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GI AND SURGERY > DIVERTICULAR DISEASE > Flashcards

DIVERTICULAR DISEASE Flashcards

1
Q

What are diverticula?

A

sac-like protrusions of mucosa through the muscular wall of the colon.

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2
Q

Where do most diverticula occur?

A

In sigmoid and descending colons in 85%

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3
Q

What group of people are more likely to have a diverticula on the right/ascending colon?

A

Asian origin

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4
Q

What proportion of adults over 50 have diverticula?

A

50%

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5
Q

What is diverticulosis?

A

The presence of diverticula without symptoms

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6
Q

What is diverticulitis?

A

Diverticula that are inflamed and may be caused by infection

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7
Q

What is diverticular disease?

A

Condition where diverticula cause symptoms

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8
Q

What symptoms may diverticular disease present with?

A

Intermittent lower abdominal pain (commonly LLQ), bloating, erratic bowel habits
In severe cases, severe pain and constipation can occur from luminal narrowing

Without inflammation and infection!!!

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9
Q

What symptoms may be present in diverticulitis?

A

Severe lower abdominal pain LIF
Fever
Constipation
Tachycardia
General malaise
Diarrhoea
Rectal bleeding

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10
Q

What is u7ncomplicated diverticulitis?

A

diverticular inflammation without symptoms of acute abdomen, or signs of perforation or abscess formation.

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11
Q

What is complicated diverticulitis?

A

iverticulitis associated with complications, such as abscess, peritonitis, fistula, obstruction, or perforation.

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12
Q

Whats the pathophysuology of diverticular disease?

A

Low fibre diet = lower stool bulk = slower transit times = increases intraluminal pressure = promotes herniation of mucosa through relatively weak areas where vasa recti penetrate colonic wall

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13
Q

What are the risk factors for diverticular disease?

A

Low fibre diet
Old age
Genetic 40-50%
Diet rich in red meat
Smoking
Obesity
NSAID use
Immunosuppression

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14
Q

What are the complications of diverticulitis?

A

Diverticular haemorrhage
Intra-abdominal abscess formation
Perforation
Peritonitis
Stricture and fistula formation
Intestinal obstruction from above due to recurrent inflammation
Sepsis

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15
Q

What causes diverticulitis?

A

faeces obstruct the neck of the diverticulum, causing stagnation and allowing bacteria to multiply and produce inflammation.

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16
Q

What proportion of diverticular disease is asymptomatic?

A

95% of cases

17
Q

How is diverticular disease diagnosed?

A

Often discovered incidentally on colonoscopy or barium enema examination

(Colonoscopy or virtual colonoscopy is investigation of choice)

18
Q

How do you manage those with diverticulosis ?

A

No treatment other than advice to increase dietary fibre is required. Advise on drinking adequate fluid when having a high fibre diet

May consider offering bulk-forming laxative for people with constipation

19
Q

How should you assess someone with suspected diverticular disease?

A

Medical history
Abdominal examination
Pelvic exam and PR exam
FBC, FOB/FIT test, U&E, eGFR, urinanalysis, CRP, ESR
Colonoscopy/other imaging

20
Q

How do you manage diverticular disease?

A

If significant rectal bleeding then urgent admission for blood transfusion

Advise on avoiding NSAIDs, opioid analgesia, diet, lifestyle, fluid, smoking, weight loss, exercise

Consider offering:
Bulk forming laxative
Simple analgesia for ongoing abdo pain
Antispasmodic for abdominal cramping

In very severe cases, surgery may be required to remove the area

21
Q

Whats an example of an anti-spasmodic?

A

Mebeverine hydrochloride

22
Q

Whats the moa of mebeverine?

A

Anticholinergic - works directly on smooth muscle in GIT - prevents muscle spasm without affecting normal gut motility

23
Q

What are the indications of mebeverine?

A

Adjunct in GIT disorders characterised by smooth muscle spasm
IBS

24
Q

Whats the contraindication of mebeverine?

A

Paralytic ileus

25
Q

How should you manage acute diverticulitis?

A

If symptoms are severe, or over 65 or risk of dehydration or significant comorbidity then arrange same-day hopsital assessment

If systemically unwell… Oral antibiotic - coamoxiclav
If systemically well … simple analgesia
Provide advice on diet, lifestyle, course, complications, symptoms, when to seek medical advice, risks of treatments etc
Reassess if symptoms persist or they deteriorate

26
Q

What will you see on CT colonography in diverticular disease?

A

Colonic wall thickening
Diverticular
Pericolic collections and abscesses

27
Q

What are true diverticula?

A

When diverticula include all the layers from mucosa to serosa

28
Q

What are pseudodivertiucla?

A

mucosal or submucosal protrusions through the muscular wall of the bowel.

29
Q

Are true or false diverticula more common in the large intestine?

A

False

30
Q

Where do most diverticula form and why?

A

Sigmoid colon
La place’s law says pressure eon the wall of a cylinder is inversely proportional to its diameter i.e. as diameter decreases pressure increases
The sigmoid colon has the smallest diameter so its subject to the highest pressures

31
Q

What genetic conditions can cause diverticula?

A

Marfan syndrome and ehlers danlos - connective tissue disorders
Without connective tissue supporting colon wall, diverticula are more likely to form

32
Q

Why is diverticulitis not commonly associated with haematochezia?

A

Because blood vessels tend to be scarred from the inflammation

33
Q

What are typical fistulas to form secondary to diverticula?

A

Colovesicular fistula - fistula between colon and bladder - can cause air (pneumaturia) and stool (fecaluria) in urine

34
Q

What is meckels diverticulum?

A

an outpouching or bulge in the lower part of the small intestine
A congenital defect
A true diverticulum

35
Q

What 2 fistulas can form as a result of diverticular disease and how do they present?

A

Colovesical fistula - pneumaturia or faecaluria
Colovaginal fistula - vaginal passage of faces or flatus

GI AND SURGERY (31 decks)

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