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YR6: GASTRO > Diverticular disease > Flashcards

Diverticular disease Flashcards

1
Q

What is a diverticulum?

A

Sac-like protrusion of mucosa through muscular wall of the colon
Acquired or congenital.

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2
Q

What is diverticulosis?

A

Presence of diverticulae outpouchings without Sx

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3
Q

What is diverticular disease?

A

Diverticula cause Sx e.g. lower abdo pain, without inflammation or infection

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4
Q

What is diverticulitis?

A

acute inflammation +/- infection of colonic diverticulae
Complicated or uncomplicated

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5
Q

Distinguish between complicated and uncomplicated diverticulitis

A

‘Uncomplicated’: diverticular inflammation without Sx of acute abdomen, or signs of perforation or abscess formation.

‘Complicated: diverticulitis a/w complications, such as abscess, peritonitis, fistula, obstruction, or perforation.

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6
Q

Describe the aetiology of diverticular disease

A

Low-fibre diet leads to loss of stool bulk.
Requires high colonic intraluminal pressures to propel the stool out
This leads to herniation of the mucosa + submucosa through muscle layers of the gut at weak points adjacent to penetrating vessels.

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7
Q

At which site are diverticula most common?

A

Sigmoid + descending colon

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8
Q

Describe the prevalence of right sided diverticula

A

15%
More common in Asians

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9
Q

Describe the epidemiology of diverticular disease

A

VERY COMMON.
60% of HIC develop colonic diverticulae
Rare < 40y

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10
Q

Give 4 risk factors for diverticular disease

A

Low fibre diet
Increasing age
Obesity
Genetics

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11
Q

Describe the Hinchey Classification of Acute Diverticulitis

A

Ia: phlegmon: spreading diffuse inflammatory process with formation of purulent exudate
Ib + II: localised abscesses
III: perforation + purulent peritonitis
IV: faecal peritonitis: faeces in peritoneal cavity, due to LB perforation.

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12
Q

How may diverticulosis present?

A

Asymptomatic (80-90%)
Commonly an incidental finding at colonoscopy

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13
Q

What symptoms may arise from complications of diverticulosis?

A

Painless PR bleeding: Blood supply to colon is where outpouches occur so bleeds a lot

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14
Q

What drug may provoke bleeding in diverticulosis?

A

NSAIDs

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15
Q

What advice is given to those with diverticulosis?

A

Condition is asymptomatic + no specific Tx needed
Healthy balanced high fibre diet
Adequate fluid intake
Exercise, WL, smoking cessation reduce risk of diverticulitis

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16
Q

Give 4 S/S of diverticular disease

A

Intermittent abdo pain in the left lower quadrant (may be triggered by eating + relieved by passage of stool or flatus).
Bloating
Rectal bleeding
Tenderness in the LLQ on palpation

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17
Q

When should patients with diverticular disease be admitted?

A

if significant rectal bleeding (haemodynamically unstable), as urgent blood transfusion may be required.

18
Q

What advice is given to those with diverticular disease?

A

AVOID NSAIDs + Opioids (increased risk perforation)
High fibre diet
Safety net

19
Q

What medication may be offered to those with diverticular disease?

A

Bulk-forming laxatives if high-fibre diet not tolerated, or if constipation/ diarrhoea persist.

Paracetamol PRN

Antispasmodic (e.g. mebeverine) if abdominal cramping.

20
Q

Give an example of a bulk-forming laxative

A

Fybogel (ispaghula husk)
Methylcellulose

21
Q

Give 4 S/S of diverticulitis

A

Constant severe abdo pain (starts in hypogastrium before localizing to LLQ)
N+V
Fever.
CIBH + significant rectal bleeding or passage of mucus PR

22
Q

List 3 signs of diverticulitis

A

Tachycardia
Tender LIF +/- palpable mass /distension due to inflammation/ abscess
Possibly reduced bowel sounds

23
Q

What bloods are seen/ taken in diverticular disease/ diverticulitis?

A

Increased WCC
Increased CRP
Check clotting + cross-match if bleeding

24
Q

What investigation should be performed in the acute setting in diverticulitis?

A

Contrast CT: evidence of diverticular disease + complications
Colonic outpouchings, bowel wall thickening > 3 mm + peridiverticular mesenteric
fat stranding
(MRI if CT CI)

25
Q

Why should Barium enema or colonoscopy not be performed in the acute setting of diverticulitis?

A

High risk of perforation

26
Q

When may an abdominal x-ray be indicated in diverticulitis?

A

Suspected perforation or bowel obstruction
OR
As part of routine workup for acute abdominal pain

27
Q

What may be seen on AXR in complicated diverticulitis?

A

Bowel perforation: pneumoperitoneum

Bowel obstruction: dilated bowel loops + multiple air-fluid levels

28
Q

What investigation is performed 6-8w after presentation with diverticulitis?

A

Colonoscopy / CT colonography to r/o IBD/ malignancy

29
Q

Describe management of complicated diverticulitis

A

IV Abx, fluids + analgesia
Bowel rest
+/- surgery

30
Q

In what setting should acute diverticulitis be managed?

A

MILD: oral Abx, liquid diet + analgesia
SEVERE/ If Sx don’t settle within 72h: Admit for IV Abx

31
Q

What antibiotics are used in diverticulitis?

A

Uncomplicated: Co-amoxiclav PO
Complicated: Cefuroxime + Metronidazole IV

32
Q

When is surgery indicated in diverticulitis?

A

If acute complicated diverticulitis (e.g. with peritonitis + sepsis)
If don’t improve with medical Tx

33
Q

What surgical procedures may be performed in diverticulitis?

A

Percutaneous drainage of large abscesses.
Laparoscopic lavage.
Simple colostomy formation.
Sigmoid resection with colostomy (Hartmann’s procedure).
Sigmoid resection with primary anastomosis +/- a diverting stoma.

34
Q

Describe the management of diverticulosis

A

Soluble high-fibre diet (20-30 g/day)
Some drugs may prevent recurrent flares of diverticulitis (probiotics + anti-inflammatories e.g. mesalazine)

35
Q

Describe the management of a GI bleed in diverticular disease

A

PR bleeding usually managed conservatively with IV rehydration, Abx + blood transfusion if necessary
Angiography + embolisation or surgery if severe

36
Q

When may elective surgery be considered for diverticulitis?

A

For recurrent complicated diverticulitis/ immunocompromised

37
Q

What is the prognosis of diverticular disease?

A

10-25% have one or more episodes of diverticulitis

38
Q

What occurs when diverticular are obstructed by thickened faeces

A

Bacterial overgrowth, toxin production + mucosal injury
Can then lead to diverticulitis, perforation, pericolic phlegmon, abscess, ulceration + fistulation or stricture formation

39
Q

List 7 complications of divertiuclitis

A

Diverticulitis
Haemorrhage
Colovesical fistula
Intra-abdominal abscess
Perforation + faecal peritonitis
Sepsis
Intestinal obstruction

40
Q

List 3 signs of colovesical fistulation

A

Pneumaturia
Faecaluria
Pyuria

YR6: GASTRO (61 decks)

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