Diverticular Disease

Question 1

What is diverticular disease?

Answer 1

Clinical condition resulting from the presence of diverticular (outpouchings of mucosa and submucosa due to increased intraluminal pressure).

Question 2

What is the presentation of diverticular disease?

Answer 2

• Constipation/altered bowel habit
• Left lower quadrant pain,
• Rectal bleeding
• Leukocytosis

Question 3

What is diverticulitis?

Answer 3

Inflammation of the diverticula. Commonly affecting patients over age 50 who consume a low fiber diet or nsaids/steroids.

Question 4

What is the presentation of diverticulitis?

Answer 4

• It presents acutely with left lower quadrant pain, fever and nausea and vomiting.
  There is tenderness/guarding. If diffuse abdominal tenderness then it suggests perforation.

Question 5

What are the complications of diverticulitis

Answer 5

• Abscess formation (managed with antibiotics, CT guided percutaneous drainage)
• Perforation
• Fistula formation,
• Faecaluria and recurrent UTIs

Question 6

What is the management for diverticulitis?

Answer 6

If acutely bleeding then stabilization and endoscopic haemostasis.
If mild - Oral abx, liquid diet and analgesia. If do not settle within 72h then admission
If unresponsive to antibiotics/abscess/perforation/stricture or obstruction then surgical intervention

Question 7

What is the management of diverticular disease?

Answer 7

• Asymptomatic do not require treatment but should be given lifestyle advice.
• Symptomatic patients should be managed with lifestyle advice, analgesia, antispasmotic (Dicycloverine) +/- antibiotics.

Question 8

What are the complications of diverticular disease?

Answer 8

• Diverticulitis,
• Haemorrhage,
• Fistulas (especially between bladder and vagina),
• Perforation and faecal peritonitis which will require surgery and stoma
• Perforation and abscess

Question 9

How can you diagnose diverticular disease?

Answer 9

• Colonoscopy,
• CT cologram,
• Barium enema

Question 10

What are the investigations for diverticulitis?

Answer 10

• FBC (raised WCC),
• CRP raised,
• Erect chest x ray if suspect perf,
• Abdominal x ray
• CT - gold standard

Question 11

What are the differential diagnosis for diverticulitis?

Answer 11

Irritable bowel syndrome: Characterised by chronic abdominal pain, bloating, and alterations in bowel habits without an identifiable cause.
Colonic carcinoma: Presents with a change in bowel habits, rectal bleeding, abdominal pain, and unexplained weight loss.
Inflammatory bowel disease: Marked by abdominal pain, diarrhoea, bloody stools, weight loss, and fatigue.
Gynaecological disorders (in women): May present with abdominal or pelvic pain, menstrual irregularities, and various urinary symptoms.
Urological disorders: These may involve symptoms such as frequency, urgency, dysuria, and lower abdominal pain.

Question 12

What is the difference between colostomy and ileostomy, loop colostomy and end colostomy

Answer 12

Colostomy - on left, flush with skin. More solid content because it is colon.
Ileostomy - Small bowel, positioned on right, contents is more watery. Outpoching.
Loop colostomy (given if not fit for surgery) or endcolostomy

Question 13

What is the classification of diverticular disease?

Answer 13

Hinchey classidication
1. Pericolic abscess
2. Pelvic, intra-abdominal or retroperitoneal abscess.
3. purulent peritonitis
4. Faecal peritonitis

Question 14

What are the four types of fistulae?

Answer 14

Enterocutaneous.
Enteroenteric or enterocolic.
Enterovaginal.
Enterovesicular - bladder

Question 15

Management of fistulas

Answer 15

They will heal providing no underlying inflammatory bowel disease.
Perianal fistulae managed slightly differently with seaton drainages and metronidazole.