Diverticular disease Flashcards
What is diverticular disease?
Diverticular disease is a permanent, progressive and irreversible condition of the large bowel (or colon), in which little pockets of bowel lining bulge out through weak spots in the muscle wall. As the colon pushes motion along its length, pressure builds up inside the tube, which pushes out the lining to form these pockets. It can also cause the thickening and lengthening of the bowel.
What % of people over the age of 50 have diverticulosis?
50%
Describe the pathophysiology of diverticulum formation: (3)
1) points of the circular muscle in the bowel wall are penetrated by blood vessels, making these areas weaker to outpouching
2) increased pressure inside the lumen over time can cause gaps to form
3) these gaps allow mucosa to herniate through the muscle layer and pouches to form diverticula
Why can’t diverticula form in the rectum?
the rectum has an outer longitudinal muscle layer that completely surrounds the diameter of the rectum, adding extra support
How many longitudinal muscle bands run across the colon?
3
What is the name given to the 3 longitudinal muscle bands that run across the colon?
teniae coli
What is diverticulosis?
the presence of diverticula without inflammation or infection
Which section of the bowel is most commonly affected by diverticulosis?
Sigmoid
Give 4 risk factors for diverticulosis:
1) increasing age
2) low fibre diet
3) obesity
4) use of NSAIDs
Why should NSAIDs not be given to those with diverticulosis?
they increase the risk of diverticular haemorrhage
How is diverticulosis typically diagnosed?
incidentally during colonoscopies or CT scans
Give 4 clinical presentations associated with diverticulosis:
1) asymptomatic
2) lower left abdominal pain
3) constipation
4) rectal bleeding
Give 3 treatments for symptomatic diverticulosis:
1) high fibre diet
2) bulk-forming laxatives
3) surgery if symptoms are significant
Give an example of a bulk-forming laxative:
Ispaghula husk
Give an example of a stimulant laxative:
Senna
What type of laxative should be avoided in diverticular disease?
stimulant laxatives
What is acute diverticulitis?
acute inflammation of a colonic diverticulum
Give 6 clinical presentations associated with acute diverticulitis:
1) pain and tenderness in the left iliac fossa/ lower abdomen
2) fever
3) diarrhoea
4) rectal bleeding
5) palpable abdominal mass (indicates an abscess)
6) raised inflammatory markers and white cell count
Give the 4 treatment steps for uncomplicated diverticulitis according to NICE:
1) oral co-amoxiclav for at least 5 days
2) analgesia (avoid NSAIDs and opiates)
3) only take clear liquids and avoid solid food until symptoms improve
4) follow up within 2 days to review symptoms
Give the 6 steps of management for severe diverticulitis (requires hospitalisation):
1) nil by mouth or clear fluids only
2) IV antibiotics
3) IV fluids
4) analgesia
5) urgent investigations e.g. CT
6) urgent surgery may be required for complications
Give 6 complications associated with diverticulitis:
1) perforation
2) fistula (between the colon and bladder or vagina)
3) peritonitis
4) peridiverticular abscess
5) ileus/ obstruction
6) large haemorrhage requiring blood transfusions
What can happen if a fistula forms?
A diverticulum can become inflamed, and as things that are inflamed become sticky, the bowel may attach to a nearby organ (for instance, the bladder, the vagina, or another segment of the bowel). The inflamed attached pocket essentially burrows into an adjacent organ, which can allow the passage of bowel contents and wind into this organ, causing the patient to experience horrible symptoms.
