diverticular disease Flashcards
definition of diverticular disease
an outpouching of gut wall, usually at site of arterial entry
gows through muscularis propria and into the subserosal (pericolic) fat
affects the sigmoid colon mostly but can be the whole large bowel.
diverticulosis is the presence of them, diverticulitis is the inflammation of them.
risk factors for diverticulosis + epidemiology
· Low dietary fibre
· Older age
· Male
· Obesity
quite common 30-50% in the over 60 category (westerners, other cultures have more fibre–> less diverticulitis.)
aetiology of diverticulosis
2 factors important for diverticula formation: raised intraluminal pressure + areas of weakness in the colonic wall
o Raised intraluminal pressure => due to insufficient dietary fibre
§ Movement of faeces from a low fibre diet along the colon => needs increased muscular effort => smooth muscle hypertrophy and hyperplasia => raised intraluminal pressure
o Areas of weakness
§ Natural defects in circular muscle layer, where blood vessels pass through to supply the mucosal layers
S+S of diverticulosis AND diverticulitis.
Most people with diverticula are asymptomatic
Heaviness/ discomfort after meals
altered bowel habit ± left sided colic relieved by defecation, nausea, flatulence. High fibre diets do not help symptoms.
· Diverticular rupture => pain starts when straining for defaecation
Signs of acute diverticulitis=> abdominal pain LIF, fever, localised tenderness=> signs of peritonitis only occur if there is perforation
may mimic closely that of bowel cancer, and may even cause a +ve FIT test due to bleeding diverticula.
pathophysiology of diverticulitis + investigation
faecolith gets stuck in the entrance to the diverticula and rubs + inflames bowel (simalar to appendicitis)
often an incidental finding at colonoscopy.
CT abdo is best to identify extent and severity + complications.
AXR- can identify blockages or free air.
treatment of diverticulitis, including surgical options
· Treat diverticulitis
o Mild attacks at home with bowel rest (only fluids) + antibiotics
o If fluids and pain not tolerated, admit for analgesia, NBM, IV fluids, IV Abx
o Simple parasympathetics
· Lifestyle changes
o High fibre diet
· Indications for surgery
o Failure of medical treatment
o Perforation
o Faecal peritonitis
o Stricture formation
o Massive bleeding => treated with angio-embolisation
· Surgical procedures
o Hartmann’s (remove the diverticular area, take the left colon out as a temporary stoma; don’t re-join as there will be faeces present and the anastomosis may leak!)
o Left hemicolectomy
complications of diverticulitis
pericolic abscess- pus + inflammatory cell debris, area gets bigger + then walled of by granulation tissue.
perforation can lead to faecal peritonitis
alternatively
faecolith may erode arteries –> bleeding.
strictures can form - smooth muscle hypertrophy- narrowing lumen OR by fibrosis around repeatedly inflamed diverticula.
V rare- but can pee poo due to fissure forming.
