Diverticula, Diverticulosis and Diverticulitis Flashcards
the difference between the 3
diverticulosis is the state of having
multiple small bulging pouches, which are called diverticulas
diverticulitis is when
one or more diverticula become inflamed or infected
acquired sigmoid diverticular disease in a consequence of
deficient dietary intake of fibre
another thing that might contribute: hyperelastosis and altered collagen structure in the colon wall related to ageing and disorders motility may contribute
lifestyle choices that reduce incidence of diverticular disease
active lifestyle 🏃🏻♀️ and the reduced intraluminal pressure associated with a high fibre diet together reduce the incidence of diverticular disease
complications of diverticular disease
- local sepsis 🦠 /localised perforation 🔪
- general peritonitis/faecal peritonitis 💩
- chronic inflammation and peritonitis
- fistulas eg. colovaginal or colovesical
- infrequent profuse bleeding 💉
aggravating factors
NSAIDs 💊
smoking 🚬
complicated diverticular disease may present with
- abdo distension and pain
- altered bowel habits
- fever
- nausea
- symptoms of irritation of pelvic viscera
- pneumaturia
- faeces per vagina
what are the symptoms of irritation of pelvic viscera
localised pain
worse on coughing and moving
typical findings on abdo examination
- distended
- localised/generalised guarding
- rebound tenderness
- absent bowel sounds
- empty rectum on PR exam
differential diagnosis for the symptom profile
appendicitis
pelvic inflammatory disease
rectus sheath hematoma
ruptured iliac artery aneurysm
Hinchey stages of complicated diverticulitis
stage 1: pericolic or mesenteric abscess
stage 2: walled off pelvic abscess
stage 3: purulent peritonitis
stage 4: faecal peritonitis
Ix for localised peritonitis
FBC, U+Es, CRP, blood cultures
abdo xray
erect chest x ray
CT scan
Ix for perforation
FBC, U+Es, CRP
AXR
CXR (pneumoperitneum)
CT scan
Ix for fistula
FBC - inflammation
U+Es - dehydration
CT scan
+/- cystoscopy
colonoscopy (exclude cancer)
