diverticular disease Flashcards
what is the difference between a true diverticulum and a pseudodiverticulum ?
true diverticulum : composed of all layers of the intestines
pseudodiverticulum : lacks a muscularis ( mucosa and submucosa only)
what are the different sites associated with diverticular disease?
predominant right sided in south-asians
predominant on the left side in western populations
which part of the colon is affected by diverticular disease ?
the sigmoid colon ( smallest diameter )
followed by the descending colon
what is the presentation of pain in diverticular disease ?
intermittent left iliac fossa pain ( if complicated ) but mainly asymptomatic
what are the different causes of symptoms in diverticular disease ?
physiologic changes in colonic motility
where does the diverticulum appear in relation to the taenia of the colon ?
between the middle diverticula and the lateral diverticula
where do diverticula not form ?
they do not form on the antimesenteric side of the colon
what is the management for uncomplicated diverticular disease ?
high fibre diet
muscle relaxants may be used
muscular thickening characteristic to which part of the colon ?
the sigmoid
what type of diet is more associated with diverticular disease ?
western diet
what are the two presentations associated with symptomatic diverticular disease ?
diverticulitis
or
bleeding
perforation of diverticulitis is better called ?
peridiverticulitis
what are the different types of diverticulitis ?
non-inflammatory
acute
chronic
complex
when can non-inflammatory diverticulitis be diagnosed ?
postoperative diagnosis probably due to a microabscess that healed
what is the presentation of acute diverticulitis ?
pain in the lower abdomen especially in the left iliac fossa
( tenderness and guarding in LIF )
fever altered bowel habits
what makes simplee acute diverticulitis different from complicated diverticulitis ?
simple - limited to the colonic wall with systemic signs of fever and leukocytosis
complicated - with perforation, added signs of tachycardia and hypotension
what classification is used for perforations due to acute diverticulitis ?
hinchey classification
what might mild diverticulosis mimic ?
IBS
as a result of increased intra-luminal pressure
what are the complications associated with diverticular disease ?
diverticulitis
perforation
abscess
peritonitis
intestinal obstruction
fistula formation
which presentation of diverticulitis that shows no signs of fever or leucocytosis ?
chronic atypical
which presentation of diverticulitis presents with tachycardia and hypotension ?
acute complicated
what is the main investigation for acute diverticulitis ?
CT
what is the main investigation for chronic diverticulitis ?
colonoscopy and contrast studies
then CT for differential diagnosis
what are the differential diagnosis for acute diverticulitis ?
pelvic inflammatory disease
appendicitis
crohn’s colitis
ischaemic colitis
perforated colonic carcinoma
pyelonephritis
what are the different grades for hinchey classification ?
grade 1 - pericolic or mesenteric abscess
grade 2- pelvic or retroperitoneal abscess
grade 3 - generalized purulent peritonitis
grade 4 - faecal peritonitis
mngmnt for hinchey grade 1 and 2 hinchey ?
IV ab and radiological ( CT or US percutaneous drainage ) drainage of abscess
what is the management for grade 2 and 3 hinchey ?
resuscitation
then surgical exploration
what is the surgical procedure for type 3 and 4 hinchey ?
hartmann or mikulicz
what is the safest surgery for emergency situations ?
hartmann’s procedure
when is laparoscopic washout used ?
for perforated diverticular disease to avoid performing hartmann
when should the patient follow up after resolution of diverticular disease ?
6 weeks
