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Colorectal > Diverticular Disease > Flashcards

Diverticular Disease Flashcards

1
Q

What is a GI diverticulum?

A

Outpockets of colonic muscosa/submucosa usually at sites of perforation by arteries. NOT INFLAMED

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2
Q

What is diverticular disease?

A

Divertuclum have become symptomatic

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3
Q

What is diverticulitis?

A

Inflammation and infection of diverticulum

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4
Q

What are the two main types of diveritculum?

A

Aquired

Congenital

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5
Q

What causes diverticulum?

A

UNKNOWN, SEVERAL THEORIES

  • fibre deficiency
  • change in strength of colonic wall w/ age/CT deficiencies
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6
Q

Describe the fibre deficiency theory

A

Lack of dietary fibre –> high intraluminal pressure –> mucosa herniates adjacent to perforating arteries

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7
Q

Describe the colonic wall theory

A

Change in strength of colonic wall due to
-age
-CT disorders
-collagen disorder
Weakened, increased risk of diverticulitis

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8
Q

What are the risk factors for diverticular disease?

A 
>50
Low dietary fibre
Obesity
Smoking
NSAIDs/Paracetamol
Marfans, Ehler's-Danlos, PKD
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9
Q

Where do most diverticulum occur?

A

Sigmoid colon

-95% of complications here

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10
Q

In what less common places can diverticulum occur?

A

Right colon

Massive single diverticulum anywhere

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11
Q

What are the complications of diverticulosis?

A 
Perforation
Abscess formation
Bleeding
Fistula formation
Intestinal obstruction
Strictures
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12
Q

What are the symptoms/signs of diverticular disease?

A 
Can be asymptomatic
Left sided colic (relieved by defecation
Altered bowel habit (blood/mucus)
Nausea
Flatulence
Severe pain/constipation (if luminal narrowing)
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13
Q

What investigations are appropriate in suspected diverticular disease?

A

PR (pelvic abscess? colorectal cancer?)
Sigmoidoscopy/Colonoscopy
Barium enema
CT

Think about 2ww criteria- most patients will be referred on this

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14
Q

What is the 1st line medical management for diverticular disease?

A

Mebeverine

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15
Q

What is diverticulosis?

A

The presence of diverticula

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16
Q

What causes diverticulitis?

A

Infection due to stagnation of contents of diverticula

17
Q

What are the sx of diverticulitis?

A 
Severe L. sided colic
Constipation (or overflow diarrhoea)
N&V
Rectal bleeding
Urinary frequency and urgency with dysuria due to irritation of bladder
Sx of complications
18
Q

What are the signs of diverticulitis?

A

Fever
Tachycardia
Tenderness, guarding, rigidity (on LHS)
Palpable mass in LIF

19
Q

What are the management options for mild attacks of diverticulitis?

A

UNCOMPLICATED - LOW GRADE FEVER

  • bowel rest (fluids only) at home
  • oral co-amoxiclav +/- metronidazole
20
Q

What are the management options for severe attacks of diverticulitis?

A

COMPLICATED - HIGH GRADE FEVER or symptoms remaining despite >72hrs abx treatment

  • admit if pain cannot be controlled/oral fluids not tolerated
  • analgesia, IV fluids, NBM
  • IV cefuroxime & metronidazole
  • DO NOT SCOPE
21
Q

What are the key features of perforation, as a complication of diverticulosis?

A

Usually in acute diverticulitis
Can lead to abscess formation/peritonitis/fistula
Presents w/ ileus & peritonitis +/- shock
Mortality 40%
Manage w/ laparotomy +/- Hartmann’s

22
Q

What are the key features of abscess formation, as a complication of diverticulosis?

A

Presents w/ swinging fever, leucocytosis & localising signs

Drain under CT guidance

23
Q

What are the key features of bleeding, as a complication of diverticulosis?

A

Sudden painless OR chronic occult
Large volumes can be lost
Often stop w/ bed rest
If do not stop treat w/ angiography + embolisation
-adrenaline injections & diathermy may negate need for surgery

24
Q

What are the key features of fistula formation, as a complication of diverticulosis?

A

Colovesical - UTI & pneumaturia

Colovaginal - foul discharge

25
Q

What are the key features of intestinal obstruction, as a complication of diverticulosis?

A

Most commonly in sigmoid, after repeated bouts
Scarring, formation of diverticular mass
May mimic colonic carcinoma

26
Q

What are the key features of strictures, as a complication of diverticulosis?

A

Post-infective strictures in colon

Hard to distinguish from malignant strictures on barium studies

27
Q

How should asymptomatic diverticulae be managed?

A

Dietary advice only

  • avoid processed food
  • increase dietary fibre (>20g/day)
28
Q

What are the indications for surgical management of diverticular disease?

A

V. severe/recurrent (rarely resorted to)
Small, confined, pericolonic abscesses (rarely)
Generalised peritonitis (all)
Massive haemorrhage/perforation (emergency colonic resection)

29
Q

What investigations are needed in diverticulitis?

A

Bloods

  • FBC= raised WCC
  • CRP= raised
  • U&Es
  • LFTs
  • Group and Save

Obs and ECG

Erect CXR for perforation
CT for abscesses
DO not scope

Colorectal (7 decks)

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