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Lower GI > Diverticular Disease > Flashcards

Diverticular Disease Flashcards

1
Q

What are true diverticula?

A

Small outpouchings in colon walls

  • involves all layers (e.g. Meckle’s)
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2
Q

What is diverticulosis?

A

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
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3
Q

What are pseudodiverticula?

A

Outpouchings of only mucosal / submucosal layers

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4
Q

What are the risk factors for diverticulitis?

A
  • age
  • obesity
  • smoking
  • lack of exercise
  • high-fat, low-fibre diet (& red meat)
  • drugs (steroids, opioids, NSAIDs)
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5
Q

How does diverticulosis present?

A
  • asymptomatic incidental finding (bowel thickening on A-CT or colonoscopy
  • symptomatic: abdo pain
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6
Q

How is diverticulosis treated?

A
  • high fibre diet
  • grains & vegetables
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7
Q

What are the complications of diverticulosis?

A
  • bleeding (painless haematochezia -> hypovolaemic shock)
  • diverticulitis
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8
Q

How is rectal bleeding in diverticulosis investigated?

A
  • FBC (anaemia, platelets)
  • gastric lavage (upper GI bleed)
  • upper endoscopy
  • colonoscopy (ID & therapeutic)
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9
Q

How is haemorrhaggic diverticulosis managed?

A
  • 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
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10
Q

How does acute diverticulitis present?

A

Infection of diverticula = raised intraluminal pressure

  • food impaction
  • micro-perforations
  • abscesses
  • fistulae
  • LBO
  • peritonitis
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11
Q

What are the symptoms of acute diverticulitis?

A
  • abdo pain (LLQ)
  • fever
  • change in bowel habits
  • distension
  • vomiting
  • guarding
  • rigidity
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12
Q

What signs are indicative of a colovesical fistula?

A
  • dysuuria
  • pneumaturia
  • faecaluria
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13
Q

What investigations indicate acute diverticulitis?

A
  • FBC (dehydration: leukocytosis & electrolytes)
  • U&Es (sterile pyuria)
  • stool cultures (diarrhoea: salmonella, shigella, yersina, campylobacter, E.coli)
  • stool microscopy (C.diff, ova, parasites)
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14
Q

How is acute diverticulitis diagnosed?

A

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)
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15
Q

How is uncomplicated acute diverticulitis treated?

A

Oral abx (7-10d)
Gm-ves & anaerobes

  • metronidazole
    (+ amoxicillin / levofloxacin etc)
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16
Q

How is severe acute diverticulitis treated?

A
  • IV metronidazole (+ amox etc)
  • IV fluids & analgesia

Abscess - percut drainage (recurrence risk)
Fistula - surgically closed
Perf & peritonitis - surgery
Obstruction - surgical resection

17
Q

What is segmental colitis?

A

Inflammation of mucosa (spares diverticular opening)
?due to faecal stasis

18
Q

How does segmental colitis present?

A
  • chronic diarrhoea
  • crappy abdo pain (LLQ)
  • haematochezia/melaena
19
Q

How is segmental colitis diagnosed?

A

Colonoscopy

  • diverticular orifices
  • surrounding oedema & erosions
  • aphthous ulcers

Bloods

  • FBC (leukocytosis if severe)
  • faecal calprotectin raised
20
Q

How is segmental colitis treated?

A

Oral abx - ciprofloxacin, metronidazole (10-14d)

  • oral masalamine (5-ASA) 2w titrated dose
  • oral prednisolone (6w-1m)

Surgical resection

21
Q

What are symptoms of malabsorption?

A
  • early satiety
  • bloating
  • upper abdo discomfort
  • steatorrhoea
22
Q

How do small bowel diverticula present?

A

Asymptomatic (incidental finding)

  • malabsorption
    (Treat same + rifaximin/norfloxacin)
23
Q

How does Meckle’s diverticulum present?

A
  • bowel obstruction
  • GI bleeding
  • painless haematochezia from vitelline artery
  • intussusception (lead point, pressure)
    = bowel necrosis
24
Q

How is Meckle’s diverticulum diagnosed?

A

Meckle’s scan

  • nuclear Tc-99 study
  • IV
  • scintigraphy

Shows ectopic gastric mucosa from foetal development

25
Q

What are the complications of Meckle’s diverticulum?

A
  • SBO (intussusception/volvulus)
  • Littre’s hernia
26
Q

How is Meckle’s diverticulum treated?

A
  • PPIs (GI bleed)
  • NG tube drip & suck (obstruction)
  • IV fluids (hypovolaemia)
  • surgical removal
27
Q

Why might diverticulosis be associated with frequent vaginal infections?

A

Colovaginal fistulae

Lower GI (7 decks)

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