Diverticular Disease Flashcards
What are true diverticula?
Small outpouchings in colon walls
- involves all layers (e.g. Meckle’s)
What is diverticulosis?
Out-pouchings of the bowel; typically caused by high-fat, low-fibre diets
Herniation of colonic mucosa through muscularis layer - all layers of bowel wall
- Pain in LIF
What are pseudodiverticula?
Outpouchings of only mucosal / submucosal layers
What are the risk factors for diverticulitis?
- age
- obesity
- smoking
- lack of exercise
- high-fat, low-fibre diet (& red meat)
- drugs (steroids, opioids, NSAIDs)
How does diverticulosis present?
- asymptomatic incidental finding (bowel thickening on A-CT or colonoscopy
- symptomatic: abdo pain
How is diverticulosis treated?
- high fibre diet
- grains & vegetables
What are the complications of diverticulosis?
- bleeding (painless haematochezia -> hypovolaemic shock)
- diverticulitis
How is rectal bleeding in diverticulosis investigated?
- FBC (anaemia, platelets)
- gastric lavage (upper GI bleed)
- upper endoscopy
- colonoscopy (ID & therapeutic)
How is haemorrhaggic diverticulosis managed?
- adrenaline
- thermocoagulation (cautery probes)
- vasoconstricting meds
- embolisation (coils, polyvinyl alcohol particles) using catheter
- segmental colectomy
angiography if cannot be visualised on colonoscopy
- only shows active bleeding
How does acute diverticulitis present?
Infection of diverticula = raised intraluminal pressure
- food impaction
- micro-perforations
- abscesses
- fistulae
- LBO
- peritonitis
What are the symptoms of acute diverticulitis?
- abdo pain (LLQ)
- fever
- change in bowel habits
- distension
- vomiting
- guarding
- rigidity
What signs are indicative of a colovesical fistula?
- dysuuria
- pneumaturia
- faecaluria
What investigations indicate acute diverticulitis?
- FBC (dehydration: leukocytosis & electrolytes)
- U&Es (sterile pyuria)
- stool cultures (diarrhoea: salmonella, shigella, yersina, campylobacter, E.coli)
- stool microscopy (C.diff, ova, parasites)
How is acute diverticulitis diagnosed?
CT scan
- colonic diverticula (bowel thickening, high density fat)
- abscess (fluid collection)
- fistula (colonic & bladder thickening, air collections)
- partial bowel obstruction (dilated intestinal loops)
- perforation & peritonitis (free air)
How is uncomplicated acute diverticulitis treated?
Oral abx (7-10d)
Gm-ves & anaerobes
- metronidazole
(+ amoxicillin / levofloxacin etc)
How is severe acute diverticulitis treated?
- IV metronidazole (+ amox etc)
- IV fluids & analgesia
Abscess - percut drainage (recurrence risk)
Fistula - surgically closed
Perf & peritonitis - surgery
Obstruction - surgical resection
What is segmental colitis?
Inflammation of mucosa (spares diverticular opening)
?due to faecal stasis
How does segmental colitis present?
- chronic diarrhoea
- crappy abdo pain (LLQ)
- haematochezia/melaena
How is segmental colitis diagnosed?
Colonoscopy
- diverticular orifices
- surrounding oedema & erosions
- aphthous ulcers
Bloods
- FBC (leukocytosis if severe)
- faecal calprotectin raised
How is segmental colitis treated?
Oral abx - ciprofloxacin, metronidazole (10-14d)
- oral masalamine (5-ASA) 2w titrated dose
- oral prednisolone (6w-1m)
Surgical resection
What are symptoms of malabsorption?
- early satiety
- bloating
- upper abdo discomfort
- steatorrhoea
How do small bowel diverticula present?
Asymptomatic (incidental finding)
- malabsorption
(Treat same + rifaximin/norfloxacin)
How does Meckle’s diverticulum present?
- bowel obstruction
- GI bleeding
- painless haematochezia from vitelline artery
- intussusception (lead point, pressure)
= bowel necrosis
How is Meckle’s diverticulum diagnosed?
Meckle’s scan
- nuclear Tc-99 study
- IV
- scintigraphy
Shows ectopic gastric mucosa from foetal development
