Diverticular Disease Flashcards
What is the difference between diverticulosis and diverticulitis?
Diverticulosis
Presence of diverticula without inflammation or infection
Diverticulitis
Inflammation and infection of diverticula
What is the pathophysiology of diverticulitis?
Large intestine has circular muscle, where the muscle is penetrated by blood vessels are areas of weakness
Increased pressure can form a gap in these parts of circular muscle
Gaps allow mucosa to herniate through to form diverticula
Why do diverticula not form in the rectum?
Outer longitudinal muscle completely surrounds diameter of the rectum giving support
Which areas of the colon are vulnerable to diverticula development?
Areas not covered by taeniae coli
What part of the bowel is most commonly affected by diverticulosis?
Sigmoid colon, small bowel diverticula much less common
When is diverticulosis more common?
Increased age
Low fibre diets
Obesity
NSAID use
How is diverticulosis normally diagnosed?
Incidentally on colonoscopy or CT
Treatment not needed if asymptomatic
What symptoms can diverticulosis cause?
LIF pain
Constipation
Rectal bleeding
How is diverticulosis managed?
Increased fibre diet
Bulk-forming laxatives (ispaghula husk)
Avoid stimulant laxatives, Senna
Surgery
How does acute diverticulitis present?
LIF pain
Fever
Diarrhoea
Nausea and vomiting
Rectal bleeding
Palpable abdominal mass
Raised inflammatory markers and WBCs
What is the suggested NICE management of uncomplicated diverticulitis?
Oral co-amoxiclav at least 5 days
Analgesia
Only clear liquids, avoid solid food until improved symptoms
What are the complications of acute diverticulitis?
Perforation
Peritonitis
Peridiverticular abscess
Large haemorrhage
Fistula
Ileus
