Diverticular Disease Flashcards
What is a diverticulum?
Outpouching of gut wall
What is Diverticulosis?
Presence of diverticula (asymptomatic)
What is diverticular disease?
Symptoms arising from diverticula
What is Diverticulitis?
Inflamm. of diverticulum
What is the pathophysiology of a diverticulum? (3 steps)
- Naturally weakened bowel over time
- Movement of stool –> increases luminal pressure
- Outpouching of mucosa @ weaker areas
What is the pathophysiology of diverticulitis?
Bacteria grows in diverticula –> inflam
How are diverticulitis classified?
Simple vs Complicated
What makes a diverticulitis a Complicated diverticulitis? (2 things)
- Abscess
- Perforation
What are the risk factors for developing a diverticulum? (6 things)
- Age
- FHx
- Obesity
- Smoking
- NSAIDs
- Low fibre intake
What are the clinical features of Diverticular disease? (4 things)
- Nausea
- LIF pain (colicky, relieved by defecation)
- Alt bowel habits
- Flatulence (farting)
What are the clinical features of Diverticulitis ? (8 things)
- Fever
- Nausea
- LOA
- Tachycardia
- LIF pain (SHARP, worse on movement)
- Localised tenderness
- Guarding + rigidity (suggests complicated: absc + perf)
- Reduced bowel sounds
How will a perforated diverticulum present?
Localised peritonism / generalised peritonitis
Very unwell, maybe fatal
What can mask the symptoms of diverticulitis, even if its perforated?
If patient taking corticosteroids / immunosuppressants
What are other differentials of suspected diverticular diseases? (5 things)
Lower abdominal pain + bowel symptoms
- Inflamm bowel disease
- Bowel cancer
Abdominal pain
- Mesenteric ischaemia
- Gynae causes
- Renal stones
What lab tests should be done for suspected diverticular diseases? (4 things)
- FBC (raised WCC)
- CRP (raised)
- U&Es
- Faecal calprotectin (if diagnosis not clear)
In addition to routine blood tests, what other lab tests should be done especially for suspected diverticulitis? (2 things)
- Group & Save
- Urine dipstick (exclude urological causes)
What is the best scan for suspected diverticulitis?
CT abdomen-pelvis
What may a CT abdomen-pelvis of suspected diverticulitis show? (4 things)
- Thickened colon wall
- Pericolonic fat stranding (fasc inf of mesentry in pic)
- Abscesses
- Localised air bubbles / free air
Why should a colonoscopy NOT be done for suspected diverticulitis?
Risk of perforation
What scans should be done for suspected diverticulitis? (3 things)
- CT: best for abscesses
- Erect CXR: pneumoperitoneum in perforation
- AXR: dilated bowel loops / obstruction / abscesses
What is the staging system for acute diverticulitis?
Hinchey Classification
What are the stages of Hinchey Classification for acute diverticulitis? (4 stages)
Stage 1a: Phlegmon (inflamm w no liquid / pus)
Stage 1b: Pericolic / Mesenteric abscess
Stage 2: Walled off pelvic abscess
Stage 3: Generalised purulent (pus) peritonitis
Stage 4: Generalised faecal peritonitis
What is a phlegmon?
Inflamm of soft tissue w NO liquid / pus
How do you manage a patient with uncomplicated diverticular disease? (4 things)
- As outpatient
- Simple analgesia
- Encourage oral fluid intake
- Outpatient colonoscopy (to exclude any masked malignancies)
How do you manage a patient with diverticular bleeds? (3 things)
- Conservatively, most will be self-limiting
- Significant bleeding –> resuscitation with blood products + stabilisation
- Failed conservative –> embolisation / surgical resection
When should you admit a patient with (uncomplicated) diverticular disease into hospital? (5 things)
- Uncontrolled pain
- Dehydration concerns
- Significant co-morbidities / immunocompromised
- Significant PR bleeding
- Symptoms 48 hours + despite conserv. management
How do you manage a patient with acute diverticulitis? (3 things)
Conservatively
- Abx
- IV fluids
- Analgesia
When is surgical intervention indicated for acute diverticulitis? (2 things)
Perforation with:
- Faecal peritonitis (Hinchey Classification Stage 4)
- Sepsis
What is the surgical procedure for acute diverticulitis?
Hartmanns Procedure
(Sigmoid colectomy w. formation of end colostomy)
What are the complications of diverticulitis?
- Perforation –> peritonitis / sepsis / death
- Diverticular stricture
- Fistula (colovesical (bowel n bladder) / colovaginal (bowel n vagina))
- Haemorrhage
- Abscess
How do you manage a haemorrhage of acute diverticulitis? (2 things)
- Colonoscopic haemostasis
- Embolization / colonic resection (if haemostasis not successful)
How do you manage a fistula of acute diverticulitis?
- Colonic resection (surgery)
What are the features of an abscess of acute diverticulitis? (3 things)
- Swinging fever
- Leucocytosis
- Rectal mass
How do you manage an abscess of acute diverticulitis? (2 things)
- Abx
- US / CT guided drainage
