Diverticular Disease Flashcards
Define Diverticular disease
A condition where small pouches (diverticula) form in the wall of the colon and causing Sx
Common site of diverticula formation
Sigmoid colon
Define Diverticulosis
the presence of diverticula (outpouching of the bowel wall) (asymptomatic, incidental on imaging)
Define Diverticulitis
- Inflammation or infection of the diverticula (often caused by bacteria)
Define Diverticular bleed
where the diverticulum erodes into a vessel and causes a large volume painless bleed
Diverticulum formation risk factors
- Aging >50 years
- low dietary fibre intake
- obesity
- smoking
- family history
- NSAID use.
Diverticulitis Gold standard Ix
CT Abdo/Pelvis
Diverticulitis Sx
- Sudden, onset abdo pain (LIF region) worse on movement
- Pyrexia
- Nausea and vomiting
- PR bleed
- loss of appetite
what Ix is contraindicated in diverticulitis and why
Colonoscopy - perforation risk
what type of meds can mask the Sx of diverticulitis
- Steroids
- Immunosuppressant
RIF / Suprapubic pain
Diverticular disease complications
- Perforation
- Bleeding
- Abscess
- Fistula
- Stricture
Define complicated diverticulitis
Diverticulitis with the presence of abscess or perforation
Define uncomplicated diverticuliltis
Diverticulitis without the presence of abscess and perforation
Uncomplicated diverticulitis Mx
1st line: Co-amox 625mg 5/7
2nd line: Cefalexin 500mg + metronidazole 400mg
Recurrent diverticulitis complications
- Diverticular stricture
- Fistula formation
Common types of fistula formation in diverticulitis
- Colovesical: bowel and bladder
- Colovaginal: bowel and vagina
Colovesical fistula complications
- Recurrent UTIs
- Pneumoturia
- Faecal in urine
Colovaginal fistula complications
- copious vaginal discharge
- Recurrent vaginal infections
uncomplicated diverticular disease Mx
- simple analgesia (paracetamol)
- Oral fluid intake
- Increase dietary fibre
what analgesia should be avoided in diverticular disease
- NSAIDs
- Opioid
Choice of laxative for diverticular disease
Bulk-forming i.e ispaghula husk
Hartmann’s procedure indications
- Peritonitis
- Sepsis
Surgical intervention for diverticular abscess >5cm
Percutaneous drainage
Diverticular Stricture complication
large bowel obstruction
Diverticulosis pathophysiology
- Bowel wall become weakened over time
- movement in stool increase in luminal pressure
- Resulting outpouching of the mucosa through the weaker areas
