Diverticular Disease Flashcards
What is a GI diverticulum?
Outpockets of colonic muscosa/submucosa usually at sites of perforation by arteries. NOT INFLAMED
What is diverticular disease?
Divertuclum have become symptomatic
What is diverticulitis?
Inflammation and infection of diverticulum
What are the two main types of diveritculum?
Aquired
Congenital
What causes diverticulum?
UNKNOWN, SEVERAL THEORIES
- fibre deficiency
- change in strength of colonic wall w/ age/CT deficiencies
Describe the fibre deficiency theory
Lack of dietary fibre –> high intraluminal pressure –> mucosa herniates adjacent to perforating arteries
Describe the colonic wall theory
Change in strength of colonic wall due to
-age
-CT disorders
-collagen disorder
Weakened, increased risk of diverticulitis
What are the risk factors for diverticular disease?
>50 Low dietary fibre Obesity Smoking NSAIDs/Paracetamol Marfans, Ehler's-Danlos, PKD
Where do most diverticulum occur?
Sigmoid colon
-95% of complications here
In what less common places can diverticulum occur?
Right colon
Massive single diverticulum anywhere
What are the complications of diverticulosis?
Perforation Abscess formation Bleeding Fistula formation Intestinal obstruction Strictures
What are the symptoms/signs of diverticular disease?
Can be asymptomatic Left sided colic (relieved by defecation Altered bowel habit (blood/mucus) Nausea Flatulence Severe pain/constipation (if luminal narrowing)
What investigations are appropriate in suspected diverticular disease?
PR (pelvic abscess? colorectal cancer?)
Sigmoidoscopy/Colonoscopy
Barium enema
CT
Think about 2ww criteria- most patients will be referred on this
What is the 1st line medical management for diverticular disease?
Mebeverine
What is diverticulosis?
The presence of diverticula
What causes diverticulitis?
Infection due to stagnation of contents of diverticula
What are the sx of diverticulitis?
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
What are the signs of diverticulitis?
Fever
Tachycardia
Tenderness, guarding, rigidity (on LHS)
Palpable mass in LIF
What are the management options for mild attacks of diverticulitis?
UNCOMPLICATED - LOW GRADE FEVER
- bowel rest (fluids only) at home
- oral co-amoxiclav +/- metronidazole
What are the management options for severe attacks of diverticulitis?
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
What are the key features of perforation, as a complication of diverticulosis?
Usually in acute diverticulitis
Can lead to abscess formation/peritonitis/fistula
Presents w/ ileus & peritonitis +/- shock
Mortality 40%
Manage w/ laparotomy +/- Hartmann’s
What are the key features of abscess formation, as a complication of diverticulosis?
Presents w/ swinging fever, leucocytosis & localising signs
Drain under CT guidance
What are the key features of bleeding, as a complication of diverticulosis?
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
What are the key features of fistula formation, as a complication of diverticulosis?
Colovesical - UTI & pneumaturia
Colovaginal - foul discharge
What are the key features of intestinal obstruction, as a complication of diverticulosis?
Most commonly in sigmoid, after repeated bouts
Scarring, formation of diverticular mass
May mimic colonic carcinoma
What are the key features of strictures, as a complication of diverticulosis?
Post-infective strictures in colon
Hard to distinguish from malignant strictures on barium studies
How should asymptomatic diverticulae be managed?
Dietary advice only
- avoid processed food
- increase dietary fibre (>20g/day)
What are the indications for surgical management of diverticular disease?
V. severe/recurrent (rarely resorted to)
Small, confined, pericolonic abscesses (rarely)
Generalised peritonitis (all)
Massive haemorrhage/perforation (emergency colonic resection)
What investigations are needed in diverticulitis?
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
