain in LLQ
- N&V
- bowel habit changes
- urinary frequency/urgency/dysuria
- PR bleeding
- pneumaturia or faecaluria
How may acute diverticulitis affect Asian patients differently?
RLQ
Why do you get N&V?
Colonic obstruction
What do pneumaturia or faecaluria suggest?
Colovesical fistula
If in vaginal passage = colovaginal fistula
Signs
Low grade pyrexia
Tachycardia
Tender LIF
Sometimes mass in LIF if inflammation/abscess
Reduced bowel sounds?
Guarding, rigidity and rebound tenderness = perforation
Lack of improvement with Tx = abscess
Ix
High WCC High CRP CXR = pneumoperitoneum if perforation AXR = dilated bowel loops, obstruction or abscess CT = best for abscess Colonoscopy = avoid as perforation risk
Tx
Mild = Oral AB, liquid diet, analgesia
If symptoms don’t settle in 72 hours = hospital IV AB
Surgery
Indications for surgery
- major rectal bleeding = endoscopic haemastasis
- colonic resection if recurrent diverticulitis
- if generalised purulent peritonitis
- generalised faecal peritonitis
What is seen on AXR?
dilated bowel loops, obstruction or abscess
What is seen on CXR?
Pneumoperitoneum
Why is there changes in urinary symptoms?
Irritation of the bladder by the inflamed bowel
