Diverticular disease Flashcards
Anatomy
- Describe the two types of diverticula that can form
- Which is more common?
Diverticulosis
- How can diverticula form from diet?
Low fibre diets can result in constipation. With constipation there is increased straining (and thus pressure on the intestinal wall), leading to diverticula formation
Diverticulosis
- 4 anatomical reasons why diverticula can form?
Narrow lumen
Weakness between teniae coli
Weakness made by vasa recta
Connective tissue disorders
Diverticulosis
- Why does a narrow lumen predispose to diverticulosis?
- Where do diverticula generally form in the GIT?
Pressure on a vessel wall is inverse to its diameter. More pressure –> more likely to herniate and form diverticula.
The smallest diameter within the GIT is sigmoid colon.
Diverticulosis
- Describe longitudinal vs circular muscle in small versus large intestine
- How does this structure predispose to diverticula formation in the large intestine?
- Both the small and large intestine have inner circular muscle layer.
The small intestine has a continuous outer circular muscle layer; the large intestine only has the teniae coli (3 thin bands) - Easier to herniate/form diverticula in the large intestine, between the teniae coli, where there’s only one continuous layer
Diverticulosis
- Do the vasa recta perforate the muscularis to supply the endothelium?
- How does this predispose to diverticula formation?
- Can these blood vessels rupture?
Yes
Act as weak points - easier herniation/diverticula formation
Yes
Diverticulosis
- How do CT disorders (eg. Marfan and Ehlers Danlos syndromes) predipose?
- Weaken the CT –> more prone to herniation
Diverticulitis
- How does it arise from diverticulosis?
- Is it more or less prone to bleeding than diverticulosis? Why?
The diverticula become inflammed - due to erosion of the diverticular wall, or stool getting stuck within them.
Less - blood vessels tend to get scarred from the inflammation
3 complications of diverticular disease?
Abscess
Perforation
Fistula
Risk factors for diverticular disease?
Demographics: age >50
Past medical history
- Obesity
- NSAID use, opioid use
Social history
- Low fibre diet + constipation
Prevention of diverticular disease?
- Diet - increased fibre, reduced sugar/salt/red meats
- Exercise - reduce obesity
Symptoms of diverticular disease?
- Left lower quadrant pain
- Nausea and vomiting
- Fever
- Diarrhoea and constipation +- blood
- Abdominal distension
Exam findings
- Vital signs?
- Abdomen: inspection, palpation?
Vital signs: febrile, tachycardic, hypotension
Abdomen: distended; LLQ tenderness/guarding, +- palpable mass (abscess)
Investigation: lab tests
- FBC: increased WCC and neutrophils –> inflammation
- UEC: find baseline in case contrast scanning is required
- CRP: increased
- If septic: blood cultures, ABG (and lactate)
Investigation: imaging
- What is the imaging modality for diverticular disease?
- What will we see?
CT abdomen with contrast
Management: diverticulosis
- Treatment if asymptomatic?
Management: diverticulosis
- Treatment if symptomatic?
Management: diverticulitis
- Treatment if uncomplicated?
Management: diverticulitis
- Treatment if complicated?
Explain diverticular disease to a patient
- What is it?
- Symtpoms
