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Peri-op > Diverticular disease > Flashcards

Diverticular disease Flashcards

1
Q

What is diverticular disease?

A

Herniation of colonic mucosa through the muscular wall of the colon

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2
Q

Pathophysiology of diverticular disease

A
  1. Bowel weakens with age
  2. Movement of stool within lumen causes an ↑ in luminal pressure
  3. Results in outpouchings of mucosa through weaker areas of the bowel wall
  4. Bacteria overgrow within outpouchings, leading to diverticulitis
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3
Q

Which area of the intestine does diverticular disease affect?

A

Sigmoid - between the taenia coli

The rectum (lacks taenia) is often spared

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4
Q

How does diverticular disease present?

A
  1. Constipation
  2. Left lower quadrant pain (colicky, relieved by defecation)
  3. Some patients experience rectal bleeding
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5
Q

Imaging investigations for diverticular disease

A

colonoscopy, CT cologram or barium enema

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6
Q

List 4 risk factors for diverticular disease

A
  1. Increased age
  2. Low fibre diets
  3. obesity
  4. use of NSAIDs
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7
Q

How is diverticular disease diagnosed?

A

Colonoscopy or CT scans (often incidentally)

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8
Q

Examination findings of diverticular disease?

A
  1. May be normal
  2. May be tenderness in the left lower quadrant
  3. May be tenderness on digital rectal examination
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9
Q

Treatment if diverticular disease?

A
  1. High fibre diet and weight loss
  2. Bulk-forming laxatives (eg. ispaghula husk)
  3. Weight loss

If severe, surgery to remove affected area may be required

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10
Q

List 2 common complications of diverticular disease?

A
  1. Strictures - due to repeated episodes of inflammation
  2. Fistulas (Colovesical and Colovaginal)
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11
Q

What is Diverticulitis?

A

Inflammation in the diverticula

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12
Q

How does diverticulitis present?

A
  1. Pain and tenderness in left iliac fossa
  2. Fever
  3. Diarrhoea
  4. Nausea and vomiting
  5. Rectal bleeding
  6. Palpable abdominal mass (if abscess)
  7. Raised inflammatory markers (CRP) and WBCs
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13
Q

List 4 signs of diverticulitis

A
  1. Low grade pyrexia
  2. Tachycardia
  3. Tender LIF
  4. Guarding, rigidity and rebound tenderness (complicated)
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14
Q

First line imaging for diverticulitis?

List 3 changes which may be seen

A

CT abdomen-pelvis:

  1. Thickening of colonic wall
  2. Pericolonic fat stranding
  3. Abscesses
  4. localised air bubbles or free air
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15
Q

Are Colonoscopy’s used in patients presenting with suspected diverticular disease?

A

NO, due to increased risk of perforation

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16
Q

Compare complicated with uncomplicated diverticulitis

A

Uncomplicated: localised inflammation that does not extend to the peritoneum

Complicated: associated with complications ie. rectal bleeding, abscess, peritonitis, fistula, obstruction, or perforation

17
Q

Management of uncomplicated diverticulitis in primary care?

A
  1. Oral co-amoxiclav (at least 5 days)
  2. Analgesia (avoid NSAIDs and opiates)
  3. Clear liquids onlyuntil symptoms improve
  4. Follow-up within 2 days to review symptoms
18
Q

Management of complicated diverticulitis in hospital?

A
  1. Nil by mouth or clear fluids only
  2. IV antibiotics and fluids
  3. Analgesia
  4. Urgent investigations (eg. CT scan)
  5. Urgent surgery may be required for complications
19
Q

When may surgery be required for acute diverticulitis?

A
  1. Perforation with faecal peritonitis
  2. Overwhelming sepsis
20
Q

What is the name of the most common surgical procedure performed for diverticulitis?

A

Hartmann’s procedure

Sigmoid colectomy with formation of an end colostomy (anastomosis with reversal of colostomy may be possible at a later date).

21
Q

List 4 complications of diverticulitis

A
  1. Perforation
  2. Peritonitis
  3. Peridiverticular abscess
  4. Large haemorrhage
  5. Fistula
  6. Ileus / obstruction
22
Q

What classification systemic is used for acute diverticulitis?

A

Hinchey

23
Q

How will a perforated diverticulum present?

A

Signs of localised peritonism or generalised peritonitis

Patient will be extremely unwell, can often be fatal

24
Q

Management of a Peridiverticular abscess?

A

< 5 cm IV antibiotics. If any bigger, radiological drainage is first-line

Complicated multi-loculated abscesses require a laparoscopic washout or Hartmann’s procedure

25
Q

What can mask the symptoms of diverticulitis, even if its perforated?

A

If patient is taking corticosteroids / immunosuppressants

Peri-op (22 decks)

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