Diverticular disease Flashcards
Define diverticulosis
Presence of diverticulae outpoutchings of the colonic mucosa & submucosa through the muscular wall of the large bowel
Define diverticular disease
Diverticulosis associated w/ COMPLICATIONS (e.g. haemorrhage, infection, fistulae)
Define diverticulitis
Acute inflammation & infection of colonic diverticulae
Classification of acute diverticulitis
4/5
Hinchley classification of acute diverticulitis Ia - phlegmon Ib & II - localised abscesses III - perforation & purulent peritonitis IV - faecal peritonitis
Aetiology of diverticular disease
3
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
Pathogenesis of diverticular disease
4
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
Epidemiology of diverticular disease
prevalence, industrialised, age, right sided
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
Presenting symptoms of diverticular disease
general + 3
Often ASYMPTOMATIC (80-90%)
Complications can lead to:
PR bleeding
Diverticulitis (LIF & lower abdo pain, fever)
Diverticular fistulation (pneumaturia, faecaluria, recurrent UTI)
Signs of diverticulitis on physical examination
Tender abdomen & signs of local/generalised peritonitis if a diverticulum has perforated
Investigations for diverticular disease
4
Bloods
Barium enema
Flexible sigmoidoscopy & colonoscopy
Acute
Investigations for diverticular disease - bloods
2
FBC - increased WCC & CRP
Check clotting & cross match if bleeding
Investigations for diverticular disease - barium enema
3
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
Investigations for diverticular disease - flexible sigmoidoscopy & colonoscopy
Diverticulae can be visualised & other pathology excluded (e.g. polyps & tumours)
Investigations for diverticular disease - in acute setting
CT scan for evidence of diverticular disease & complications may be performed
Management of diverticular disease
4
Asymptomatic
GI bleed
Diverticulitis
Surgery