Diverticular Disease Flashcards
What are the risk factors for diverticular disease?
- Male
- Over 50
- Low fibre diet
What are the gastro symptoms of diverticular disease?
- Left lower quadrant abdominal pain
- Leukocytsosis
- Fever
- Rectal bleeding
- Bloating
- Constipation or diarrhoea
- Guarding/tenderness in left lower quadrant
What are possible differential diagnosis of diverticular disease?
- Endometriosis
- Colorectal cancer
- Appendicitis
- Ulcerative colitis
- Crohn’s disease
- Urinary tract infection (UTI)
- Pyelonephritis
- Ischaemic colitis
- Pelvic inflammatory disease
- Irritable bowel syndrome
What bloods do you order for diverticular disease?
- FBC
- U+Es
- CRP
What is FBC like in diverticular disease?
leukocytosis
What are U+Es like in diverticular disease?
uraemia, elevated creatinine
What is the CRP like in diverticular disease?
high
What imaging may you carry out for diverticular disease?
contrast CT
What may you find on contrast CT for diverticular disease?
- thickening of bowel wall
- mass
- abscess
- streaky mesenteric fat
- may show gas in the bladder in cases of fistula
What do you immediately need to think about with someone presenting with acute diverticular disease?
sepsis??
What is the 1st line treatment for asymptomatic diverticulosis?
dietary and lifestyle modifications
What is the 1st line treatment for symptomatic diverticulosis?
1st line: dietary and lifestyle modifications
Consider:
Analgesia
Antispasmodic
What is the 1st line treatment for acute diverticulitis uncomplicated?
1st line: analgesia Consider: Antispasmodic Oral antibiotics Plus low-residue diet
What is the 1st line treatment for acute diverticulitis with complicated acute rectal bleeding?
1st line: stratify as table or unstable and manage bleeding Plus: 1. Supportive therapy 2. IV antibiotics 3. Analgesia 4. Low-residue diet
What is the 2nd line treatment for acute diverticulitis with complicated acute rectal bleeding?
2nd line: surgery Plus: 1. Supportive therapy 2. IV antibiotic 3. Analgesia 4. Low residue diet
What is the 1st line treatment for acute diverticulitis: complicated with abscess, perforation, fistulae or obstruction?
1st line: radiological drainage/surgery Plus: 1. IV antibiotic 2. Analgesia 3. Low-residue diet
What is the 1st line treatment for ongoing recurrent diverticulitis?
elective surgery
What are the possible complications of diverticular disease?
- Fistula
- Colorectal neoplasm
- Abscess
- Perforation
- Strictures, obstruction
What is the prognosis of diverticular disease like?
- Recures in 1/3 of patients
2. Post surgery ¼ remain symptomatic
What is a diverticulum?
an outpouching of the gut wall usually at sites of entry of perforating arteries
What is diverticulosis?
means that diverticula are present
What is diverticular disease?
means that diverticula are present and symptomatic
What is diverticulitis?
inflammation of a diverticulum
Where is diverticulosis found most?
within sigmoid colon
How common is diverticular disease?
30% of westerners have diverticulosis by age 60
What is diverticular disease?
Herniation of mucosa and sub mucosa through muscle layer of colonic wall
What is psuedodiveticular disease?
muscle layer does NOT Outpouch
What is true diverticular disease?
muscle layer DOES Outpouch
What is a diverticulum?
1 outpouching
What is diverticula?
multiple outpouchings
What is diverticulosis?
presence of outpouching but ASx
What is diverticular disease?
diverticulosis WITH Sx
What is diverticulitis?
inflammation + infection of outpouching
What is the patho of diverticular disease?
- Taeniae coli (muscle that runs along the colon)
- present in bands
- herniation of the mucosa occurs in between these bands
What side are the diverticulum found?
- WEST: L side of colon (descending colon + sigmoid)
- NEVER found in the rectum
- Right side of colon more common in asia
What is the diagnostic test for diverticular?
- Barium Enema
- CT
What imaging is done for diverticular disease and what does it show?
- Barium Enema: saw tooth appearance of lumen – DIAGNOSTIC not if v sick as risk of perforation
- Colonscopy if diverticular disease
What is important to remember when giving medication and diveritcular disease?
- Laxative post surgery: osmotic not stimulant
2. No constipating analgesia e.g. opiods (morphine)
What are symptoms for divertciluosis?
- ASx
- May have blood in stool
What are symptoms for diverticulitis?
- Left illiac fossa bain
- Tachycardia
- Fever
- Abdo distenstion
