Diverticular Disease Flashcards
What is GI diverticulum and why do they form?
Out-pouching in gut wall (95% sigmoid colon) at sites where perforating arteries enter, which are weaker areas of the bowel wall
Occur due to high intramural pressures causing mucosa of bowel to perforate through the muscle layer
What are precipitating/risk factors for diverticular disease?
Low-fibre diet
-leads to increased risk of constipation and stool impaction which increases the intramural pressure
Immobility or being bed bound
-leads to increased risk of constipation
Obesity
Use of NSAIDs= increases the risk of diverticular haemorrhage
What is the difference between complicated and uncomplicated diverticuli?
Complicated= bowel perforated and stool escaping and collecting
Uncomplicated= bowel no perforated or fistula formed
How would you investigate someone suspected of diverticular disease?
Can be found incidentally on colonoscopy
Abdominal CT scan
Cytoscopy= if fistula has formed with bladder will find faeces in bladder
What is the difference between diverticular disease and diverticulitis?
DD:
- altered bowel habits
- rectal bleeding
- left-side colic which is relieved by defecation
Diverticulitis differentiated by additional symptoms which indicate inflammation
- pyrexia (fever)
- raised WCC/CRP/ESR
- tender colon
- general or localised peritonism
How is diverticulitis treated conservatively?
When mild, can be treated at home with antibiotics and bowel rest
When more severe:
- IV fluids
- IV antibiotics
- NBM to rest the bowel
What are the complications associated with diverticulitis?
Abscess formation
Perforation of bowel: i.e. fluid/faeces/air
- leads to ileus, peritonitis and shock
- may require Hartmann’s procedure
Haemorrhage= sudden and painless i.e. can be cause of big rectal bleeds
Fistulae:
- enterocolic (small bowel + colon)
- colovaginal
- colovesical i.e. can be associated with UTIs
Post-infective strictures-> present with obstruction
What is Hartmann’s procedure and when is it performed?
It is a type of end colostomy surgery which involves the bowel being divided so the proximal end is brought out as a stoma and the distal end is closed and left in the abdomen
It is used in bowel cancer and diverticular disease
After a Hartmann’s procedure a patient is likely to require a colostomy. Where is this stoma located and how can you differentiate it from an ileostomy?
LIF
Colostomy:
Solid faecal contents
Stoma flush with skin
Ileostomy:
RIF
Liquid contents
Stoma raised from skin to prevent acid eroding skin and causes fistula
What is the difference between diverticulosis and diverticular disease and diverticulitis?
Diverticulosis= presence of diverticula in bowel wall
Diverticular disease= when patient experiences symptoms due to diverticula
Diverticulitis= inflammation or infection of diverticula
Which parts of the bowel are vulnerable to developing diverticula? Why do diverticula NOT form in the rectum?
Parts of the colons diameter which are not covered by teniae coli (3 longitudinal layers of muscle which support the bowel wall)
Rectum has outer longitudinal layer of muscle which complete surrounds the rectum to provide extra support
How is diverticular disease managed?
Increased fibre diet
Bulk-forming laxatives
Anti-spasmodics
