Diverticular disease Flashcards

1
Q

Define diverticulosis

A

Presence of diverticulae outpoutchings of the colonic mucosa & submucosa through the muscular wall of the large bowel

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2
Q

Define diverticular disease

A

Diverticulosis associated w/ COMPLICATIONS (e.g. haemorrhage, infection, fistulae)

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3
Q

Define diverticulitis

A

Acute inflammation & infection of colonic diverticulae

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4
Q

Classification of acute diverticulitis

4/5

A
Hinchley classification of acute diverticulitis
Ia - phlegmon
Ib & II - localised abscesses
III - perforation & purulent peritonitis
IV - faecal peritonitis
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5
Q

Aetiology of diverticular disease

3

A

Low fibre diet leads to loss of stool bulk
Leads to high colonic intraluminal pressure to propel stool out
This leads to herniation of mucosa & submucosa through muscularis

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6
Q

Pathogenesis of diverticular disease

4

A

Most common in sigmoid & descending colon (but can be right sided)
NOT found in rectum
Found particularly at sites of nutrient artery penetration
Diverticular obstruction by thickened faeces can lead to bacterial overgrowth, toxin production & mucosal injury —> diverticulitis, perforation, pericolic phlegm, abscess, ulceration & fistula or stricture formation

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7
Q

Epidemiology of diverticular disease

prevalence, industrialised, age, right sided

A

Diverticular disease is VERY COMMON
60% people living in industrialised cities will develop colonic diverticulae
Rare <40 yrs
Right sided diverticulae more common in Asia

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8
Q

Presenting symptoms of diverticular disease

general + 3

A

Often ASYMPTOMATIC (80-90%)

Complications can lead to:
PR bleeding
Diverticulitis (LIF & lower abdo pain, fever)
Diverticular fistulation (pneumaturia, faecaluria, recurrent UTI)

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9
Q

Signs of diverticulitis on physical examination

A

Tender abdomen & signs of local/generalised peritonitis if a diverticulum has perforated

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10
Q

Investigations for diverticular disease

4

A

Bloods
Barium enema
Flexible sigmoidoscopy & colonoscopy
Acute

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11
Q

Investigations for diverticular disease - bloods

2

A

FBC - increased WCC & CRP

Check clotting & cross match if bleeding

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12
Q

Investigations for diverticular disease - barium enema

3

A

Shows presence of diverticulae - saw-tooth appearance of lumen
Reflects pseudo hypertrophy of circular muscle
Should NOT be performed in acute setting due to high risk of perforation

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13
Q

Investigations for diverticular disease - flexible sigmoidoscopy & colonoscopy

A

Diverticulae can be visualised & other pathology excluded (e.g. polyps & tumours)

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14
Q

Investigations for diverticular disease - in acute setting

A

CT scan for evidence of diverticular disease & complications may be performed

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15
Q

Management of diverticular disease

4

A

Asymptomatic
GI bleed
Diverticulitis
Surgery

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16
Q

Management of diverticular disease - asymptomatic

2

A

Soluble high fibre diet (20-30 g/day)

Some drugs are under investigation for their use in preventing recurrent flares

17
Q

Management of diverticular disease - GI bleed

2

A

PR bleeding usually managed conservatively w/ IV rehydration, antibiotics & blood transfusion if necessary
Angiography & embolisation or surgery if severe

18
Q

Management of diverticular disease - diverticulitis

4

A

IV antibiotics
IV fluid rehydration
Bowel rest
Abscesses may be drained by radiologically sited drains

19
Q

Management of diverticular disease - surgery

3/4

A

May be necessary in patients w/ recurrent attacks or complications (e.g. perforation or peritonitis)
Open surgery:
- Hartmann’s procedure (proctosigmoidectomy leaving stoma)
- One-stage resection & anastomosis (risk of leak) w/without defunctioning stoma
Laprascopic drainage, peritoneal lavage & drain placement can be effective

20
Q

Complications of diverticular disease

7

A
Diverticulitis
Pericolic abscess
Perforation
Faecal peritonitis
Colonic obstruction
Fistula formation (bladder, small intestine, vagina)
Haemorrhage
21
Q

Prognosis of diverticular disease

A

10-25% have 1+ episodes of diverticulitis