Diverticular Disease Flashcards
What is diverticular disease?
-Herniation of colonic mucosa through the muscular wall of the colon.
=The usual site is between the taenia coli where vessels pierce the muscle to supply the mucosa.
=For this reason, the rectum, which lacks taenia, is often spared.
SYMPTOMATIC
Symptoms of diverticular disease
-Altered bowel habit (with bloating)
-Rectal bleeding
-Abdominal pain (colicky left sided LLQ)
Complications of diverticular disease
-Diverticulitis
-Haemorrhage
-Development of fistula
-Perforation and faecal peritonitis
-Perforation and development of abscess
-Development of diverticular phlegmon
Diagnosis of diverticular disease
-Colonoscopy
-CT cologram
-Barium enema
Treatment of diverticular disease
-Increased dietary fibre
-Diverticulitis= antibiotics
-Peri colonic abscess: drained surgically or radiologically
-Recurring acute diverticulitis= segmental resection
-Generalised faecal peritonitis= resection and stoma
What is diverticulosis?
-Extremely common
-Multiple outpouchings of bowel wall, sigmoid most common
-DIVERTICULA PRESENT
Risk factors for diverticulosis
-Increasing age
-Low fibre diet
-Obesity in younger patients
-Sedentary lifestyle
Presentation of diverticulosis
-Painful diverticular disease
-Diverticulitis (infection of diverticula)
Presentation of diverticulitis
-Severe left iliac fossa pain and tenderness
-Anorexia, nausea and vomiting
-Diarrhoea/ constipation
-Features of infection (pyrexia, raised WBC and CRP)
-PR bleeding, urinary frequency and dysuria
Hinchey’s classification
Complications of diverticulitis
-Abscess formation
-Peritonitis
-Obstruction
-Perforation
Investigations of diverticulitis
-FBC: raised WCC
-CRP: raised
-Erect CXR: may show pneumoperitoneum in cases of perforation
-AXR: may show dilated bowel loops, obstruction or abscesses
-CT: this is the best modality in suspected abscesses
-Colonoscopy: should be avoided initially due to the increased risk of perforation in diverticulitis
Management of diverticulitis
-Mild attacks can be treated with oral antibiotics, liquid diet, and analgesia
-More significant episodes are managed in hospital.
=Patients are made nil by mouth, intravenous fluids and intravenous antibiotics (typical a cephalosporin + metronidazole) are given
Oral co-amox 5 days, analgesia, clear diet= if uncomplicated
Severe: nil by mouth, IV
