Diverticular disease Flashcards
describe true vs false diverticula
true: congenital, all layers of the colonic mucosa and underlying connective tissue are involved
false: acquired, only the mucosa and submucosa out pouch
how do diverticula form
pressure increases within the lumen
mucosa protrudes through the weakest part of the colonic wall which is where blood vessels penetrate
where do diverticula form most commonly
the sigmoid colon
due to its smaller lumen, which means there is higher pressure
what are risk factors for diverticular disease
age (>50)
M>F
obesity
low fibre diet
NSAID use
corticosteroid use
smoking
lack of exercise
how does diverticular disease present
pain in left iliac fossa - often worse after eating
constipation / diarrhoea
occasional blood in stools
how can you investigate diverticular disease
barium enema
colonoscopy
CT to identify complications
how is diverticular disease managed
unless experiencing severe symptoms or exacerbations generally managed conservatly
Hydration, fibre and lifestyle modification
what is diverticulitis
inflammation/ infection of diverticula
occur due to blockage of diverticula leading to ischaemic necrosis followed by inflammation
or by infection which leads to inflammation
how does diverticulitis present
fever
N&V
pain in LIF which may persist for several days
blood/mucus in stools
PR bleeding
loose stools
tachycardia
can also have frequency or dysuria
what are some complications which can arise from diverticulitis
abscess formation
obstruction of bowels by scarring
perforation
can lead to peritonitis
perforation can also lead to fistula formation
what type of fistula can be formed by rupture of sigmoidal diverticulitis
colonvesicula fistula
can lead to symptoms of UTI and bubbly urine
how can mild/uncomplicated diverticulitis be managed
PO/IV ABX, hydration
may benefit from a liquid only diet to aid healing
when would surgical resection be indicated for diverticulitis
perforation
abscess
inflammation which fails to respond to conservative treatment
