Diverticular Disease Flashcards
What are diverticula?
Pouches in the bowel wall, usually 0.5-1cm
Diverticula can be asymptomatic or symptomatic depending on their condition.
What is diverticulosis?
Diverticula with no symptoms
This condition indicates the presence of diverticula without any accompanying symptoms.
What is diverticular disease?
Diverticula with symptoms
This condition suggests that the diverticula are causing clinical issues.
What is diverticulitis?
Inflammation and infection of diverticula
This condition can lead to complications if not treated promptly.
What causes diverticula to form?
High intraluminal pressure causes mucosa to herniate through muscle layer
This process leads to the formation of out-pouches in the bowel.
How do teniae coli affect diverticula formation?
They prevent formation of diverticula in areas of bowel where present
This is why diverticula are never found in the rectum.
List some risk factors for diverticular disease.
- Increasing age
- Low-fibre diet
- Smoking
- Obesity
- NSAIDs and opioids
These factors can contribute to the development of diverticular disease.
What are common symptoms of acute diverticulitis?
- Abdominal pain (left lower quadrant)
- Change in bowels (diarrhoea)
- Nausea and vomiting
- PR bleeding
- Anorexia
These symptoms help in diagnosing acute diverticulitis.
What are some clinical signs of acute diverticulitis?
- Fever
- Palpable abdominal mass (if abscess)
- Tenderness left lower quadrant
- Raised inflammatory markers (CRP, WCC)
- Tachycardia
These signs are crucial for clinical evaluation.
What are potential complications of diverticulitis?
- Abscess
- Perforation → peritonitis, sepsis, fistula
- Bowel obstruction
- Major haemorrhage
Complications can worsen the patient’s condition significantly.
How is uncomplicated diverticulitis managed?
- Manage in primary care
- Oral co-amoxiclav (5 days)
- Analgesia (avoiding NSAIDs and opioids)
- Only clear liquids (avoid solid food) (2-3 days)
- Follow-up at 2 days
This management approach helps alleviate symptoms and prevent complications.
How is complicated diverticulitis managed?
- Manage in secondary care
- Nil by mouth or clear fluids only
- IV antibiotics, IV fluids
- Analgesia
- Urgent investigations +/- urgent surgery (Hartmann’s)
This approach is necessary for more severe cases.
What follow-up procedure is recommended after an episode of diverticulitis?
Colonoscopy 6 weeks post-episode
This is important to assess the bowel and prevent future episodes.
What dietary changes are recommended for managing diverticular disease?
- High-fibre diet
- Good oral fluid intake
- Bulk-forming laxatives (e.g., ispaghula husk)
These changes can help manage symptoms and prevent complications.
