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FFP Abdominal pain and PR bleeding > Diverticular disease > Flashcards

Diverticular disease Flashcards

1
Q

Where do diverticula occur

Where are they most common

A

In GI tract but more common in sigmoid and descending colon

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2
Q

What is a true diverticulum

A

Involving all layers of intestine

  • serosa
  • muscle
  • submucosa
  • mucosa
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3
Q

What is a false diverticulum

A

Does not contain all layers

-Often mucosa pushed through muscle defect

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4
Q

What is diverticulum pathology

A

Lack of dietary fibre leads to high intraluminal pressures

This allows the mucosa to herniate through the muscle layers of the gut at weak points close to penetrating vessels

Causes outputting of bowel wall

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5
Q

Risk factors for diverticular disease

A

Western/ low fibre diet

Age
Male
Obesity
Connective tissue disorders
Smoking
Fam history
NSAID use
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6
Q

What is Meckel’s diverticulum

A

Outpouching in the lower part of the intestine

It is a congenital abnormality

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7
Q

Who is likely to have mocker’s diverticulum

A

<2yo

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8
Q

Symptoms of mocker’s diverticulum

A

painless melaena
Followed by obstruction/intussusception

Can mimic appendicitis

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9
Q

Meckel’s rule of 2

A 
Affects 2% of pop
2 yo
2:1 M:F ratio
2 inches ling
2 feet proximal to ileocaecal valve
2 types of ectopic tissue (gastric/pancreatic)
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10
Q

What is diverticulitis

A

bacterial overgrowth which causes inflammation of diverticulum

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11
Q

Complications of diverticulitis

A

Perforation of the bowel and fistula formation

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12
Q

Who has an increased risk of complications and recurrence of diverticulitis

A

Younger pts

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13
Q

Presentation of diverticulosis

A

asymptomatic

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14
Q

Presentation of diverticular disease

A

Colicky Lowe abdo pain (often left sided)

relieved by defecation or flatus and exacerbated by eating

Altered bowel habit. Associated nausea, bloating and flatulence

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15
Q

Presentation of divet=rticulitis

A

acute onset.
Sharp, LIF pain
Worsened by movement with localised tenderness

Loose stools

Symptomatically unwell- nausea, fever, tachycardia, N+V

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16
Q

Presentation of diverticular bleed

A

Large scale painless bleed

Dark red blood

Severe haemorrhage in 3-5% of pts

17
Q

Differentials for diverticular disease

A 
IBD
Bowel cancer 
ISchaemic colitis
Gyno causes
renal stones
IBS
Coeliac disease
18
Q

Bedside exams for diverticular disease

A

General obs + PR exam
Abdo exam
Urine dip to exclude urinary cause
(+/- Faecal calprotectin- can be raised in diverticulosis or IBD or IBS)

19
Q

Bloods for diverticular disease

A

FBC
U&E
LFT
CRP

should all be normal

20
Q

specialist imaging for diverticular disease

A

Sigmoidoscopy or colonoscopy

CT colonogram if pt not fit enough for colonoscopy procedure

21
Q

Flexi sigmoidoscopy vs colonoscopy

A

Colonoscopy looks at entire large bowel

Sigmoidoscopy looks up to half of descending colon

22
Q

Bedside exams for diverticulitis

A

GEneral obs (increased HR, febrile, hypotension)

Abdo exam- palpable mass +/- localised peritonism

Urine dip to exclude urinary cause

+/- faecal calprotectin

23
Q

Bloods to do for investigating diverticulitis

A

FBC
U&E
CRP

-Increased WCC and CRP

Blood cultures

VBG/ABG
-Increased lactate

24
Q

imaging for Diverticulitis

A

Erect CXR for pneumoperitoneum indicating perforation

AXR to look for bowel obstruction

USS abdomen/pelvis
CT abdomen/pelvis

25
Q

What to avoid when investigating diverticulitis

A

Endoscopic procedures due to risk of perforation

26
Q

Bedside investigations for diverticular bleed

A

General obs
-Hypotension, Increased HR and RR

Abdo exam-
palpable mass + peritonitis abdomen

Urinary dip

+e faecal calprotectin

27
Q

Bloods for diverticular bleed

A

FBC
U&E
CRP
-Increased WCC, Increased CRP and decreased HB

VBG/ABG
-increased lactate

Group and save and crossmatch
-For blood transfusion

Blood cultures

28
Q

Imaging for Diverticular bleed

A

Erect CXR for pneumoperitoneum indicating perforation

AXR to look for bowel obstruction

CT abdomen/pelvis

Urgent colonoscopy to find source of bleeding and treat if indicated

29
Q

MAnagemt of diverticulosis

A

No follow up if asymptomatic

Propylactic benefit of high fibre diet

30
Q

Mnagemtn of diverticular disease

A

Conservative -

  • Encourage PO fluids
  • High fibre diet
  • Weight loss
  • Smoking cessation

Medical

  • Paracetamol
  • If high fibre diet not effective then bulk forming laxatives
31
Q

Management of diverticulitis

A

Conservative

  • Encourage PO fluids
  • Clear fluids only, reintroducing solids as Symptoms improve over 2-3 days

Medical

  • Paracetamol
  • Broad spectrum antibiotics IV
  • IV fluids
  • Blood transfusion if haemorrhage

Surgical

  • for acute complicated diverticulitis (perforation) surgical management may be indicated
  • Hartmann’s procedure or sigmoid resection with primary anastomoses are most likely
32
Q

Complications of diverticulitis

A

Pericolic abscess (collection of pus within large bowel wall)

Fistulas (abnormal connection between two epithelialise surfaces)

Perforation

Bowel obstruction (small bowel obstruction due to inflammation)
-If there is a stricture formation, warrants further investigations)
33
Q

Presentation and treatment of pericolic abscess

A

Swinging fevers, mass OE and generally unwell

If small, can be treated with antibiotics

Normal need USS or CT guided drainage

34
Q

Presentation and treatment of fistulas

A

Colovesical fistula- connection between colon and bladder

Colovaginal fistula- connection between colon and vagina

Colovesical fistulae present with pneumoturia (bubbles in urine), faecal matter in urine and recurrent UTIs

colovaginal fistulae present with faecal matter in vagina and recurrent vaginal infections

Surgical intervention usually indicated

35
Q

Symptoms and treatment of perforation

A

Generalised peritonitis
Ileus +/- shock

Surgical emergency

36
Q

Symptoms and treatment of bowel obstruction

A

Abdo pain and distension

N&V and absolute constipation

If SBO during acute episode, may resolve spontaneously

If ongoing, may need stenting or surgery

FFP Abdominal pain and PR bleeding (5 decks)

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